#lipoid pneumonitis

[biology-geology-beaches-india]

TSRNOSS, p 515.

[massachusettsjofw176-blog]

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By far the most plausible rationalization for your respiratory diseases is that vaping oil-primarily based THC solutions is bringing about lipoid pneumonia, a scarce condition brought on by Extra fat particles while in the lungs, or eosinophilic chemical pneumonitis, a condition marked by elevated levels of white blood cells while in the lungs. A number one suspect is vitamin E acetate, which was detected in many of the THC fluids analyzed because of the FDA and Ny's state lab.

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[benediktine]

【「電子タバコ」パンデミック～米国で何が起きているのか】 - Yahoo!ニュース : https://news.yahoo.co.jp/byline/ishidamasahiko/20191005-00145393/ : https://archive.is/QtAQT 石田雅彦  | ライター、編集者 10/5(土) 9:00

　{{ 図版 : （写真:アフロ） }}

　米国では電子タバコによる呼吸器疾患の患者が急増し、亡くなる人も2桁になっている。パンデミック（伝染性の大流行）という表現も使われ、大きな社会問題になっている。いったい何が起きているのだろうか。

■《電子タバコでどんな病気になるのか》 　米国CDC（疾病予防管理センター）によれば、電子タバコによる健康被害は、 {{ 2019年10月3日の時点で48州と1つの米国��において1080の肺損傷症例と15の州で18人の死亡を報告 : https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#what-we-know }} している。患者の約70％が男性、約80％が35歳未満（18～20歳が約21％）だという。

　タバコを吸うと気管や肺などの呼吸器に吸い込んだ物質が触れ、あるいは身体中の細胞に入り込み、直接的に悪影響を及ぼす。その結果、肺がん、COPD（慢性閉塞性肺疾患）、気管支喘息、鼻腔や口腔などの頭頸部がん、といった病気になる（※1）。だが、最近の電子タバコによる呼吸器疾患の場合、少し病気の種類が異なるようだ。

　ニコチンが添加されたリキッドを使う電子タバコは、日本を除く各国で売られている。電子タバコで病気になった事例はいつ頃から現れてくるのだろうか。

　例えば、急性好酸球性肺炎（Acute Eosinophilic Pneumonia）という病気がある。日本から加熱式タバコ（アイコス＝IQOS）を吸ったことで急性好酸球性肺炎になったという症例報告があるが（※2）、電子タバコでもこの病気になる危険性はありそうだ。

　以前から、タバコを吸うと急性好酸球性肺炎という重篤な肺炎になることが知られていたが（※3）、この病気はわりに珍しく（※4）、他の肺炎と紛らわしいため、症例報告に上がりにくかった可能性もある。好酸球というのは白血球の一種でアレルギー反応を制御する。タバコに含まれる物質が劇症のアレルギー反応と好酸球の活性化を引き起こすのではないかと考えられている。

■《好酸球性肺炎よりもリポイド肺炎か》

　では、電子タバコを吸ったことによる急性好酸球性肺炎の症例報告はあるのだろうか。

　過去の文献を検索すると、2009年に出版された急性好酸球性肺炎の症例報告のレビュー（※5）には、紙巻きタバコによる論文は紹介されているが、まだ電子タバコについての言及はない。

　電子タバコを吸って急性好酸球性肺炎になったという症例報告は、2014年に男性で1例（※6）、2019年に女性で1例（※7）あるだけだ。最近の電子タバコ騒ぎで入院した患者17人の肺細胞の臨床検査によれば、好酸球はあまり見られなかったらしい（※8）。

　結論を出すのは早いが、おそらく今回の電子タバコの健康被害は急性好酸球性肺炎ではないのかもしれない。

　ところで、電子タバコを吸うことによる呼吸器疾患の問題がクローズアップされるのは2012年になってからだ。しかし、2012年前後の段階では電子タバコによる健康への害は不明で、リキッドに含まれるグリセロール、プロピレングリコール、ニコチン、添加された香料などを容疑者として探索が続けられていた（※9）。

　電子タバコによるグリセリンはリポイド肺炎（Lipoid Pneumonia）という、これも珍しい呼吸器疾患との関連が示唆され、例えば呼吸困難とひどい咳、発熱で入院した42歳の女性の事例では、約7ヶ月前から電子タバコを吸い始めてから症状がひどくなり始めたという（※10）。

　リポイド肺炎というのは外因性の場合、パラフィン（流動パラフィン≒ベビーオイル）などの油性物質を吸い込んだり誤嚥したりして起きる急性の肺炎だ（※11）。肺の内部にべっとりと油成分が貼り付いて呼吸機能を阻害する。幼児が誤飲することが多く、火を噴くパフォーマーがパラフィンを使って誤嚥し、リポイド肺炎になるという症例も報告されている（※12）。

　2016年に出された電子タバコを吸った症例報告のレビュー（※13）では、25人の患者に健康への悪影響があった。そのうち呼吸器系の症例報告が6例あり、内訳は外因性のリポイド肺炎2例、気管支炎、急性好酸球性肺炎、肺炎、過敏性肺炎がそれぞれ1例となっている。

　今年2019年7～8月に米国ノースカロライナ州の2つの病院で、電子タバコを吸ったと思われる呼吸困難の患者5人が治療を受けたが、5人とも急性の外因性リポイド肺炎との診断だった（※14）。だが、前述の肺細胞の生検のレポートでは、外因性のリポイド肺炎の特徴を示していないという指摘がなされていて混乱している。

■《複合的な作用かもしれない》

　こうした報告をざっと眺めた印象では、電子タバコに含まれるグリセロールやプロピレングリコールといった化学物質が気化して呼吸器に送り込まれ、肺の中に貼り付いてしまい、好酸球性肺炎やリポイド肺炎のような症状を引き起こしたのかもしれない。

　ただ、9月24日の米国46州の患者805人を調べたCDCの疫学週報（MMWP、罹患率と死亡率の週報）によれば、男性69％、13～72歳（中央値23歳）となっていて、さらに患者514人を調べてみるとTHC（Tetrahydrocannabinol、テトラヒドロカンナビノール）という大麻成分の入ったリキッド使用者が76.9％、ニコチン添加リキッド使用者が56.8％となっている（※15）。

