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Utah doctors identify ‘best practice’ treatment for vaping illness

By Lisa Riley Roche, KSL | Updated - Nov 8th, 2019 @ 5:26pm | Posted - Nov 8th, 2019 @ 4:40pm



MURRAY — Intermountain Healthcare doctors have developed new treatment guidelines for the vaping-related lung injury responsible for deaths around the country, including one in Utah, that were published Friday by a major medical journal, the same day U.S. health officials reported a breakthrough in finding the cause of the outbreak.

“What’s unique about the guidelines is, first of all, that they’re out there. Nobody else really knows how to treat these patients,” Dr. Denitza Blagev said at a news conference held in an Intermountain Medical Center trauma room shortly before the Centers for Disease Control and Prevention announcement.

The federal agency said vitamin E acetate was found in fluid taken from the lungs of 29 patients from 10 states. The substance is used to thicken the fluid in vaping cartridges, particularly those sold on the black market that may contain THC, an active ingredient in marijuana that is illegal or only legal for medical use in many states.

Vitamin E acetate had been discovered previously in fluids from vaping devices used by those who became ill, but this is the first time a suspicious common substance has been found in the damaged lungs of all the patients tested, The Associated Press reported.

“We are in a better place in terms of having one very strong culprit,” Dr. Anne Schuchat of the CDC told the wire service. But officials also cautioned that other toxic substances cannot be ruled out and it may take studies using animals to confirm vitamin E acetate could cause the lung damage.

Blagev said later she had been told that three of the patients that had the substance in their lungs were from Utah, although it was not clear if they also were part of the Intermountain study. She said the new findings do not change the treatment guidelines.

She said she hopes to see a routine test developed for vitamin E acetate because diagnosing the vaping illness has relied on ruling out other causes. Some patients are not forthcoming about their vaping, so such a test also could help doctors confirm use of the devices.

“We’re excited like everyone else is to see progress,” Blagey said. “It’s probably not a done deal but I think it’s an exciting breakthrough on this. I think we and other clinicians are really excited to have this extra information, and I think it would be a leap forward to be able to test for it and react to in real time to take care of patients.”

The pulmonary and critical care physician said Intermountain’s newly published guidelines, which include a call for varied doses of steroids depending on severity of the symptoms, are based on the treatment of more than 60 patients at 13 different Intermountain hospitals and clinics between June and October.

“It’s more than just a handful of cases. It’s being able to know, here is what we did for this larger number of patients and here is how it worked out. Here is how they did,” Blagev said. She said patients who are not as sick do not need to be hospitalized and can even be treated at home.

Getting the guidelines to other physicians through the article published in The Lancet, an internationally recognized medical journal, also serves as a reminder the mysterious illness tied to using e-cigarettes or vaping that first surfaced in March in the United States is still a threat.

“Through sharing the guideline, we’re reaching clinicians and keeping e-cigarette- or vaping-associated lung injury on everyone’s minds, especially as we enter flu season,” Blagev said, making diagnosing more difficult because of the shared symptoms of shortness of breath, cough, chest pain as well as nausea and vomiting.

The number of vaping-related illness cases in Utah is set to be updated Tuesday, but there were 109 cases reported as of Oct. 28, including of a Salt Lake County man under the age of 30 who died. He had vaped the marijuana compound THC and had not been hospitalized, according to the Utah Department of Health.

Nationwide, there have been 2,051 cases reported to the Centers for Disease Control and Prevention from every state except Alaska, and 39 deaths in 24 states and the District of Columbia, according to the most recent numbers reported on Tuesday.

Only three states — California, Texas and Illinois — reported more cases than Utah.

Blagev’s advice for avoiding becoming a statistic was simple — don’t vape.

“Really, the most important message is there is no safe thing to vape,” she said. “It’s not just THC. We’ve seen it with nicotine, people who have been vaping for years and years and have gotten sick over the summer and the fall. This is different and for right now, we don’t know what the cause it and the safest thing to do is not vape.”

Contributing: The Associated Press

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