AUSTIN September 9, 2019 - "Many patients have required supplemental oxygen. Some have required assisted ventilation and oxygenation, and some were intubated," Texas Department of State Health Services (DSHS) said Thursday. "On imaging, chest radiographs have demonstrated bilateral opacification, and CT imaging has demonstrated diffuse ground-glass opacification."

Six cases are consistent with symptoms and substance use in other states, officials with the  said in a news update Wednesday. The rest are under investigation.

Symptoms have included cough, shortness of breath, nausea, vomiting, and diarrhea that have worsened over time, the Centers for Disease Control and Prevention (CDC) said in an alert.

As of late August, 215 potential cases of severe lung illness associated with e-cigarette product use had been reported in 25 states, including Texas, CDC said. Three deaths have been reported nationwide, officials have said.

DSHS was first notified of possible cases early last month.

“DSHS is working with local health departments, other states, and the Centers for Disease Control and Prevention to better characterize case demographics, clinical characteristics, and exposures,” the update said.

The CDC has several recommendations for physicians who suspect severe lung disease caused caused by e-cigarettes, including: 

• Report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days to your state or local health department. Reporting of cases may help CDC and state health departments determine the cause or causes of these pulmonary illnesses.
• Ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness.
• If e-cigarette product use is suspected as a possible etiology of a patient’s severe pulmonary disease, obtain detailed history regarding: 
  • Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances
  • Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids
  • Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil)
  • Where the product(s) were purchased
  • Method of substance use: aerosolization, dabbing, or dripping
  • Other potential cases: sharing e-cigarette products (devices, liquids, refill pods, or cartridges) with others
   
• Determine if any remaining product, including devices and liquids, are available for testing. Testing can be coordinated with the local or state health departments. 

Suspected cases should be reported to DSHS at (512) 776-7268.

Thanks to Texas Medical Association advocacy, lawmakers this year passed a law that raises the minimum age to buy tobacco and vaping products from 18 to 21 (except for military personnel). The law took effect Sept. 1.

If you’re looking for ways to talk effectively to teenagers about the dangers of vaping, the Texas Health and Human Services Commission is offering a free online course entitled Escape the Vape: Help Stop the E-Cigarette Epidemic Among Adolescents.