　また、イリノイ州とウィスコンシン州の患者127人を調査したMMWPによれば、項目に回答した86人のうち75人（87％）がTHCリキッドを使用し、61人（71％）がニコチン添加リキッドを使用していた。また、THCリキッドを使用した人の89％が友人や家族、路上の違法売人などから入手していたこともわかったという（※16）。

　こうしたことから米国の電子タバコによる健康被害は、THCとグリセロールやプロピレングリコール、さらにニコチンといった複合的で複雑な作用で起きている危険性が考えられる。

　2019年10月4日、米国FDA（食品医薬品局）は、電子タバコのどの成分が影響しているのか現状では不明としつつ、 {{ THCを含んだ電子タバコを使用しないように警告 : https://www.fda.gov/news-events/press-announcements/statement-consumer-warning-stop-using-thc-vaping-products-amid-ongoing-investigation-lung-illnesses }} し、自分でリキッドに変更を加えず、違法なルートからの購入を止めるよう指示している。THC成分の添加を米国政府（FDA）は禁止しているが、合法的に認可している州も多い。実質的には野放し状態といっていいだろう。

　また、 {{ カナダのケベック州でも電子タバコによる重篤な肺疾患の患者が出て : https://www.msss.gouv.qc.ca/ministere/salle-de-presse/communique-1927/ }} いる。米国での事例を含め、2019年9月28日に {{ カナダ保健省は電子タバコを吸うことの健康上のリスクについて警告 : https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/70919a-eng.php }} した。

　電子タバコのリキッドにTHCを添加することは、以前から健康への悪影響が指摘されてきた（※17）。米国内のタバコ産業は、同国内の大麻の合法化の流れを受け、THC成分を加えたタバコ製品を全米で発売しようとしている。

　日本ではニコチン添加リキッドを電子タバコで使用することは規制されているが、加熱式タバコはかなり広まっている。加熱式タバコからもニコチンはもちろんグリセロールやプロピレングリコールが吸収され、複合的な作用の起きる危険性は高い。

　前述したように実際、アイコスを吸うことによって、急性好酸球性肺炎という重篤な呼吸器疾患になった症例報告もある。日本でタバコ製品の安全性について行政機関の審査などは全くない。米国と同じ状態にならないという保証は何もないのだ。

============≫ ※2019/10/05：15:37：内容を部分的に修正し、文献を3つ追加した。

※2019/10/06：15:12：英国の医学雑誌「BMJ（the British Medical Journal）」に2019年9月30日に出た論文（※18）によれば、電子タバコを吸うことによる長期的な悪影響は研究されていないが、呼吸器疾患の症例が増加している現状をみれば、電子タバコが肺に何らかの悪影響を及ぼすことは十分考えられるという。その理由として、電子タバコを吸うことで、肺に脂肪蓄積マクロファージ（lipid-laden macrophage）による泡沫細胞（Foam Cell）ができることが関与しているのかもしれないとする。マクロファージは白血球の一種で、死んだ細胞など生体廃棄物のスカベンジャー（腐肉あさり）の役割をする。脂質をあさって泡だった状態になったのが脂肪蓄積マクロファージだ。脂肪蓄積マクロファージはアテローム性動脈硬化症の原因になることが知られている。また、この論文では電子タバコの成分が免疫機能を抑制するかもしれないとも述べている。 ≪============ ============≫ ※1-1：Irfan Rahman, William MacNee, "Lung glutathione and oxidative stress: implications in cigarette smoke-induced airway disease." Lung Cellular and Molecular Physiology, Vol.277, Issue6, L1067-L1088, 1999

※1-2：Anupam Kumar, et al., "Current Concepts in Pathogenesis, Diagnosis, and Management of Smoking-Related Interstitial Lung Diseases." CHEST, Vol.154, Issue2, 394-408, 2018

※2-1：Takahiro Kamada, et al., "Acute eosinophilic pneumonia following heat‐not‐burn cigarette smoking." Respirology Case Reports, Vol.4, Issue6, 2016

※2-2：Toshiyuki Aokage, et al., "Heat-not-burn cigarettes induce fulminant acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation." Respiratory Medicine Case Reports, Vol.26, 87-90, 2019

※3-1：Hiroshi Uchiyama, et al., "Alterations in Smoking Habits Are Associated with Acute Eosinophilic Pneumonia." CHEST, Vol.133, Issue5, 1174-1180, 2008

※3-2：Federica De Giacomi, et al., "Acute Eosinophilic Pneumonia. Cause, Diagnosis, and Management." American Journal of Respiratory and Critical Medicine, Vol.197, No.6, 2018

※3-3：Beenish Fayyaz, "Acute eosinophilic pneumonia associated with smoking: a case report." Journal of Community Hospital Internal Medicine Perspectives, Vol.8, Issue3, 2018

※4：Federica De Giacomi, et al., "Acute Eosinophilic Pneumonia: Correlation of Clinical Characteristics With Underlying Cause." Chest, Vol.152, Issue2, 379-385, 2017

※5：David R. Janz, et al., "Acute eosinophilic pneumonia: A case report and review of the literature." Critical Care Medicine, Vol.37, No.4, 1470-1474, 2009

※6：Darshan Thota, Emi Latham, "Case Report of Electronic Cigarettes Possibly Associated with Eosinophilic Pneumonitis in a Previously Healthy Active-duty Sailor." The Journal of Emergency Medicine, Vol.47, Issue1, 15-17, 2014

※7：Zhaohui I. Arter, et al., "Acute eosinophilic pneumonia following electronic cigarette use." Respiratory Medicine Case Reports, Vol.27, 2019

※8：Yasmeen M. Butt, et al., "Pathology of Vaping-Associated Lung Injury." New England Journal of Medicine, DOI: 10.1056/NEJMc1913069, 2019

※9：Dominic L. Palazzolo, "Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review." frontiers in Public Health, doi.org/10.3389/fpubh.2013.00056, 2013

※10：Lindsay Mccauley, et al., "An Unexpected Consequence of Electronic Cigarette Use." CHEST, DOI: 10.1378/chest.11-1334, 2012

※11：Kevin Davidson, et al., "Outbreak of Electronic-Cigarette-Associated Acute Lipoid Pneumonia-North Carolina, July-August 2019." Morbidity and Mortality Weekly Report, Vol.68(36), 784-786, 2019

