Perspective from Michael Siegel, MD, MPH
Perspective from Harold J. Farber, MD, MSPH
September 26, 2019
3 min read

‘We don’t know’: CDC lacks key answers about vaping lung injuries

Perspective from Michael Siegel, MD, MPH
Perspective from Harold J. Farber, MD, MSPH
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

Anne Schuchat
Ned Sharpless

Federal lawmakers questioned health officials in two hearings this week about lung injuries and deaths related to vaping in the United States.

However, Anne Schuchat, MD, CDC principal deputy director, and Ned Sharpless, MD, acting FDA commissioner, could not answer every question, explaining that the outbreak was only recently detected and investigators are having difficulty keeping up with it.

Many questions, few answers

Specifically, lawmakers asked Schuchat and Sharpless who is being impacted by the lung injuries and what e-cigarette brand is to blame. They also wanted to know how to stop the outbreak before it gets worse.

Federal lawmakers questioned health officials in two hearings this week about lung injuries and deaths related to vaping in the United States.

“We know that a significant part of this outbreak is impacting youth,” Schuchat said at the House Subcommittee on Economic and Consumer Policy hearing on Tuesday. “But we don’t know the cause. No single product, brand, substance or additive has been linked to all cases. Whether the products in one state are the same problematic products in another state or if it’s manipulation of the product is what’s going on, we don’t know. ... The epidemic is moving faster than our data-gathering processes and we are really losing people in the meantime.”

Symptoms are not universal

There was also little information about how patients with lung injuries related to e-cigarette use can be recognized and treated, according to Schuchat.

Although symptoms include cough, shortness of breath and chest pain, they can also include nausea, vomiting and fatigue. Additionally, the duration of symptoms can take several days to several weeks to appear, Schuchat said.

“The respiratory symptoms these patients have are very nonspecific and their X-ray findings are diverse,” she noted, adding that although steroids and corticosteroids have helped some patients, physicians may also need to individualize treatment for patients based on their symptoms.

Schuchat emphasized that patients should be followed after discharge, and that clinicians should conduct pulmonary function tests “to see if the lungs’ function return to expected levels of a healthy person before the injury occurred.”

Mistakes were made

According to the FDA’s website, a rule that went into effect Aug. 8, 2016, required all manufacturers of e-cigarettes to file premarket tobacco product applications with the FDA within 2 years. The applications are required to contain information about the product’s health risks, the product’s ingredients and how the it is made, among other items.

One lawmaker criticized the federal agencies’ shortsightedness in allowing e-cigarettes on the market without completing those applications.

“There was clearly a massive regulatory failure that allowed for this to happen," Rep. Joe Kennedy III, D-Mass., said during the House Committee on Energy and Commerce hearing on Wednesday. “Nobody thought that there would be the possibility of diversion or illicit use or that there could be adverse health impacts?”

Sharpless acknowledged that the government should have regulated the products sooner, but he also defended the agency, saying that “since I have been at the FDA, we have greatly accelerated the review date, we have done education campaigns, we will be issuing guidance ... we’re going to catch up.”

Rep. Paul Tonko, D-N.Y., also wanted to know why e-cigarette manufacturers were not required to file their premarket tobacco product applications.

“The data back then suggested that e-cigarette use was lowering or leveling off among children,” Sharpless responded. “That was before the explosion that we have seen the past 2 years. When the FDA began to appreciate that this rocket was taking off, we stepped up our enforcement and educational activity. In retrospect, we should have acted more urgently.”

The FDA said it has sent out more than 8,000 warning letters and levied more than 1,000 fines against manufacturers and retailers for marketing and sales practices that have increased the accessibility and appeal of e-cigarettes among youth.

Another lawmaker, Rep. Janice D. Schakowsky, D-Ill., said she didn’t “feel a sense of urgency” from the FDA and CDC to curb the use of e-cigarettes and the vaping illnesses.

“We have a strong sense of urgency,” Sharpless responded, adding that the FDA plans to remove all e-cigarettes products with flavors such as bubble gum and cotton candy from the market in the near future.

Recommendations for physicians, patients

As the CDC investigation into the lung injuries continues, Schuchat said physicians have a role in reducing the risk to children.

“We recommend that doctors ask their patients not only ‘do you smoke cigarettes?’ but also ‘do you use e-cigarettes or vaping products?’ We think it is important for clinicians and parents to educate themselves about the types of products that are out there and to ask the right questions,” she said.

According to the CDC, 12 deaths and 805 hospitalizations have been linked to e-cigarette use. However, Schuchat said during the hearings that the number of hospitalizations is expected to be “hundreds higher” as the CDC continues its investigation. by Janel Miller

Editor's Note: This story has been updated from an earlier version to reflect updated death and hospitalization numbers from the CDC.