Samples of lung fluid from patients with the mysterious illness led to a breakthrough in finding a possible cause. More than 2,000 people have been sickened, many from illicit marijuana-based products.
About Vaping An electronic cigarette, also known as e-cigarette among other names, is a handheld battery-powered vaporizer that simulates smoking and provides some of the behavioral aspects of smoking, including the hand-to-mouth action of smoking, but without burning tobacco. Using an e-cigarette is known as “vaping” and the user is referred to as a “vaper.” Instead of cigarette smoke, the user inhales an aerosol, commonly called vapor. E-cigarettes typically have a heating element that atomizes a liquid solution called e-liquid. E-cigarettes are automatically activated by taking a puff; others turn on manually by pressing a button. Some e-cigarettes look like traditional cigarettes, but they come in many variations. Most versions are reusable, though some are disposable. There are first-generation, second-generation, third-generation, and fourth-generation devices. There is also pod mod devices that use nicotine in the form of a protonated nicotine, rather than free-base nicotine found in earlier generations. E-liquids usually contain propylene glycol, glycerin, nicotine, flavorings, additives, and differing amounts of contaminants. E-liquids are also sold without propylene glycol, nicotine, or flavors.The benefits and the health risks of e-cigarettes are uncertain. There is tentative evidence they may help people quit smoking, although they have not been proven to be more effective than smoking cessation medicine. There is concern with the possibility that non-smokers and children may start nicotine use with e-cigarettes at a rate higher than anticipated than if they were never created. Following the possibility of nicotine addiction from e-cigarette use, there is concern children may start smoking cigarettes. Youth who use e-cigarettes are more likely to go on to smoke cigarettes. Their part in tobacco harm reduction is unclear, while another review found they appear to have the potential to lower tobacco-related death and disease. Regulated US Food and Drug Administration (US FDA) nicotine replacement products may be safer than e-cigarettes, but e-cigarettes are generally seen as safer than combusted tobacco products. The risk of early death is anticipated to be similar to that of smokeless tobacco. The long-term effects of e-cigarette use are unknown. The risk from serious adverse events was reported in 2016 to be low. Less serious adverse effects include abdominal pain, headache, blurry vision, throat and mouth irritation, vomiting, nausea, and coughing. Nicotine itself is associated with some health harms. In 2019, an outbreak of severe lung illness across multiple states in the US was linked to vaping.E-cigarettes create vapor made of fine and ultrafine particles of particulate matter, which have been found to contain propylene glycol, glycerin, nicotine, flavors, small amounts of toxicants, carcinogens, and heavy metals, as well as metal nanoparticles, and other substances. Its exact composition varies across and within manufacturers, and depends on the contents of the liquid, the physical and electrical design of the device, and user behavior, among other factors. E-cigarette vapor potentially contains harmful chemicals not found in tobacco smoke. E-cigarette vapor contains fewer toxic chemicals, and lower concentrations of potential toxic chemicals than cigarette smoke. The vapor is probably much less harmful to users and bystanders than cigarette smoke, although concern exists that the exhaled vapor may be inhaled by non-users, particularly indoors.Since their entrance to the market in 2003, global use has risen exponentially. In a 2014 survey, about 13% of American high school students reported using them at least once in the previous month, and in 2015 around 10% of American adults were users. In the UK, users have increased from 700,000 in 2012 to 2.6 million in 2015. About 60% of UK users are smokers and about 40% are ex-smokers, while use among never-smokers in the UK is negligible. Most still use traditional cigarettes, raising concern that dual use may “delay or deter quitting”. Most peoples’ reason for using e-cigarettes involve trying to quit smoking, though a large proportion use them recreationally. It is commonly stated that the modern e-cigarette was invented in 2003 by Chinese pharmacist Hon Lik, but tobacco companies had been developing nicotine aerosol generation devices since as early as 1963. As of 2018, 95% of e-cigarettes were made in China. Because of overlap with tobacco laws and medical drug policies, e-cigarette legislation is being debated in many countries. The revised EU Tobacco Products Directive came into effect in May 2016, providing stricter regulations for e-cigarettes. As of August 2016, the US FDA extended its regulatory power to include e-cigarettes. Large tobacco companies have greatly increased their marketing efforts. As of 2014, there were 466 brands of e-cigarettes, with global sales of around $7 billion.
Vaping Illnesses Are Linked to Vitamin E Acetate, C.D.C. Says …
About Illnesses A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that is not due to any external injury. Diseases are often known to be medical conditions that are associated with specific symptoms and signs. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies and autoimmune disorders.
In humans, disease is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases can affect people not only physically, but also mentally, as contracting and living with a disease can alter the affected person’s perspective on life.
Death due to disease is called death by natural causes. There are four main types of disease: infectious diseases, deficiency diseases, hereditary diseases (including both genetic diseases and non-genetic hereditary diseases), and physiological diseases. Diseases can also be classified in other ways, such as communicable versus non-communicable diseases. The deadliest diseases in humans are coronary artery disease (blood flow obstruction), followed by cerebrovascular disease and lower respiratory infections. In developed countries, the diseases that cause the most sickness overall are neuropsychiatric conditions, such as depression and anxiety.
The study of disease is called pathology, which includes the study of etiology, or cause.
Nov. 8, 2019Updated 6:10 p.m. ET
A form of vitamin E has been identified as a “very strong culprit” in lung injuries related to vaping THC, health officials reported on Friday, a major advance in a frightening outbreak that has killed 40 people and sickened 2,051.