※12：I Weinberg, Z G. Fridlender, "Exogenous lipoid pneumonia caused by paraffin in an amateur fire breather." Occupational Medicine, Vol.60, Issue3, 2010

※13：My Hua, Prue Talbot, "Potential health effects of electronic cigarettes: A systematic review of case reports." Preventive Medicine Reports, Vol.4, 169-178, 2016

※14：Sonia L. Betancourt, et al. "Lipoid pneumonia : spectrum of clinical and radiologic manifestations." American Journal of Roentgenology, Vol.194, Issue1, 103-109, 2010

※15：C G. Perrine, et al., "Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping- United States, 2019." Morbidity and Mortality Weekly Report, Vol.68(39), 860-864, 2019

※16：I Ghana, et al., "E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury- Illinois and Wisconsin, April-September 2019." Morbidity and Mortality Weekly Report, Vol.68(39), 865-869, 2019

※17：Christian Giroud, et al., "E-Cigarettes: A Review of New Trends in Cannabis Use." International Journal of Environmental Research and Public Health, Vol.12, Issue8, 2015

※18：Jeffery E. Gotts, et al., "What are the respiratory effects of e-cigarettes?" the BMJ, Vol.366, doi.org/10.1136/bmj.l5275, 2019 ≪============ ============≫ ※筆者は喫煙者を批難しない。喫煙者は、日本では国によって推進されてきたタバコ政策とタバコ会社のビジネスの犠牲者だからだ。禁煙外来などで処方されるニコチンパッチやニコチンガム、ニコチン代替薬には免疫系への悪影響がないことがわかっている（1）。ある物質は毒にも薬にもなる。医師の適切な指示に従って処方されるなら、ニコチンは禁煙にとって重要な薬物となる。1）Kate Cahill, et al., "Nicotine receptor partial agonists for smoking cessation." Cochran Database of Systematic Reviews, 2008 ≪============

●石田雅彦　ライター、編集者 　Masahiko Ishida：医科学修士（MMSc）。近代映画社で出版の基礎を学び、独立後はネットメディア編集長、紙媒体の商業誌編集長などを経験。ライターとして自然科学から社会科学まで多様な著述活動を行う。法政大学経済学部卒、横浜市立大学大学院医学研究科修士課程修了、同博士課程在学中。JASTJ会員。1日20本25年の元喫煙者。サイエンス系の著書に『恐竜大接近』（集英社、監修：小畠郁生）、『遺伝子・ゲノム最前線』（扶桑社、監修：和田昭允）、『ロボット・テクノロジーよ、日本を救え』（ポプラ社）などが、人文系著書に『季節の実用語』（アカシック）、『おんな城主 井伊直虎』（アスペクト）などがある。

[respiratorydecade]

#Pulmonary illnesses that have been linked to #ecigarette use have been limited to individual case reports. #Nicotine-containing liquids have been associated with a variety of #disease presentations. Diffuse alveolar hemorrhage and exogenous lipoid pneumonia have been observed. Acute interstitial #lung #disease, including acute eosinophilic #pneumonia, respiratory bronchiolitis-associated #interstitial lung disease, and #hypersensitivity pneumonitis, has also been associated with use of nicotine-containing liquids. https://www.instagram.com/p/B2GD5yhg-CU/?igshid=14ob6kj0ks08t

[tophateliquids]

My Testimony Today Regarding the Massachusetts Emergency Ban on the Sale of Electronic Cigarettes

Testimony of Michael Siegel, MD, MPH

Professor, Boston University School of Public Health

November 22, 2019

The Department of Public Health justified its emergency order by arguing that removing vaping products from the market would protect the public – and especially youth – from the vaping-associated respiratory disease outbreak that has now affected more than 2,000 people and caused 47 deaths.

However, unbeknownst to many, this emergency order was not successful in removing all vaping products from the market. In fact, the Department’s emergency order exempted – and therefore failed to remove from the market - a large number of flavored e-liquid products that are highly popular among youth and which Massachusetts youth continue to use, despite the emergency order. These flavored e-liquids are used by 63% of youth who vape regularly. Unfortunately, all of the following flavors are exempt from the ban and remain on the market today throughout the Commonwealth, easily accessible to youth. The exempted flavors include all of the following:

     "Mario Carts Vanilla Glue,"

     "Heavy Hitters Vape Strawberry,"

     "Honey,"

     "Gelato,"

     "Blueberry,"

     "Banana Sherbet,"

     "Jillybean,"

     "Super Lemon Haze,"

     "Romulan Grapefruit,"

     "Sour Tangie,"

     "Biscotti,"

     "Pineapple Express,"

     "Mango,"

     "Juicy Melon,"

     "Strawnana,"

     "Granddaddy Purp,"

     "Forbidden Fruit,"

      "Lemon Lime,"

      "Golden Goat,"

        "Butter,"

        "Orange Cream,"

        "Banana Cream,"

        "Strawberry Banana,"

        "Grapevine,"

        "Lime Sorbet,"

        "Potent Pineapple,"

        "Pure Pear,"

        "Red Apple,"

        "Blue Raz,"

        "Strawberry Sherbet,"

        "Grape Soda,"

        "Pink Sherbet,"

        "Cactus Cooler,"

        "Sunset Sherbet Sauce,"

��       "Sunset Gelato,"

        "It's Yo Birthday,"

        "Wedding Cookies,"

        "Orange Cookies,"

        "Girl Scout Cookies,"

        "Grape Pie,"

        "Cookies n Cream,"

         "Apple Jacks,"

         "Banana OG,"

         "Birthday Cake,"

         "Black Berry Kush,"

         "Blue Dream,"

         "Blueberry Kush,"

         "Bubble Gum,"

         "Candy Land,"

         "Cherry Pie,"

         "Cotton Candy,"

         "Fruity Pebbles,"

         "Gelato,"

         "Grape Ape,"

         "Honey Berry,"

         "Honey Dew,"

         "Ice Blue Raspberry,"

         "Key Lime Pie,"

         "Lemon Berry,"

         "Lemon Head,"

         "Lemon Slushie,"

         "LSD,"

         "Mai Tai,"

         "Mango Kush,"

         "Maui Wowie,"

         "Mimosa,"

         "Mojito,"

         "Orange Chai,"

         "Orange Cookies,"

         "Orange Daiquiri,"

         "Peach,"

         "Pineapple Express,"

         "Pot of Gold,"

         "Purple Punch,"

         "Rose Gold,"

         "Russian Cream,"

         "Sour Apple,"

         "Strawberry Shortcake,"

         "Sweet Aromatic,"

         "Tangie,"

         "Vanilla Kush,"

         "Water Melon,"

         "Wedding Cake," and

         "Zskittlez."

