Newswise — Using data from a large federal government telephone survey of adults, Johns Hopkins Medicine researchers report evidence that inhaling heated tobacco vapor through e-cigarettes was linked to increased odds of asthma and chronic obstructive pulmonary disease (COPD), conditions long demonstrated to be caused by smoking traditional, combustible cigarettes. The data, the researchers say, also suggest that odds of developing COPD may be as much as six times greater when people report they both vape and smoke tobacco regularly, compared with those who don’t use any tobacco products at all.

Reports on the studies are published Jan. 2 in the

American Journal of Preventive Medicine

and on Oct. 16 in

BMC Pulmonary Medicine

.

For both studies, the researchers caution that they weren’t designed to show that vaping directly causes lung disease, but only whether doing so was associated with an increased likelihood of having disease. The researchers also didn’t distinguish between vaping tobacco compared with cannabis. They also cautioned that self-reports via telephone surveys may not be wholly reliable. However, they say their findings demonstrate the need for continued research with e-cigarette users over time to confirm and clarify the risks.

“

Although e-cigarettes may turn out to be safer overall than traditional combustible cigarettes, our studies add to growing evidence that they carry health risks,” says

Michael Blaha, M.D., M.P.H.

, professor of medicine at the Johns Hopkins University School of Medicine.

“

These studies are the first in a series of larger and long-term studies that will more definitively provide evidence to inform tobacco users and regulators.”

Asthma, marked by inflammation of the airways and shortness of breath, affects an estimated 25 million Americans, and life-threatening episodes can be triggered easily by pollution, allergies and smoking. COPD, which affects some 16 million Americans, describes a group of disorders including emphysema and chronic bronchitis that make it hard to breathe due to permanent damage to the lungs over time. Rates of asthma and COPD are rising worldwide, according to the World Health Organization. Most cases of COPD result from smoking traditional cigarettes.

A study published by Blaha earlier this year in the

Annals of Internal Medicine

estimated that 1.4% of people, or about 1.9 million people in the U.S., solely use e-cigarettes. Scattered reports have linked the practice to a spike in respiratory illnesses dubbed EVALI (e-cigarette, or vaping, product use-associated lung injury), affecting more than 2,500 people and associated with numerous deaths, according to the Centers for Disease Control and Prevention. Because vaping and the products inhaled with it are still relatively new to the market, its safety remains unclear.

To shed some light on the risk, the researchers took advantage of national survey data gathered by the Behavioral Risk Factor Surveillance System from 2016 and 2017. This annual survey, commissioned by the U.S. Centers for Disease Control and Prevention, consisted of telephone interviews of more than 400,000 adult participants and provides data on health-related risk behaviors and chronic medical conditions.

In the analysis published in

BMC Pulmonary Medicine

, the investigators analyzed data from 402,822 people who identified themselves as never smokers, meaning they said they had smoked less than 100 combustible cigarettes in their lifetimes. Of these, 3,103 reported using e-cigarettes or vaping, and separately 34,074 people reported having asthma. The average age of e-cigarette users was 18–24. About 67% of e-cigarette users were men. Approximately 57% of e-cigarette users reported that they were white, 19% were Hispanic and 12% were black.

Almost 11% of the e-cigarette users reported having asthma, compared with 8% of those who had never used e-cigarettes. Those people who reported being current e-cigarette users were 39% more likely to self-report having asthma compared with those people who said they never used e-cigarettes. Those who said they used e-cigarettes some days were 31% more likely, and daily users were 73% more likely to report asthma, compared with non-e-cigarette users.

For the study published in the

American Journal of Preventive Medicine

, the researchers analyzed the same data from all the questioned participants. From the more than 700,000 interviewees, about 61% reported being never smokers, about 9% were current smokers, 30% were former smokers, more than 3% said they currently used e-cigarettes, and 2% said they used both e-cigarettes and smoked. The e-cigarette users were more likely to fall in the age range of 30–34, almost 60% were men, 72% identified as white, 8% as black, 3.5% as Asian and 11% as Hispanic.

Of those who said they used e-cigarettes, about 11% said they had chronic bronchitis, emphysema or COPD, compared with 5.6% of people who said they had never used e-cigarettes. Among never smokers, current e-cigarette users were 75% more likely to report having COPD, compared with those who had never used them. Those who said they used both e-cigarettes and smoked cigarettes were almost six times more likely to report having COPD, compared with those who had never used either, whereas just using combustible cigarettes alone increased the odds by three times.

