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As More People Die After Using Vaping Products, St. Louis Doctor Warns Of The Risks

Michael Plisco, a critical care pulmonologist at Mercy Hospital St. Louis, says vaping still carries serious unknown risks.
Sarah Fentem | St. Louis Public Radio
Michael Plisco, a critical care pulmonologist at Mercy Hospital St. Louis, says vaping still carries serious unknown risks.

Across the U.S., 18 people have died and more than 1,000 have become sick from a little-understood respiratory disease linked to vaping products. In Missouri, one patient has died, and state health officials have confirmed at least seven cases.

People with the illness report shortness of breath, nausea and coughing. Doctors have placed some patients on life support or respirators because their lungs have stopped working entirely.

Until doctors know more about the effects of vaping, people should stay away from the products, said Dr. Michael Plisco, a pulmonologist at Mercy Hospital St. Louis who treated the man who died.

Public health officials from the Missouri Department of Health and Senior Services have said many of the patients who have become ill in Missouri reported using vaping products that had been tampered with to smoke cannabis, vitamin E and other substances. 

However, experts say that without more research and evidence, it’s still unclear what exactly is making people sick. A report from doctors at the Mayo Clinic published this week studied the lung tissue of 17 people with the illness and found damage that resembled chemical burns from toxic fumes or even the chemical weapon mustard gas, but the authors remained inconclusive about the cause.

The patient who died at Mercy Hospital spent more than two weeks on life-support machines. Plisco, a pulmonologist in the hospital’s intensive care unit, spoke with St. Louis Public Radio's Sarah Fentem about the risks of vaping.

Sarah Fentem: Do experts think that vaping is hurting people’s health? Why? 

Dr. Michael Pilsco: I would say the master question is not answered. We don't know if all vaping is hurting people; we just know we have a series of coincidences. And case reports and reports from different people are saying that they are having a variety of symptoms, and they didn't have any prior lung disease. And the common factor between them is they were vaping.

So until we know exactly what's causing it, it's hard to say. Was it 100% vaping altogether, or is it only vaping certain substances that's causing the trouble? So I'm not saying it all vaping is bad; I'm just saying we need more information until we can make our recommendation to everybody across the board.

SF: [With vaping products], it seems like they weren’t there and all of a sudden they were everywhere. And so does that make this more difficult to understand, that this is something that has become popular so quickly?

MP: Take something like asbestos, you know? You can go back and Google asbestos and lung disease. And you'll have it go back 30, 40 years. And you Google vape-related lung disease, it's going to go back two, three years, tops. And if you go even beyond that, why are people having vape-related lung disease? You're going to have even less information.

And we're not finding a whole lot of common things until the last few weeks, which seem to be more and more reports of some abnormalities that they're finding [because of] more the manufactured stuff off the streets, as opposed to something that's a little bit more controlled. So I'm hoping that we're getting somewhere, but we don't have answers yet.

SF: So if somebody uses e-cigarettes and they start having, you know, coughing, respiratory problems — all of these signs that we've been seeing — what would your advice be to them? 

MP: So my advice would be to stop putting abnormal things in your system. And that's when you want to have a conversation with your family. If you're young, have a conversation with your parents and say, 'Is this something I need to be concerned about?' If you stop and things continue, you should probably go get checked out.

I think the more honest you can be with your physician, the better. This is not to go out and get these people in trouble if they come forward.

The FDA came here and I met with them, and they flat-out said this is not to go out and get these people in trouble if they come forward, (who) said that they were vaping a substance that had CBD in it or marijuana in it, or specific oils that they got off the street from person X. That is not their goal, to get these people in trouble. Their goal is to get to the source to say, 'Hey, is there a source that should not be used?'

SF: What can you tell me about the patient you saw here at Mercy? I know that he was the first fatality in Missouri. Can you talk a little bit about that specific case and how that illustrates how difficult and mysterious this problem is?

MP: The unique thing about that case was this was a gentleman who was clinically doing fine. He was breathing fine, according to his family, who saw him before all this. And then he’s not breathing fine.

There were questions that were asked of him by consultants and physicians along the way. And because he didn’t think much of [the vaping], or because he thought people were going to judge him or he’s going to get in trouble, it wasn’t brought out there in any of the reports. So he was never told to stop doing it.

He made a conscious decision when he was getting worse to stop doing it. And unfortunately, the ball kept rolling so fast. By that point, the damage continued until he acutely got worse and ended up here.

SF: What might that illustrate about what vaping does to your lungs? Can we make any inferences about vaping-related illness based on what happened to this patient?

MP: So here we have a process that happened so fast, and it got so bad so fast, that before he knew it, he was on this artificial heart-lung machine. And I’m glad that he was at a place where we were actually able to offer that.

Not all places offer that, so it was eye-opening that if this happens outside of the bigger cities … it’s a battle against the clock to get them to the centers, once it’s recognized they’re going to need this type of support.

Follow Sarah on Twitter:@Petit_Smudge

Send questions and comments about this story to feedback@stlpublicradio.org

Sarah Fentem is the health reporter at St. Louis Public Radio.