All of these flavors remain on the market, despite what policy makers are telling the public. The truth is that while the sale e-liquids that contain nicotine has been banned, all of the above flavors, which are available in THC vape cartridges, remain on the market.

And in fact, it is these products, not the nicotine e-liquids sold in retail stores, that are responsible for the respiratory disease outbreak. Recently, the CDC found that the lungs of every single one of the 29 patients whose lung fluids were tested contained vitamin E acetate. This is a thickening agent that is used only in THC vape carts and possibly in black market, counterfeit or adulterated nicotine cartridges, but not in legal nicotine-containing e-liquids sold at stores.

You can now easily see why the ban on the sale of nicotine e-liquids at retail stores is no longer justified. There is simply no evidence that these products are causing the outbreak, and there is incontrovertible evidence that vitamin E acetate oil – or some chemical contained in that oil – is now implicated as the culprit. Therefore, the only rational action for the Department to take at this point is to discontinue the emergency ban on nicotine-containing vaping products sold at retail stores in the Commonwealth.

Not only is this ban not preventing any outbreak cases – because those cases are not being caused by the banned products – but the ban is likely making the outbreak worse. Why? Because youth who can no longer access nicotine e-liquids are simply switching over to many of the sweet, fruity, alcohol-based, and other attractive flavors that are readily available in THC vape products. The tragedy, of course, is that these flavored THC e-liquids are precisely the ones that are killing many people and causing life-threatening illness. Banning nicotine e-liquids is not preventing youth from dying due to respiratory failure. But it may actually increase the number of kids who develop respiratory failure. With flavors like Girl Scout Cookies, Cookies and Cream, Mimosa, Banana Sherbet, It's Yo Birthday, Russian Cream, Gelato, Grape Soda, Potent Pineapple, and Super Lemon Haze available, do you really think that youth are just going to completely stop vaping? In the short time that JUUL has limited access to many of its flavors (such as mango and creme), youth have just shifted over to vaping the mint-flavored JUUL pods. They didn't stop vaping because some flavors were taken off the market. Youth are resourceful, vaping is cool, and they will simply switch to whatever flavors are available. Those flavors will be vape juices like Zskittlez, Bubble Gum, Cotton Candy, and Cherry Pie. And the only difference will be that instead of the risk of mild respiratory irritation (with most nicotine-containing e-liquids) or nicotine addiction (with JUUL), the major risk for our nation's youth will now be DEATH from lipoid pneumonia or chemical pneumonitis. How is that good public health policy?

Moreover, the ban on electronic cigarettes is already having devastating impacts on the public’s health.

Sales data reported by PiperJaffray for the four weeks ending October 20 (when the Massachusetts emergency ban was in effect for 25 of the 28 days) and the four previous weeks (mostly before the ban went into effect) were compared to sales data for the previous year. The PiperJaffray analysis revealed that there has been a substantial shift from vaping to smoking in the state. This indicates that ex-smokers in Massachusetts who were reliant on e-cigarettes to stay smoke-free are now returning to smoking in large numbers. Nationally, there was very little difference in the rate of decline in cigarette sales between these two time periods from 2018 to 2019. The rate of decline decelerated by just 0.3 percentage points (from -7.8% to -7.5%). However, in Massachusetts, the rate of decline decelerated by a massive 5.7 percentage points (from -9.8% to -4.1%).

The emergency ban on e-cigarettes did not prevent any respiratory disease cases, but it did send tobacco stocks soaring. Because the stock analysts understood that this ban would result in a substantial return to smoking among vapers.

In fact, recent survey data of Massachusetts e-cigarette users revealed that a substantial proportion of them reported returning to smoking after the emergency order went into effect.

As you may know, I did not believe that the emergency order was justified when it was issued on September 24thbecause it was clear to me that the outbreak was being caused primarily, if not solely, by THC vaping products. However, even if it was justified on September 24th, it is not justified on November 22nd, after overwhelming evidence has been uncovered that unequivocally ties the outbreak to cannabis vaping cartridges or other black market products that have been adulterated with vitamin E acetate oil.

I therefore recommend that the Department rescind the emergency order as it relates to nicotine e-cigarettes sold at retail stores in the Commonwealth.

My Testimony Today Regarding the Massachusetts Emergency Ban on the Sale of Electronic Cigarettes was originally posted by E-Sigaret Nieuws

[torixus]

The dangers of vaping That Doctors want everyone to know

The vaping crisis is real and the number of people affected continues to grow.

