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September 24, 2019

Lung illnesses associated with use of vaping products in the US: The facts

3 minutes to read
Skepticism and fear around vaping has emerged following the cases of respiratory illness and deaths in the US associated with the use of e-cigarettes.

Investigations into respiratory failure cases are ongoing, and much is unknown, but here’s a quick summary of what is known:


  • Hundreds of cases have been reported in dozens of states, and at least 12 deaths have been confirmed, following claims they had been using vaping devices.
  • The US Food and Drug Administration (FDA) is analyzing samples of the liquids submitted by a number of states for the presence of nicotine, tetrahydrocannabinol (THC – a psychoactive component of the marijuana plant) and other cannabinoids, along with cutting agents/diluents and other additives, pesticides, opioids, poisons, heavy metals and toxins.
  • Although it is not yet clear if the cases have a common cause, a preliminary analysis of a cluster of cases in Wisconsin and Illinois published in the New England Journal of Medicine found that 84 percent of patients reported having used THC in e-cigarettes.
  • Federal and state partners are following potential leads, including the presence of Vitamin E acetate – reportedly used as a “thickening” or “cutting” agent in illicit cartridges – which has been found in many of the samples containing THC.
  • While the FDA does not have enough data presently to conclude that Vitamin E acetate is the cause of the lung illness in these cases, the agency believes it is prudent to avoid inhaling this substance.
  • The FDA also recommends that users of THC-containing vaping products should monitor themselves for symptoms (coughing, shortness of breath and chest pain, for example) and promptly seek medical attention if they have health concerns.
  • The FDA has NOT advised adult consumers to stop using legal forms of e-cigarettes and vaping liquids.
  • PMI does not sell any vaping products in the US, and no PMI vaping product has been identified in any of the reported cases.
  • Public Health England tweeted on September 12: “Our advice on e-cigarettes remains unchanged – vaping isn’t completely risk-free but is far less harmful than smoking tobacco.”
  • The best thing adults who smoke can do to protect their health is quit tobacco and nicotine altogether. For those who do not quit, they deserve access to and information about products which are a better choice than continuing to smoke.
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To best address critical questions related to new and innovative nicotine-containing products, including guarding against youth use and defining the appropriate quality and safety standards, manufacturers in the US must put their products and scientific evidence before the US Food and Drug Administration (FDA) for scientific review.

PMI did so for its electrically heated tobacco product, IQOS, and is sharing comprehensive information and scientific evidence on IQOS with authorities in many other countries. On April 30 2019, the FDA authorized IQOS for sale in the US, finding that marketing of the product would be “appropriate for the protection of public health”. Parallel applications seeking authorization to market IQOS as a “Modified Risk Tobacco Product” remain under scientific review by the FDA.

We fully back efforts to understand the root causes of this lung disease outbreak, followed by targeted action to prevent it happening again.

We also support proportionate regulation of smoke-free products that ensures quality and safety standards are met in the US and elsewhere.

But we value the crucial role smoke-free alternatives play when manufactured according to appropriate safety and quality standards and used responsibly by adult smokers who would otherwise continue smoking.

The FDA has created an information page on “Lung illnesses associated with use of vaping products”, including links to further resources and recommendations for the public.

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