“As a physician, I am most worried about those who use both e-cigarettes and combustible cigarettes because they may end up taking in the most nicotine, which may do the most damage,” says Albert Osei, M.D., M.P.H., a postdoctoral fellow at the Johns Hopkins University School of Medicine and lead author on the study.

“

Through public health campaigns, we finally had smoking levels down in some populations, but now with the current vaping epidemic, I foresee a whole new previously tobacco-naïve, young generation becoming dependent on nicotine if we do not intensify public health education efforts.”

According to the CDC, of the 16 million people in the U.S. who have COPD, 38% of them still smoke.

Additional authors on these studies include Mohammadhassan Mirbolouk, Olusola Orimoloye, Omar Dzaye, S. M. Iftekhar Uddin, Zeina Dardari and Shyam Biswal of Johns Hopkins; Andrew DeFilippis and Aruni Bhatnagar of University of Louisville; Emelia Benjamin of Boston University; and Michael Hall of University of Mississippi Medical Center.

This study was supported by a grant from the American Heart Association Tobacco Regulation and Addiction Center, which is funded by the National Heart, Lung, and Blood Institute/U.S. Food and Drug Administration (2U54HL120163).

COI: Defilippis receives funding from Astra Zeneca and consults for Radiometer America, Inc.

SEE ORIGINAL STUDY

A North Carolina Family is Celebrating Blood Donors and Organ Donors on Their Son’s One-Year Double Lung Transplantaversary

January 2, 2020

—

January is designated as National Blood Donor Month by The American Red Cross. During this month, all are encouraged to give blood, which is typically in short

COTA Patient Charlton Buchanan Double Lung Transplant Recipient

supply at this time of the year due to the holidays and an increase in communicable illnesses. A COTA family in North Carolina will be forever grateful to the blood donors whose blood was used throughout their son’s transplant journey and his life-saving transplant that occurred last year on January 16

th

.

Charla and Trevor Buchanan of Robbinsville, North Carolina, are stepping into 2020 hoping and praying this is a year of no medical emergencies, no surgeries, no complications and no setbacks for their son, Charlton, who will be celebrating his 26

th

birthday in September — a dream come true for this family.

According to Charla, “For 24 years we have been on a Cystic Fibrosis (CF) journey … but more than that, we have been on a faith journey. Our son, Charlton, was born with CF, which is a progressive, genetic disease that causes persistent lung infections and an overall inability to thrive. From his premature birth until very recently, Charlton’s life has consisted of daily physical and respiratory therapy, medications, quarterly clinic visits to UNC Medical Center in Chapel Hill and annual (sometimes bi-annual) hospital stays. Although his treatment regimen has been incredibly time consuming (2-4 hours daily), Charlton seldom complained as a little boy … as a teenager … or as a young adult. He has always had a positive attitude and has lived a full and active life. In fact, many people never knew he was battling a challenging and life-threatening disease.”

Cystic Fibrosis (CF) is a genetic disorder that primarily affects the lungs, but also the pancreas, liver, kidneys and intestines. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. CF is an inherited disease, and while there is promising research, there is no known cure.

Even with a multitude of CF-related challenges, Charlton attended and graduated from Robbinsville (NC) High School. He then attended Western Carolina University in Cullowhee, North Carolina, and received a degree in computer information systems on May 12, 2018. Charlton was hired by the Graham County (NC) government to work in its Information Technology Department. His life definitely seemed to be moving in the right direction. His friends and family were thrilled for this young man who simply was not going to let anything stand in his way … including his battle with Cystic Fibrosis.

However, 2018 proved to be one of the hardest years of Charlton’s life due to nine hospitalizations. His lung function rapidly declined, and with each hospital stay, increasing amounts of oxygen were required. During a challenging two-week hospital stay in December, Charlton’s transplant team decided it was time to list Charlton for a double lung transplant while he was still healthy enough to thrive and before there was further lung decline. Charla, Trevor and many other family members and friends knew this would one day be his reality, but the news took everyone by surprise.

Charlton was officially listed for new lungs on January 9, 2019. One week later on January 16

th

, the Buchanan family received ‘the call’ telling them lungs were available. Charla posted this update on Facebook, “Transplant day has been long for everyone. We are all excited and want to hear good news, but the only news so far is that the surgery is going well and it will still be a long wait. On January 17

th

she updated, “Charlton is out of surgery and in recovery. He woke up easily, was taken off the ventilator, took his first breath with lungs that are NOT diseased with Cystic Fibrosis — and never will be. To say we are amazed, awed and blown away is an understatement.”