In early September, the Centers for Disease Control and Prevention issued a warning to the general public. In this document, the government organization asked people "to consider not using electronic cigarettes". The US Food and Drug Administration has issued a similar warning, urging users of vaping devices not to buy them "off the street" or to change electronic cigarettes or substances for which they are intended. The two announcements from the two main national health agencies were not unexpected. In the past two months, the media has provided new information on the latest effects of vaping on health. Currently, 26 deaths have been confirmed as a result of vapor inhalation-related illnesses in 21 different states and 1,299 cases of severe lung disease associated with e-cigarettes have been reported in the United States. UU. Because? Researchers still do not know for sure, mainly because vaping is a relatively new trend (from 2011 to 2018, the rate of vaping among US high school students increased by 1.5%, or 220,000 students, to 20.8%, or 3.05 million students, according to the CDC). But this does not mean that experts are totally unaware of the harmful effects of vaping on health. From lung diseases to rare accidents, here's all we know about the dangers of using electronic cigarettes. First, an exploder of what vaping really is, if you still did not know it. Any terminology can be quite confusing, but here's how it breaks down: a vaporizer (or vaporizer) is any device that heats and aerosolizes a solution or a juice to be inhaled. An electronic cigarette is a type of vaporizer that uses a nicotine-based solution (hence the inclusion of "cigarette" in the name), and a JUUL is a branded electronic cigarette. For your information: Vaping devices can also be used to smoke marijuana. While vaping devices themselves may be harmful in certain situations (we will talk about them later), vaping solutions or vapors pose the most important problems: "This solution consists of particles associated with cardiopulmonary toxicity and cancer. ", Tamanna Singh, MD, a cardiologist at the Cleveland Clinic, told Health. "Formaldehyde, for example, has been isolated from steam and is a known carcinogen." (Formaldehyde is a fungicide and industrial strength disinfectant, and is used to embalm or preserve bodies in morgues, according to the National Cancer Institute). According to the National Institute on Drug Abuse, vapor solutions also often contain nicotine, which is highly addictive. It is so addictive mainly because it triggers the release of dopamine, which the brain translates as a reward. Nicotine has also been recognized as an entry drug and actually makes other drugs and even more enjoyable activities. Why do people vape? It's simple: marketing. In the most basic terms, current electronic cigarettes have been advertised as healthy alternatives to cigarettes. In fact, JUUL recently received a warning from the FDA for violating federal regulations by selling its vaping products as healthier options than cigarettes without FDA approval. But that has not always been the case, said John Health, MD, a pulmonologist at Cleveland Clinic. He explains that electronic cigarettes were initially identified as devices that can help you quit smoking. "They were" smoking cessation devices, "he says, and people who use e-cigarettes for this purpose generally benefit, provided they are used in conjunction with help you change your behavior. " context of a rigorous program, "says Dr. Carl. But again, these benefits only apply to people who are trying to quit smoking and killing 480,000 people a year, according to the CDC. Thus, although vaping may be less harmful, the key word is "less," so it's not completely safe, but it's still incredibly unhealthy. The general feeling of the CDC: "If you have never smoked or used other tobacco products or electronic cigarettes, do not start." So what exactly is this vaping-related disease that everyone is talking about? According to The Wall Street Journal, the vaping crisis began in the summer of June and July in a Wisconsin hospital when doctors realized that six healthy patients, often teenagers, were coming shortly after, with shortness of breath, chest pain and fatigue, but with no signs of infection. The common denominator would have been vaping. This sounded the alarm all over the country, opened criminal investigations against vape manufacturers and stimulated investigations in medical journals, which led to what is currently known about diseases related to vaping, which the CDC has now officially called "electronic cigarette or vaping". use of the product associated with lung injury "or EVALI.

In the same statement, published in October, the CDC went into great detail about the symptoms of vaping disease. In patients diagnosed with EVALI, 95% of patients experienced respiratory symptoms such as cough, shortness of breath, and chest pain. Other patients have reported gastrointestinal symptoms such as nausea, diarrhea and vomiting; and even others have reported chills, weight loss and fever, according to the CDC. A report from the New England Journal of Medicine, published in September, looked at these symptoms of vapor-related diseases. The report analyzed cases of 53 patients with "unexplained serious respiratory illness" in Wisconsin and Illinois, who were again the first cases of severe pulmonary disease associated with vaping in late July and early August. . All patients were admitted to the hospital and had respiratory, gastrointestinal and constitutional symptoms such as nausea, vomiting, cough, chest pain, shortness of breath, fever and weight loss. All had reported the use of electronic cigarettes 90 days before His symptoms began. The CDC noted that a significant percentage of people admitted to using THC-containing products in electronic cigarettes or vaping devices before they became ill with EVALI. Of the 573 patients who provided information on the use of their e-cigarette or vape machine, 76% reported using THC-containing products in the 90 days prior to the onset of EVALI symptoms. Nearly one third of these 573 patients reported using only products containing THC in their devices. "Available evidence suggests that THC-containing products play a role in this outbreak, but the specific chemist or chemists responsible for EVALI have not yet been identified, and products containing nicotine have not been excluded. as a possible cause, "the CDC said.

Vaping can also damage the lungs and the respiratory system in other ways. Since vaping is still relatively new, research on its long-term effects (such as how smoking can cause cancer) is not available. But with respect to the short-term effects of spraying, especially the spray-related disease, the risk is real. "We know a lot of the short-term effects [on the lungs]," says Dr. Carl, explaining that vaping increases inflammation in the lungs. Vaping can also paralyze eyelashes, "hairy" projections into the airways of the lungs that remove germs and debris, says Dr. Carl. When these eyelashes become paralyzed, they can no longer protect the lungs, increasing the risk of infection, such as pneumonia. (Both lipoid pneumonias, a lung infection caused by the presence of lipids or fats in the lungs, and chemical pneumonitis, a pulmonary infection caused by inhalation of chemicals, have been associated with vaping.) According to a research article published in 2019 in the BMJ, the vape has also been associated with an "increased risk of wheezing and associated respiratory symptoms". The report's authors analyzed data from nearly 30,000 people who smoked cigarettes, vapes, or both. According to the findings, "compared to non-users, the risks of wheezing and associated respiratory symptoms have increased significantly in current vapers". This is mainly due to inflammation of the airways of the users.

