South Valley public health officials are warning people who vape they may be exposing themselves to a potentially dangerous respiratory illness.
In recent months, health officials have reported a spike of people in Kings, Fresno, and Tulare counties being admitted to hospitals with Acute Respiratory Distress Syndrome (ARDS) or wet lung.
Wet lung is a severe pulmonary condition that produces flu-like symptoms and can rapidly escalate, health officials say.
Symptoms may include rapid breathing, nausea, a low blood-oxygen level, low blood pressure, confusion, and extreme tiredness.
Wet lung can be caused by vaping cannabis, CBD oils or similar products, health officials say.
Vaping is using a battery-powered device to heat liquid-based nicotine into an inhalable vapor. The liquids often come in enticing flavors, like cotton candy or bubble gum. Many of the devices, including Juul, look more like a flash drive than a cigarette.
Others looks like candy and have been targeted by proponents of vaping because they believe children are more likely to use if the cartridges look like candy.
Recent cases of ARDS are being investigated in Kings County in partnership with the California Department of Public Health.
The uptick in Central Valley ARDS cases comes as electronic-cigarette or vaping use continues to rise, especially among young people.
The results of the 2018 National Youth Tobacco Survey (NYTS) show some staggering numbers: from 2017 to 2018, there was a 78 percent increase in e-cigarette use among high school students and a 48 percent increase in middle school students.
More medical news: 4 people infected with a disease spread by mosquitoes, Tulare County health officials say
Here's why a Tulare doctor may have his medical license revoked over opioids
Rabid bats invade Visalia, Tulare. County health officials urge caution
In November 2018, the Food and Drug Administration announced it would crack down on sales of flavored e-cigarette to minors.
In stores, age-restriction measures must be put into place, and firmer age verification practices should be developed for online sales. This is seen as a win for health advocates and activists.
“E-cigarettes have been increasingly used by minors, especially when they are used in combination with flavors, making them more addictive to minors,” said Dr. Khalil Diab, a pulmonologist for Indiana University Health.
But what harm does vaping do to users, especially teenagers? There's still research to be done, but here's what we know:
Is vaping safe?
Not according to those in the public health community.
Scientists know that even in the absence of nicotine, vaping lets loose other substances such as formaldehyde that can be detrimental to one’s health. And there’s evidence in the short term that vaping may damage tissue.
What is in vape juice?
It depends on what specific product you buy, and ingredients vary by manufacturer. Generally, vape juice, or e-liquid, contains nicotine, propylene glycol, vegetable glycerin and flavorings.
Nick Torres director of advocacy for the American Lung Association, said one challenge of studying e-cigarettes is that the liquid contains ingredients unknown to the users.
“We really see e-cigarettes as unregulated tobacco products,” he said. “The FDA has not reviewed the products, the chemicals…in the devices. That’s a big gap in terms of monitoring what’s on the market.”
People often argue that e-cigarettes are better because they don’t contain tobacco or tar, but they can release potentially toxic chemicals including formaldehyde.
What does vaping do to the body?
A 2018 report “Public Health Consequences of E-Cigarettes” from the National Academies of Sciences, Engineering concluded that, “in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances.”
A recent University of North Carolina study discovered that propylene glycol and vegetable glycerin are found to be toxic to cells, and the more ingredients in the liquid, the higher the toxicity.
Torres said it’s important to stress that most e-cigarette liquid contains nicotine.
“There’s overwhelming evidence to show nicotine has a harmful effect on the developing brain,” he said. “What’s perhaps most alarming about that is a lot of kids don’t know there’s nicotine in these devices. That is basic knowledge, it’s important to know.”
The American Chemical Society published a 2017 report that shows in addition to formaldehyde, e-cigarettes produce other chemicals including acetaldehyde and acrolein, which are linked to lung disease and cardiovascular disease.
Users with lung conditions may be at higher risk for issues down the line, from chronic obstructive pulmonary disease (COPD) to lung diseases.
“Folks with asthma are often triggered by e-cigarette aerosol, sometimes more dramatically than cigarette smoke,” Torres said.
A recent study of youth ages 11 to 17 conducted by Chest, a peer-reviewed medical journal, found that that 21 percent of respondents had an asthma attack in 12 months, and 33 percent reported vape exposure.
What is Juul?
Juul is one type of flavored e-cigarette that contains nicotine. The lightweight device can fit in the palm of the hand. Juul devices charge by plugging into a computer's USB port.
The Juul starter kit costs $49.99. After that, it costs $15.99 for a pack of four flavored liquid cartridges called pods, which are 5 percent nicotine. Each pod is the equivalent of a pack of cigarettes, according to Juul's website, but pods are about $1.50 cheaper than a pack of cigarettes.
Juul's website describes the product as having “cigarette-like” nicotine levels.
Are Juuls and other vaping products just as toxic as traditional cigarettes?
The two work in different ways, said Dr. Richard Feldman, director of medical education in Indiana, Cigarettes involve combusted, or burned, tobacco. E-cigarettes are heated, but not to the point of combustion. Combustion will liberate the most toxins, but even heating a substance can lead to the release of toxins, Feldman said.
“It probably is safer, but I like to call it less toxic rather than safer than combusted tobacco,” he said.
What we don't know
E-cigarettes were only imported to the U.S. in 2006, so the mid to long-term effects of vaping are not yet known.
Research should be done about the psychological effects that vaping as on minors, and “the outcomes down the road when you start now until 20 to 30 years from now,” said Dr. Khalil Diab, a pulmonologist from Indiana.
Torres wants to see the FDA take action on labeling and urging e-cigarette manufacturers to be more transparent.
“It would make it a lot easier to know what you’re getting,” he said. “Some lab studies test the different concentrations, but in many cases it doesn’t always match up with what’s on the label. This is something the FDA has not standardized, so you have no way to know exactly what you’re getting.”
USA TODAY NETWORK and IndyStar reporter Kellie Hwang contributed to this report.