Even nicotine-free electronic cigarettes can damage lungs; parents urged to warn teens about dangers of e-cig smoking

Kentucky has one of the nation's highest smoking rates, but electronic cigarettes, or e-cigs, are becoming more popular. These battery-powered vaporizers produce a vapor that usually does not contain nicotine. Some have claimed that e-cigs can help people quit smoking because the amount of nicotine can be reduced until it isn't present in the vapor. However, new research shows that other substances in e-cigs may damage the lungs.

Research has found that nicotine in any form damages the endothelial cells that line the lungs, and can cause them to become inflamed or injured. The new research has found that e-cigarette solutions without nicotine contain other substances like acrolein, which damage the lungs in other ways.

"This research reports that components found in commercially available e-cigarette solutions and vapors generated by heating them may cause lung inflammation," said lead researcher Irina Petrache. Long-term effects haven't yet been studied, but the results of this study warn that e-cig inhalation may involve adverse effects on lung health, she said.

Centers for Disease Control and Prevention research shows that e-cigarette use among middle and high school students has tripled. "The development and marketing of e-cigarettes has the potential of hooking a whole new generation on nicotine," Garry Sigman, director of the Loyola University Health System Adolescent Medicine Program, said. It's very addictive and can lead to health issues such as lung disease, heart disease, hypertension and nervous system problems, he said.

Sigman said parents need to made sure their children understand that e-cigarettes are just as addictive as other substances. "Nicotine is so addictive that with only a few inhales, it can create an addiction," he said. Because adolescents enjoy and use technology so much, the modern qualities of the e-cigs might make them seem cool. "Setting rules and monitoring behavior is essential to keeping our teens safe," Sigman said.

Plight of woman needing lung transplant, who has fallen through the cracks of the health-care system, gets attention from CNN

Update: CNN reports that Kentucky issued a Medicaid provider number to the University of Pittsburgh Medical Center, and the hospital confirmed that they now have enrolled in Kentucky Medicaid and are working to complete the enrollment of some of their physicians, all of which helps clear the way for Katie Prager to get her lung transplant.  "Kentucky Medicaid executives are helping us to get this done in a streamlined fashion that overcomes previous administrative hurdles and misunderstandings in this complex case," Wendy Zellner, a spokeswoman for UPMC, told CNN. Dalton, Katie's husband, has since been discharged from the Pittsburgh hospital where he received his lung transplants in November and has returned to Kentucky. CNN reports Katie and Dalton were only able to communicate through the doorway of her University of Kentucky hospital room because of his risk of getting Katie's infection, which could kill him.

A 24-year-old Kentucky woman with cystic fibrosis who needs a lung transplant to live is caught in the middle of a financial and policy battle among Medicare, Medicaid, a state agency and the University of Pittsburgh Medical Center, one of only two hospitals in the United States qualified to do lung transplants on patients with her specialized condition.

Prager at University of Kentucky hospital (Image from CNN)

"I feel like they're putting a dollar sign on my life," Katie Prager of Ewing, in Fleming County, told CNN. "I don't want to die because of money. That's stupid. Nobody should have to do that." Katie's story was first reported by The Ledger Independent of Maysville and excerpted in Kentucky Health News.

Katie longs to be with her husband, Dalton Prager, but can't until she gets her lung transplant because in addition to cystic fibrosis, she has an infection, Burkholderia cepacia, that is "horribly dangerous" to him, Elizabeth Cohen and John Bonifield report for CNN. Dalton, who also has cystic fibrosis, received his lung transplants Nov. 17 at the Pittsburgh hospital, and the immunity-suppressing drugs he takes for the transplants make him highly vulnerable to infection.

"I just want to make it to see our four-year anniversary in July and be able to hold hands and just hug. That's all I really want -- to be able to hug my husband on our fourth anniversary," Katie told CNN.

Katie and Dalton met on Facebook in 2009 when they were 18 and Dalton lived in Missouri and Katie in Kentucky. And though Katie's doctors had warned her many times that it was dangerous to be around other CF patients because of the risk of shared infections, Katie decided to meet Dalton, even after he had told her he had Burkholderia cepacia, CNN reports. They married two years later.

Photo from CNN

"I told Dalton I'd rather be happy -- like really, really happy -- for five years of my life and die sooner than be mediocre happy and live for 20 years," she told CNN. "That was definitely something I had to think about, but when you have those feelings, you just know."

Their health "quickly deteriorated, and within months, they went on oxygen full time" and had to quit work, CNN reports. They entered the Pittsburgh hospital together in August 2014 to wait for new lungs. Dalton got his in November; Katie is still waiting.

One month after Dalton got his transplants, UPMC discharged Katie because they told her "It would be psychologically good for her to get out for a while," she told CNN. After only three days out she began to have "serious trouble breathing" and tried to go back into the hospital, but was told she could not return because "she had used up her supply of Medicare days."

Medicare wouldn't pay for another hospitalization until Katie had been out of the hospital for 60 days. She is too sick to do that, and has since been a patient at the University of Kentucky, where she relies on the federal-state Medicaid program for the poor and disabled to pay for her care, and doctors have predicted that she won't live a year without new lungs, CNN reports.

