Update on Severe Pulmonary Disease Associated with Vaping or Dabbing:
As of September 19, 2019, over 530 possible cases of severe pulmonary disease and 7 deaths associated with vaping or dabbing[i] have been reported in the United States.
No cases have been reported in British Columbia and only one case has been reported in Canada (Ontario). Based on information to date, no single substance or e-cigarette product has been consistently associated with illness.
In severe cases, supplemental oxygen, assisted ventilation, and intubation have been required. The time between exposure to vaping or dabbing and symptoms ranges from a few days to a few weeks.
Presenting symptoms have included cough, shortness of breath, chest pain, gastrointestinal symptoms (nausea, vomiting, diarrhea) and non-specific constitutional symptoms (fever, fatigue, weight loss). Signs have included hypoxemia, fever, and tachycardia. Chest imaging may show bilateral pulmonary infiltrates or ground glass opacities.
Vapour products and other e-cigarettes may cause health risks to users through exposure to vapour/aerosols. Children, youth, pregnant women and non-smokers should never use them.
There is limited evidence that e-cigarettes are an effective tool for adults attempting to quit smoking; however, adults using e-cigarettes containing nicotine to quit smoking should not return to smoking cigarettes. They should be advised not to modify their devices or use them with illicitly manufactured vaping products such as those containing THC or CBD oils.
New Reporting Requirement for all clinicians:
The Provincial Health Officer (PHO) has issued a notice (enclosed) to report incidences of people with severe pulmonary disease associated with vaping[ii] and dabbing[iii], with no evidence of alternative plausible diagnoses, to a Medical Health Officer (MHO).
Please contact the MHO if you have a patient who meets the following criteria with symptoms onset on or after June 1, 2019:
- Report vaping or dabbing using e-cigarette devices, related products or other means of inhaling a variety of products in the 90 days before symptom onset, AND
- Who have pulmonary infiltrates on X-ray imaging, AND
- Whose illness is not attributed to other causes.
Please call the NH Communicable Disease unit during business hours (Monday-Friday 8:30 am to 4:30 pm) at 1-855-565-2990. After hours and on weekends/holidays, please call the UHNBC switchboard at 250-565-2000 (option #7) and ask for Medical Health Officer on call.
If your answers to criteria 1-3 are ALL affirmative, please have the following information ready to relay when you call:
Provider information:
- Name and contact information of the reporting physician or NP
- Name of hospital or clinic where patient assessed and/or admitted
Patient Information:
- Full name of patient
- Personal Health Number
- Phone number of patient
- Sex of patient
- Date of Birth
Case information:
- Date of patient’s symptoms onset
References:
US CDC – “Outbreak of Lung Disease Associated with E-Cigarette Use, or Vaping”
US CDC – "Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance"
BC Gov – “Health link BC – Vaping information”
Enclosure: Notice of the Provincial Health Officer
[i] https://www.cdc.gov/tobacco/basic_information/e-cigarettes/sever-lung-disease.html
[ii] Vaping includes the use of electronic devices that can vaporize a combination of nicotine, flavors, and/or other substances (e.g. marijuana, tetrahydrocannabinol (THC), THC concentrates, cannabidiol (CBD), synthetic cannabinoids) for inhalation. Examples of these devices include electronic cigarettes or e-cigarettes, such as JUUL, SMOK, Suorin, Vuse, or blu. They are also known as vapes, mods, e-cigs, e-hookahs, vape-pens, electronic nicotine delivery systems (ENDS) or another electronic vapor producing product.
[iii] Dabbing is the process of heating concentrated doses of cannabis on a hot surface, usually a nail, and then inhaling through a dab rig. Concentrated doses of cannabis are made by extracting THC, CBD and other cannabinoids using a solvent like butane or carbon dioxide, resulting in sticky oils also commonly referred to as wax, shatter, budder, and butane hash oil.