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Vaping Dangers for Older Adults

What to know about recent lung illnesses and deaths

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If you're over 50 and vaping, it's officially high time to switch off that e-cigarette. All those scary headline-grabbing warnings about vaping-related illnesses apply to you, too. “Everyone, including older adults, should refrain from using all e-cigarettes and vape products,” says Brian King, deputy director for research translation of the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC).

Reports of severe breathing problems and deaths related to vaping began to surface in late summer and have now soared to 1,299 confirmed cases of vaping-related illness. There have been 33 confirmed deaths as of Oct. 17 — roughly half of them in people over age 50, according to the CDC. Most vaping patients were under 35 but a new CDC report shows adults older than 50 are getting hit hard: Among 342 people with vaping illness, 69 percent of those over age 50 were admitted to hospital intensive-care units compared with 38 to 56 percent of younger adults and teens; older adults were more likely to need breathing tubes and spent nearly 15 days in the hospital, compared with six to seven days for younger people.

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“Anyone who vapes puts their lungs at risk,” says pathologist Maxwell Smith, coauthor of a recent Mayo Clinic study of lung damage. Numbers are higher in young people simply because so many of them vape, King notes. But the high percentage of deaths among older users suggest that they may be at greater risk for the most serious effects of vaping.

As the federal government and medical organizations urge consumers not to vape, some states are also limiting sales. A four-month emergency ban on all vaping products is underway in Massachusetts (through Jan. 25), and New York state is battling a legal challenge to its proposed ban on flavored vape products. Kroger, Walgreens and Walmart said they would halt e-cigarette sales, too.

If you're among the estimated 3 to 7 percent of adults ages 50 to 64 who vape nicotine or the 1 in 4 medical marijuana users age 50-plus who vape their cannabis, here's what you should know:

How does vaping work, anyway?

E-cigarettes and vape pens heat up liquid nicotine or the cannabis compounds tetrahydrocannabinol (THC) and/or cannabidiol (CBD). This produces an aerosol that users inhale. Nicotine vape products also contain flavorings, propylene glycol and glycerol. It's not always possible to tell what's in THC vaping products, however, even in a state-regulated marijuana dispensary.

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E-cigarettes have been seen as a safer alternative to conventional cigarettes by many users and by some proponents as a way to quit smoking. But they're not without risks. Even before the vaping crisis, studies showed that smoking e-cigarettes daily doubles the risk for a heart attack and may cause changes in cancer-related genes in human mouth tissue.

So what's causing the current problems?

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Experts aren't certain. “Nothing is off the table at this point,” King says. “Most of the cases involve THC, sometimes with nicotine, but that doesn't necessarily mean the cause is the THC itself. We are continuing to investigate a wide variety of products, substances and devices with the U.S. Food and Drug Administration” (FDA).

Flavorings, as well as thickener additives such as vitamin E acetate in THC products and other unknown additives in black-market THC vape products, have all been considered possible causes, with no single product or compound linked yet to the lung damage. In a New England Journal of Medicine report published in October, Mayo Clinic researchers said the cause looks like noxious chemical fumes from an unknown source. They looked at lung biopsies from 17 women and men, ages 19 to 67, with vaping injuries, including two who had died. The biopsies also showed brown and black particles in some samples that looked like burnt particles found in the lungs of tobacco smokers. Most lung samples in their study came from people who vaped THC. This week, a Colorado lab suggested that some vape devices themselves could be releasing damaging fumes from solder.

According to the CDC, it’s not clear whether anyone with confirmed vaping-related lung problems was “dry vaping,” as is often done with medical and recreational marijuana. Dry vaping involves inhaling vapor from dried cannabis leaves and flowers in a specialized tabletop or hand-held vaporizer rather than using liquid-filled cartridges in a vape pen. Meanwhile, the overall effects of dry vaping on lung health have not been carefully researched, according to a 2017 review in the International Journal of Drug Policy. A few small studies suggest that compared with smoking marijuana (burning it in a joint or a pipe), dry vaping may send fewer toxins into the lungs — but other researchers warn that the vapor from dry cannabis bought on the street could contain ammonia.

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What's the risk for older vapers?

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"Vaping has the same health risks and consequences for older adults as it has for younger adults,” says Jamie Garfield, an interventional pulmonologist at the Temple Lung Center at Temple University Hospital in Philadelphia. “We've had two people over age 50 in our practice with vaping-associated pulmonary injury [VAPI] just recently."

National numbers tell the story: Among cases of VAPI, 1 in 5 are in adults age 35 and older, according to the CDC. And among 26 confirmed VAPI deaths, the median age was 49, according to the CDC's latest tally.

If you have a lung problem like chronic obstructive pulmonary disease (COPD) (more common in older adults), you may have fewer reserves to help you fight off VAPI, too, Smith notes.

Are legal vape supplies from a store or marijuana dispensary safe?

"I would not say any vaping product is safe,” says Smith. “There is no great oversight over the production processes in place for developing these products. You don't know what you're putting into your lungs.”

While many vapers with VAPI say they got prefilled vape cartridges on the street or from a friend or relative, not all cases involve black-market products. Others say theirs came from state-sanctioned marijuana dispensaries, vape shops and even convenience stores. The FDA, CDC, American Medical Association and American Lung Association recommend avoiding all vape products — whether they contain THC (from marijuana), CBD (from hemp) or nicotine — because the source of the problem is unknown.

I'm using e-cigarettes to quit smoking. What should I do now?

"Try FDA-approved smoking cessation products like nicotine replacement or medications,” Garfield suggests. The FDA says these options could double your odds for success. Nicotine replacement options include inhalers, sprays, patches and gum. The FDA-approved medications Chantix (varenicline tartrate) and Zyban (bupropion hydrochloride) can help by making smoking less pleasurable.

Don't go back to regular cigarettes, Garfield says. Smoking tobacco causes cancer, heart disease, diabetes and crippling lung diseases like COPD — along with over 480,000 preventable deaths each year in the U.S., according to the CDC. “Well-designed studies show that vaping nicotine doesn't help people quit; it just leads to switching to e-cigarettes or to smoking both types,” Garfield says. That may be especially true for older adults. In a recent study of 15,456 smokers who started e-cigarettes as a way to quit tobacco, 71 percent of those age 65-plus were still smoking regular cigarettes along with e-cigarettes three months later.

Editor's note: This article was originally published on Oct. 11, 2019. It has been updated to address any role of “dry vaping” in overall CDC-confirmed cases of vaping-related lung problems.

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