Vaping can wreak havoc throughout your cardiovascular system. The nicotine content of electronic cigarettes is largely responsible for its negative effects on the cardiovascular system, especially the heart. "The cardiovascular effects of nicotine are well known and include an increase in the number of cardiovascular events, including heart attacks, strokes, sudden cardiac death, just to name a few," he says. Dr. Singh. He adds that nicotine causes high blood pressure and abnormal cholesterol, "which is linked to increased cardiovascular morbidity and mortality". Research published in 2017 in Nature Reviews Cardiology goes in this direction, explaining that "to date, most of the cardiovascular effects of [electronic cigarette] demonstrated in humans are compatible with the known effects of nicotine." Electronic cigarettes, electronic cigarette liquids with a specific flavor, can spread beyond the heart and damage the endothelial cells of the body. These are "cells that form the innermost wall of our blood vessels and are extremely important for controlling the relaxation and contraction of our blood vessels, as well as for blood clotting," says Dr. Singh. A 2019 study in the Journal of the American College of Cardiology concluded that the liquids of the electronic cigarette, ie the liquids with cinnamon, as well as five other flavors, led to cell dysfunction endothelial, which can ultimately lead to cardiovascular disease. Electronic cigarettes can explode during use. Until now, vaping solutions (and the steam they produce) were largely responsible for the health problems of electronic cigarettes, but the devices themselves can also cause harm. In June 2019, the New England Journal of Medicine published a case report telling the story of a 17-year-old boy whose electronic cigarette exploded in his mouth while he was using it. The patient was fractured in the jaw, chin, and suffered from "major lacerations," according to the case report. The patient also had to readjust his jaw. The FDA has also published a guide to avoid an electronic cigarette explosion, recommending that people store loose electronic cigarette batteries in a case so they do not come into contact with metal objects. In addition, the FDA states that you should not charge your electronic cigarette with a charger that is not made for it, such as a tablet or iPhone charger, and that you should replace the batteries of the electronic cigarette if they are wet or damaged. Vaping has been linked to seizures. An April statement by the FDA revealed that "some people who use electronic cigarettes, especially young people and young adults, have convulsions after using drugs." The statement notes that seizures, 35 of which were reported between 2010 and 2019, are side effects of nicotine intoxication, resulting from a person exposed to too much nicotine. The standard lethal dose of nicotine for adults is 30 to 60 milligrams, resulting in the ingestion of five consecutive cigarettes or "10 milliliters of a dilute solution containing nicotine," according to a 2014 article from the Archives of Toxicology . However, the FDA notes that it still does not know a clear or direct relationship between the use of electronic cigarettes and the risk of seizure. According to the press release, seizures related to the use of e-cigarettes may be related to varying levels of nicotine, users who inadvertently inhale more nicotine than expected, or users with underlying health problems. or have used other substances. Although vaping research is still in its infancy, one thing is clear: it's just not good for your health, and if the last few months are an indication of what the vaping epidemic has over , advice to stop vaping should be taken seriously (adsbygoogle = window.adsbygoogle || []).push({}); via Blogger https://ift.tt/2MFr0V4

[ruggerorespigo]

Vaping-associated lung injury findings

A clinical perspective article reviews various imaging manifestations of electronic nicotine delivery systems such as e-cigarettes, vape pens, and hookah tanks. Despite the lack of a standardized case definition for vaping-associated lung injury, the radiologist may be the first person to prompt the clinical team to ask about relevant exposures like hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, and giant cell interstitial pneumonia. Latest Science News -- ScienceDaily https://www.sciencedaily.com/releases/2019/10/191009131709.htm

[ruthsulivan]

Rampant Misinformation Could Cause Massive Damage

A rash of stories connecting vaping and mysterious lung illnesses are missing a major part of the story, and it’s leading to more damage. 

2019 has indeed been a make or break year for the vaping industry, with especially the last several months proving extremely challenging. Recent weeks have seen reports around the country of mysterious lung conditions which have media outlets looking to place the blame firmly on e-liquid vaping.

Things got worse when the Illinois Department of Health announced news of a fatality they’re connecting with vaping, despite any hard evidence linking the two. In the wake of this news, the CDC released a misleading and vague statement, which suggest all vaping products should be avoided, not just the shady products connected with these illnesses.

In fact, the CDC believes their stance is correct, even though they lack evidence connecting cases from around the country. Not only that, but they’re sending out these warnings, despite any concrete information about which products they believe have caused this damage.

Misinformation Circulating

The CDC has currently noted just over 200 cases of acute lung disease, across 22 different states. The most serious of these conditions have been things such as lipoid pneumonia, acute respiratory distress syndrome, and chemical pneumonitis. However, the overwhelming majority of these cases are not related to nicotine vaping at all.

Regardless, officials from the CDC blasted vaping and e-cigarettes as the primary culprit of the rash of lung conditions. They provided no toxicology or autopsy findings to support their claims, creating a ton of misinformation. Even worse, despite their lack of evidence, they still mentioned nicotine vaping explicitly, while not mentioning what many state health officials have identified as the real issue, counterfeit THC cartridges.

All 21 cases of acute lung disease in California were attributed by state officials to illegally produced and distributed cannabis vape pens. It wasn’t isolated to California either, as almost all 27 cases found in Wisconsin also followed this trend. Looking elsewhere, and you start to see the extent of this trend, with counterfeit carts being the most common denominator.

Reports have shown vaping butane hash oil, a popular method for these illegal carts can directly lead to acute lung disease. Meanwhile, the nicotine, propylene glycol, vegetable glycerin, and flavorings used in quality e-liquids have never been found to pose the same risks as butane hash oil.

The Case For Vaping

This type of misinformation circulated by the CDC is directly leading to many more people not having the information they need to succeed. Instead of seeing vaping as the viable alternative to smoking that it is, stories like this make it much less likely, people will understand everything they have to gain from switching to vaping.

The harm reduction value of legitimate e-liquid vaping has been proven time and time again. Going back to 2015, researchers from Public Health England concluded vaping is at least 95% safer than continued smoking. Taking things further, a report by Roswell Park Institute found the toxicants in vapor are about 93% lower than in tobacco smoke.

Looking into the smoking cessation value of vaping and the case only gets stronger. A study published by researchers at the University of Louisville tested all the most common smoking cessation tools and methods before determining vaping is the single most likely to lead to a successful quit attempt. Even more impressively, a study out of the Journal of Aerosol Sciences found the excess lifetime cancer risk of a smoker is around 57,000 times higher than a demographically similar vaper.

Implications

It’s extremely important that we fight back against these misguided claims. The CDC would have smokers around the country believe there’s no reason to switch to vaping, and it may, in fact, be even more dangerous. Given the evidence we currently have, we simply cannot abide by people thinking smoking is the safer alternative.

Stories like those spread by the CDC and news outlets are based on a genuine fear of the unknown. Vaping is still relatively new, and as such people are quite afraid of what it could do in the long run. But all the evidence we have strongly suggests that if your only alternative is continued smoking, it should be a no-brainer to give vaping a try instead.

If we don’t work together to fight back against these claims, we may soon wake up in a world where the vaping industry is merely a shell of its former self. That would be a massive loss for vapers around the country who have finally been able to quit smoking for good.

What’s the big deal with treating vaping and smoking the same? Do you think vaping counterfeit carts is dangerous? What’s the best way to protect the vaping industry moving forward? Let us know what you think in the comments, and don’t forget to check back here or join our Facebook and Twitter communities for more news and articles.

