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(NEWARK, Del.) – It’s easier to say what’s not causing hundreds of vaping-related illnesses than what is.

Vaping is now linked to 400 cases of severe lung damage nationwide, including nine confirmed and 22 suspected cases in Indiana. One of those patients died last week, the first death from vape sickness in Indiana. But American Lung Association chief medical officer Albert Rizzo says while all the patients have had inflammation leading to difficulty breathing, the specifics of those inflammations have been inconsistent. Some patients’ illnesses resemble pneumonia, other patients have had particles in their lungs, and still others have had dead lung tissue. 

Rizzo says those differences, plus the wide geographic range covered by the illnesses, suggest vape sickness isn’t a medical mystery awaiting a single solution, but multiple issues with multiple causes. Vaping ties the cases together, but Rizzo says in different cases, the illnesses could be related to patients’ past medical histories, how deeply they inhaled, the equipment they used, or the ingredients in their e-liquids. And the Wild-West e-liquid market opens up other possibilities. Rizzo says it could turn out there are otherwise harmless chemicals which become hazardous when heated or when combined with other chemicals. And homebrew e-liquids or vape pens could have quality-control issues that lead to problems.

Now that doctors are on watch for vape sickness, Rizzo says health investigators need patients to bring in the e-liquids and equipment they’ve been using so they can test those assorted possibilities. In the meantime, he notes the Centers for Disease Control and the Indiana State Department of Health have advised people not to vape at all until the problem, or problems, are identified. 

About 20 deaths nationwide have been linked to vaping since spring.

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