Medicaid cannot pay the Pittsburgh hospital because it is not in the state's network of health-care providers. CNN reports that Katie's doctor wrote a letter to Medicaid begging them to make an exception, but the state denied his plea. In a statement to CNN, a spokeswoman for the state Cabinet for Health and Family Services said the hospital had declined to enroll as a Kentucky Medicaid provider. "Medicaid policies allow for a simplified enrollment process for out-of-state providers in such situations," Gwenda Bond, spokeswoman for the cabinet wrote, offering to expedite their application when they choose to sign up.

Hospital officials counter that Kentucky officials said they would have to "sign up hundreds of their doctors to accept Kentucky Medicaid patients," which hospital spokeswoman Wendy Zellner said is "an unusually restrictive approach and contrary to single-case agreements that we have signed with other state Medicaid programs. . . . It is up to Kentucky Medicaid to address this situation."

Katie has also since had a discussion with a federal Centers for Medicare and Medicaid Services caseworker that "didn't go very well," CNN reports. Katie told CNN that the caller was "rude, mean, and angry" and "acted like it was just a pain to have to be talking to me," but said "she would look into her situation." On April 1, CMS spokesman Aaron Albright told CNN that the federal agency was "reaching out to the state agency," and later in the day Zellner said the state agency "has reached out to us to talk. So stay tuned."

The news cheered the Pragers, who continued to talk via Skype and work on their fundraising Facebook page, while dreaming of a future together, CNN reports.

Woman needing lung transplant falls through cracks of health-care system, says she's treated as nothing more than a 'price tag'

Katie Prager, a 24-year-old cystic fibrosis patient from Ewing in Fleming County, needs a lung transplant, but has been denied one because she has met her lifetime maximum on Medicare, Christy Hoots reports for The Ledger Independent in Maysville.

Photo from The Ledger Independent

"They've put a price tag on my name. That's all I am to these people right now," Prager told Hoots from her hospital bed at the University of Kentucky's Chandler Medical Center.

Prager has had cystic fibrosis her entire life, but it was a diagnosis of an infection called burkholderia cepacia in 2009 that caused her lung function to rapidly decline and caused the need for a lung transplant. She was told in 2013 that the UK Center for Cystic Fibrosis does not do transplants on cystic fibrosis patients with this infection, so she was sent to the University of Cincinnati hospital, Hoots reports.

She and her husband Dalton Prager, who also has cystic fibrosis, were then sent to the University of Pittsburgh Medical Center because it is only one of two hospitals that will transplant a lung into a patient with this infection. They began evaluations in January 2013.

Dalton Prager was quickly approved and successfully received a double lung transplant in November 2013. Katie Prager wasn't approved until June 2013. While waiting for a donor lung, she was discharged to spend Christmas with her family, only to hear from the hospital that she could not return there because the Medicare maximum had been reached.

"At first, I thought I might be able to use Medicaid, but was told that it wouldn't cover my transplant due to UPMC being out of network," Katie Prager told Hoots. "After explaining to Medicaid that there are only two places in the country who would operate, due to cepacia, they still refused to work together to help me. In January 2015 I filed an appeal with Medicaid to have them reconsider. The appeal was denied."

She was recently told she would never be eligible to return to UPMC for a transplant and there was nothing else they could do for her, Hoots reports.

"They told me to basically stop wasting my time," she told Hoots. "These are people who we're trusting with our lives and they say that. Most people have no problems when they have to have medical treatments or transplants, and I'm being given the runaround. I'm not trying to be a burden on the system -- that isn't what I want. If I could work and get my own insurance, I would. All I want is a normal chance at life. I want to get my bachelor's degree, get up every day and go to work, run a 5K and have a normal life with my husband. I want to do all the things that young people in love get to do. Is that so much to ask?"

Heavy use of e-cigarettes may deliver big doses of formaldehyde, which can be a cause of lung cancer, study suggests

Vapor produced by electronic cigarettes can contain a surprisingly high concentration of formaldehyde—a known carcinogen that can cause lung cancer through prolonged exposure—researchers reported Wednesday in a study published in the New England Journal of Medicine, Rob Stein reports for NPR. (Getty Images by Dan Kilwood)

Use of e-cigarettes among rural teens has risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

"E-cigarettes work by heating a liquid that contains nicotine to create a vapor that users inhale," Stein writes. David Peyton, a chemistry professor at Portland State University who helped conduct the research, told Stein, "We simulated vaping by drawing the vapor—the aerosol—into a syringe, sort of simulating the lungs. That enabled the researchers to conduct a detailed chemical analysis of the vapor. They found something unexpected when the devices were dialed up to their highest settings."

The e-cigarette industry dismissed the report, saying they found formaldehyde only when e-cigarettes were cranked up to their highest voltage levels, Stein writes. Gregory Conley of the American Vaping Association told him, "They clearly did not talk to [people who use e-cigarettes] to understand this. They think, 'Oh, well. If we hit the button for so many seconds and that produces formaldehyde, then we have a new public health crisis to report."

"If you hold the button on an e-cigarette for 100 seconds, you could potentially produce 100 times more formaldehyde than you would ever get from a cigarette," Conley said. "But no human vaper would ever vape at that condition because within one second their lungs would be incredibly uncomfortable." (Read more)