(Image Credit – Pixabay – https://pixabay.com/images/id-2557396/)

The post Rampant Misinformation Could Cause Massive Damage appeared first on ChurnMag.

[tophateliquids]

Case of Popcorn Lung in Canada Due to E-Cigarettes? Not so Fast

It is being widely reported in the media that there was recently a case of "popcorn lung" in Canada that was due to the use of e-cigarettes. These reports are exaggerated and inaccurate representations of a medical journal article published in the Canadian Medical Association Journal. The article reports the case of a 17-year-old patient who presented with severe respiratory failure requiring mechanical ventilation. A chest CT scan revealed a "bud-in-tree" pattern which is consistent with a diagnosis of bronchiolitis. Because the study authors had heard that some e-liquids contain a flavoring called diacetyl, which has linked to popcorn lung disease in popcorn factory workers who were exposed to very high doses of the pure chemical, they speculated that this could be a case of popcorn lung attributable to the use of e-cigarettes. The Rest of the Story It is very unlikely that this case represents popcorn lung attributable to electronic cigarette use, and there is certainly no documentation or hard evidence to draw such a conclusion. Importantly, the authors are merely speculating when they suggest that this could be popcorn lung and that it could be attributable to e-cigarettes. It also could be a different type of bronchiolitis, and it could be attributable to the use of THC vape carts, which the patient admitted using very heavily prior to becoming sick. These THC vape carts were apparently not purchased from a licensed cannabis dispensary. Importantly, the authors themselves acknowledge that they were unable to confirm a diagnosis of popcorn lung. First, they were unable to examine the patient's airway pathology. As they state: "the transbronchial biopsies did not include airway mucosa for evaluation." Thus, although they identified the presence of bronchiolitis, they are unable to assess any pathology taking place in the airway mucosa. Second, they did not even conduct testing for lipoid pneumonia. The authors acknowledge that: "because of the preparation method, no staining for lipoid pneumonia could be done." Third, the "bud-in-tree" pattern is a non-specific pattern seen in a wide variety of respiratory diseases and illnesses. It is not specific to popcorn lung. In fact, the differential diagnosis of a "bud-in-tree" pattern includes inhalation of chemical toxins. Fourth, as the authors acknowledge, several of the confirmed case patients in the U.S. also had the "bud-in-tree" pattern. So the presentation of this patient is not entirely inconsistent with that of other case patients. Fifth, there is a wide variety of ways in which patients' lungs have responded to the inhalation of vitamin E acetate oil and any contaminants in it. These presentations have ranged from lipoid pneumonia to chemical pneumonitis to crypotogenic organizing pneumonia to acute eosinophilic pneumonia. The point is that different people respond differently to whatever in vitamin E acetate oil is causing this outbreak. There are a variety of presentations and although this presentation does have some different features from many previous ones, it is not clear that this represents a completely different entity due to a completely different cause. Sixth, the patient reported heavy use of what were apparently black market THC vape carts. It is entirely possible that his respiratory illness is due to cannabis vaping, not e-cigarettes. Finally, the study authors were unable to provide one key piece of evidence that would absolutely be necessary to establish that the disease in question was caused by diacetyl: they failed to document that there was diacetyl in the e-liquids used by the patient and they were unable to verify that diacetyl was present at levels that are sufficient to cause popcorn lung. Sadly, many e-cigarette opponents are already using this case as justification for banning e-cigarettes. This is a disservice to the millions of former smokers whose health and lives depend on the continued availability of e-cigarettes. Case of Popcorn Lung in Canada Due to E-Cigarettes? Not so Fast was originally posted by E-Sigaret Nieuws

[tophateliquids]

Policy Makers are Deceiving Themselves if They Believe Banning Flavored E-Cigarettes is Going to End Youth Vaping of Flavored Products

Major Exemption in Proposed Flavor Ban Leaves Most Kid-Friendly Flavors on the Market The most basic premise of the proposal to ban flavored e-cigarettes is that it will protect youth by preventing them from vaping flavored e-liquids. The flavors are the problem, so if we ban the flavors, we'll take care of the problem. Or so the thinking goes. The Rest of the Story The problem is that politicians are deceiving themselves if they think that a ban on flavored e-cigarettes is going to prevent youth from accessing flavored e-liquids. The truth is that all of the following flavors are exempt from the ban and will remain on the market, easily accessible to youth. The exempted flavors include all of the following:

         "Mario Carts Vanilla Glue,"

     "Heavy Hitters Vape Strawberry,"

     "Honey,"

     "Gelato,"

     "Blueberry,"

     "Banana Sherbet,"

     "Jillybean,"

     "Super Lemon Haze,"

     "Romulan Grapefruit,"

     "Sour Tangie,"

     "Biscotti,"

     "Pineapple Express,"

     "Mango,"

     "Juicy Melon,"

     "Strawnana,"

     "Granddaddy Purp,"

     "Forbidden Fruit,"

     "Lemon Lime,"

     "Golden Goat,"

     "Butter,"

     "Orange Cream,"

     "Banana Cream,"

     "Strawberry Banana,"

     "Grapevine,"

     "Lime Sorbet,"

     "Potent Pineapple,"

     "Pure Pear,"

     "Red Apple,"

     "Blue Raz,"

     "Strawberry Sherbet,"

     "Grape Soda,"

      "Pink Sherbet,"

     "Cactus Cooler,"

     "Sunset Sherbet Sauce,"

     "Sunset Gelato,"

     "It's Yo Birthday,"

     "Wedding Cookies,"

     "Orange Cookies,"

     "Girl Scout Cookies,"

     "Grape Pie,"

     "Cookies n Cream,"

      "Apple Jacks,"

         "Banana OG,"

         "Birthday Cake,"

         "Black Berry Kush,"

         "Blue Dream,"

         "Blueberry Kush,"

         "Bubble Gum,"

         "Candy Land,"

         "Cherry Pie,"

         "Cotton Candy,"

         "Fruity Pebbles,"

         "Gelato,"

         "Grape Ape,"

         "Grape Stomper,"

         "Green Crack,"

         "Honey Berry,"

         "Honey Dew,"

         "Ice Blue Raspberry,"

         "Key Lime Pie,"

         "Lemon Berry,"

         "Lemon Head,"

         "Lemon Slushie,"

         "LSD,"

         "Mai Tai,"

         "Mango Kush,"

         "Maui Wowie,"

         "Mimosa,"

         "Mojito,"

         "Orange Chai,"

         "Orange Cookies,"

         "Orange Daiquiri,"

         "Peach,"

         "Pineapple Express,"

         "Pot of Gold,"

         "Purple Punch,"

         "Rose Gold,"

         "Russian Cream,"

         "Sour Apple,"

         "Strawberry Shortcake,"

         "Sweet Aromatic,"

         "Tangie,"

         "Vanilla Kush,"

         "Water Melon,"

         "Wedding Cake," and

         "Zskittlez."