Charlton’s post-transplant recovery was nothing less than amazing. On the second day after his double lung transplant, Charlton was moved to the stepdown unit and walked five laps. On day three post transplant he was able to eat real food. Eight days after his transplant, Charlton was discharged to medical housing close to the transplant center. According to Charla, this recovery timeline tied for the shortest UNC Medical Center record for a double lung transplant patient.

In the midst of this whirlwind a transplant social worker at UNC Medical Center had introduced the Children’s Organ Transplant Association (COTA) to the Buchanans and suggested they might want to consider fundraising for the transplant-related medical costs they would be facing. On January 11

th

, Charla called COTA to learn more and to ask many good questions about how COTA might be able to help. On January 29

th

, Charla and Trevor returned the paperwork and officially became part of the COTA Family.

The Children’s Organ Transplant Association (COTA) works with individuals of any age with single gene disorders, such as Cystic Fibrosis, Polycystic Kidney Disease and Sickle Cell Anemia. COTA uniquely understands that parents who care for a child or young adult before, during and after a life-saving transplant have enough to deal with, so COTA’s model shifts the responsibility for fundraising to a community team of trained volunteers. Another plus? COTA funds are available for a lifetime. On February 22

nd

, a COTA fundraising specialist trained volunteers in Robbinsville for the COTA for Team Charlton campaign and walked the group of attendees through the entire COTA fundraising process. This group of family members and friends quickly got to work organizing fundraisers for COTA to help with mounting transplant-related expenses.

According to Charla, “From the moment we reached out to COTA, we were set at ease. Every staff member we spoke to was so reassuring and helpful, patiently answering the multitude of questions and listening intently to our concerns. Charlton received his transplant so quickly that we had not yet had time to officially become part of COTA. When we reached out a week after his transplant … our minds in a whirlwind … they made the process so easy. Very soon after that we began receiving much-needed support and our team of volunteers began fundraising with COTA’s guidance and support.”

“As our COTA team of volunteers began to raise funds in honor of Charlton, we were relieved to share that COTA is a 501(c)3 charity so all contributions to COTA are tax deductible to the fullest extent of the law, and COTA funds are available for a lifetime,” Charla said. “Our volunteers were given a fundraising website at no charge and I used the COTA site to blog medical updates to our friends and family.”

Charlton remained in the Chapel Hill area, some 315 miles from their home, for three months. On April 10, 2019, Charlton was released to return home to Robbinsville. Charla blogged on the Team Charlton COTA website, “WE ARE HOME!!! Twelve weeks to the day after his transplant. Charlton even went back to work today. He feels great and has been hiking and enjoying time with friends. His lung function numbers continue to climb higher than they have been in more than two years with his oxygen levels staying at 100%.”

Recently Charlton updated his friends, family and social media followers on how things are going post-transplant. Here is the list of accomplishments he shared:

I set the hospital record for getting listed, transplanted and discharged.

I got out of ICU in one day.

I do not cough or get out of breath now.

I do not have to do breathing treatments anymore.

I am very thankful for my donor and continue to pray for his/her family.

“It is overwhelming to hear the word ‘transplant’ but even more overwhelming to learn about the related expenses. From the moment we learned about the Children’s Organ Transplant Association (COTA) and reached out prior to our son’s transplant, we were instantly set at ease. COTA is more like a family than an organization. COTA does not simply assist with transplant-related expenses, they give peace of mind. And to a family in crisis, that gift is priceless! It is hard to describe the reassurance in knowing COTA will be there for Charlton

… for a lifetime,”

Charla said.

“COTA allows us to breathe easier every day because we do not have to focus on the financial aspects of Charlton’s disease and treatment, but can enjoy the journey of healing,”

she said.

Charlton continues to thrive in every aspect. At his ten month post-transplant follow-up appointment, the doctors told him he was doing so well he did not need to come back until his one-year checkup. He never coughs any more, and he is currently at his heaviest weight. Charlton is eating well, working out at least three times a week and overall feeling great. He goes to work every day and is very active doing the things he enjoys, which include hiking, fishing, snowboarding, rock climbing, traveling, going to concerts, hanging out with friends and family, and actively participating in his church. Charlton is living life to the fullest and is now planning for a bright future — something he was previously reluctant to do.

Mom Charla reflected, “Looking back at pictures from last year at this time, it is very humbling to realize how low he actually was and now how far he has come. This lung transplant has truly been a life-saving gift in so many ways, and COTA has been there through every step of the process. We now understand why a transplant anniversary is celebrated.”