Vaping Illnesses Are Linked to Vitamin E Acetate, C.D.C. Says …
Many patients with the mysterious illness have wound up hospitalized in intensive care units, needing ventilators or even more desperate measures to help them breathe. Most are young, male adults or even teenagers.
“For the first time, we have detected a potential toxin of concern, vitamin E acetate, from biological samples from patients,” with lung damage linked to vaping, Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, said at a news briefing.
The new report, based on samples taken from the lungs of 29 patients, including two who died, she said, “provided evidence of vitamin E acetate at the primary site of injury in the lungs.”
She added, “These findings tell us what entered the lungs of some patients with these injuries.”
The patients came from 10 states scattered around the country, so the findings are considered broadly applicable and unlikely to have resulted from a single vaping product or supplier.
The results mesh with other research that found the vitamin compound in vaping products.
But Dr. Schuchat left open the possibility that other chemicals or toxins from vaping fluids or devices could also be causing the severe respiratory ailments.
The outbreak has revealed the existence of a vast, unregulated, shadowy marketplace of illicit or bootleg vaping products that are essentially a stew of unknown chemicals concocted, packed and sold by unknown manufacturers and sellers.
Hundreds of state and federal health investigators have been deployed to find out what has caused such extensive damage to patients’ lungs, which researchers have likened to the chemical burns suffered by soldiers attacked with mustard gas in World War I.
Vitamin E acetate is sticky, like honey, and clings to lung tissue, the C.D.C. said. Researchers do not know exactly how it harms the lungs, but studies in animals are being considered to help explain that, Dr. Schuchat said.
It is commonly used as a vitamin supplement or an ingredient in skin lotions. Makers of illicit vaping fluids sometimes add it as a thickener or to dilute the THC, the high-inducing ingredient in marijuana, and increase their profits. But just because something is safe to swallow or rub on the skin does not mean it is safe to inhale. The digestive system has enzymes to break down what we ingest; the lungs do not.
Samples of lung fluid from the 29 patients were also tested for plant oils, petroleum distillates like mineral oil and other potentially harmful substances. None were found, the C.D.C. said. The findings were published in Friday’s Morbidity and Mortality Weekly Report.
“C.D.C. scientists developed 12 targeted laboratory methods to identify specific substances of concern,” Dr. Schuchat said. “This kind of assay development takes time.”
About 70 percent of the people with the lung ailments are male, 79 percent are younger than 35 and 86 percent say that they have vaped THC.
Many of the products used by those who became ill were illicitly obtained, public health experts have said, by patients who bought them from friends or on the street. Vaping oils typically include other additives, solvents and flavor enhancers.
Health investigators have said since nearly the beginning of the outbreak in mid-August that some ingredients, including vitamin E acetate, could be responsible for some of the lung illness cases.
State health officials in New York had first identified vitamin E acetate from several samples of vaping products collected in August that were analyzed by the Wadsworth Center Lab.
Although most cases of the vaping illness have been linked to illicit THC, Dr. Schuchat said that did not mean other vaping products could be considered safe. She said there were anecdotal reports, not yet fully investigated, of patients who said they had bought THC from licensed dispensaries in states where marijuana is legal.
Nicotine has not been exonerated, either. Some patients say they vaped only nicotine, and state health officials consider some of those reports reliable, Dr. Schuchat said.
Hoping to identify risk factors for the vaping illness, health officials in Illinois conducted a survey of 4,631 adults 18 and older who vaped and were healthy, and compared them with those who got sick from vaping. Most of the healthy responders vaped nicotine, but 21 percent used THC.
The patients who became ill were more likely to vape only THC, and to use it frequently, more than five times a day. They were nine times as likely to buy THC from informal sources like dealers, friends or on the street, and eight times as likely to have used Dank Vapes, which the officials described as “a class of largely counterfeit THC-containing products,” from unknown sources.
It is possible to become addicted to THC, and health officials say some patients may need counseling and treatment for it.
The number of lung-injury cases increased in the last week, but not as much as in previous weeks.
“The trend in cases appears to be downward, but we understand that some states are still hard hit, and this continues to be a very active investigation,” Dr. Schuchat said.
Additional fatal cases are being investigated, she added. The death count will probably go up.
Because there is still uncertainty about what is causing the illness, the C.D.C. is continuing to urge people to avoid vaping anything, including e-cigarettes.
Because of year-over-year spikes in the use of e-cigarettes among minors, the Food and Drug Administration is expected to soon announce measures that could involve banning most flavored e-cigarettes, including mint. Prohibiting menthol had been mentioned earlier, but the vaping and tobacco industries have intensively lobbied the White House and lawmakers against such a broad ban given that traditional menthol cigarettes remain on the market.
On Thursday, Juul Labs, the nation’s largest seller of e-cigarettes, took a step ahead of the anticipated flavor ban and announced that it would discontinue sales of mint-flavored pods, after the latest national surveys showed that teenagers cited fruit and mint as their favorites.
But an aide to President Trump suggested earlier this week that vape shops might somehow be exempted from restrictions. And on Friday, he noted that the industry had created a lot of jobs.
Mr. Trump said an announcement to protect young people would be made next week and would include a proposal to raise the age limit for sales of e-cigarettes to “21 or so.” Federal law now sets a minimum age of 18 to buy both cigarettes and e-cigarettes, although about one-third of states have raised the age to 21. There is bipartisan support for such a move, which would require an act of Congress.
Sheila Kaplan contributed to this article.
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