All of these flavors will remain on the market, despite what policy makers are telling the public. The truth is that while flavored e-liquids that contain nicotine will be banned, all of the above flavors, which are available in THC vape cartridges, will remain on the market. You can now easily see why a ban on flavored nicotine e-liquids will not work. Youth will simply switch over to many of the sweet, fruity, alcohol-based, and other attractive flavors that are readily available in THC vape products. The tragedy, of course, is that these flavored THC e-liquids are precisely the ones that are killing many people and causing life-threatening illness among close to 2,000 people, mostly youth and young adults. Banning flavored nicotine e-liquids is not going to prevent 17-year-olds from dying due to respiratory failure. But it will likely increase the number of kids who die from respiratory failure. With flavors like Girl Scout Cookies, Cookies and Cream, Mimosa, Banana Sherbet, It's Yo Birthday, Russian Cream, Gelato, Grape Soda, Potent Pineapple, and Super Lemon Haze available, do you really think that youth are just going to completely stop vaping? In the short time that JUUL has limited access to many of its flavors (such as mango and creme), youth have just shifted over to vaping the mint-flavored JUUL pods. They didn't stop vaping because some flavors were taken off the market. Youth are resourceful, vaping is cool, and they will simply switch to whatever flavors are available. Those flavors will be vape juices like Zskittlez, Bubble Gum, Cotton Candy, and Cherry Pie. And the only difference will be that instead of the risk of mild respiratory irritation (with most nicotine-containing e-liquids) or nicotine addiction (with JUUL), the major risk for our nation's youth will now be DEATH from lipoid pneumonia or chemical pneumonitis. How is that good public health policy? Policy Makers are Deceiving Themselves if They Believe Banning Flavored E-Cigarettes is Going to End Youth Vaping of Flavored Products was originally posted by E-Sigaret Nieuws

[torixus]

The dangers of vaping That Doctors want everyone to know

The vaping crisis is real and the number of people affected continues to grow.

In early September, the Centers for Disease Control and Prevention issued a warning to the general public. In this document, the government organization asked people "to consider not using electronic cigarettes". The US Food and Drug Administration has issued a similar warning, urging users of vaping devices not to buy them "off the street" or to change electronic cigarettes or substances for which they are intended. The two announcements from the two main national health agencies were not unexpected. In the past two months, the media has provided new information on the latest effects of vaping on health. Currently, 26 deaths have been confirmed as a result of vapor inhalation-related illnesses in 21 different states and 1,299 cases of severe lung disease associated with e-cigarettes have been reported in the United States. UU. Because? Researchers still do not know for sure, mainly because vaping is a relatively new trend (from 2011 to 2018, the rate of vaping among US high school students increased by 1.5%, or 220,000 students, to 20.8%, or 3.05 million students, according to the CDC). But this does not mean that experts are totally unaware of the harmful effects of vaping on health. From lung diseases to rare accidents, here's all we know about the dangers of using electronic cigarettes. First, an exploder of what vaping really is, if you still did not know it. Any terminology can be quite confusing, but here's how it breaks down: a vaporizer (or vaporizer) is any device that heats and aerosolizes a solution or a juice to be inhaled. An electronic cigarette is a type of vaporizer that uses a nicotine-based solution (hence the inclusion of "cigarette" in the name), and a JUUL is a branded electronic cigarette. For your information: Vaping devices can also be used to smoke marijuana. While vaping devices themselves may be harmful in certain situations (we will talk about them later), vaping solutions or vapors pose the most important problems: "This solution consists of particles associated with cardiopulmonary toxicity and cancer. ", Tamanna Singh, MD, a cardiologist at the Cleveland Clinic, told Health. "Formaldehyde, for example, has been isolated from steam and is a known carcinogen." (Formaldehyde is a fungicide and industrial strength disinfectant, and is used to embalm or preserve bodies in morgues, according to the National Cancer Institute). According to the National Institute on Drug Abuse, vapor solutions also often contain nicotine, which is highly addictive. It is so addictive mainly because it triggers the release of dopamine, which the brain translates as a reward. Nicotine has also been recognized as an entry drug and actually makes other drugs and even more enjoyable activities. Why do people vape? It's simple: marketing. In the most basic terms, current electronic cigarettes have been advertised as healthy alternatives to cigarettes. In fact, JUUL recently received a warning from the FDA for violating federal regulations by selling its vaping products as healthier options than cigarettes without FDA approval. But that has not always been the case, said John Health, MD, a pulmonologist at Cleveland Clinic. He explains that electronic cigarettes were initially identified as devices that can help you quit smoking. "They were" smoking cessation devices, "he says, and people who use e-cigarettes for this purpose generally benefit, provided they are used in conjunction with help you change your behavior. " context of a rigorous program, "says Dr. Carl. But again, these benefits only apply to people who are trying to quit smoking and killing 480,000 people a year, according to the CDC. Thus, although vaping may be less harmful, the key word is "less," so it's not completely safe, but it's still incredibly unhealthy. The general feeling of the CDC: "If you have never smoked or used other tobacco products or electronic cigarettes, do not start." So what exactly is this vaping-related disease that everyone is talking about? According to The Wall Street Journal, the vaping crisis began in the summer of June and July in a Wisconsin hospital when doctors realized that six healthy patients, often teenagers, were coming shortly after, with shortness of breath, chest pain and fatigue, but with no signs of infection. The common denominator would have been vaping. This sounded the alarm all over the country, opened criminal investigations against vape manufacturers and stimulated investigations in medical journals, which led to what is currently known about diseases related to vaping, which the CDC has now officially called "electronic cigarette or vaping". use of the product associated with lung injury "or EVALI.

In the same statement, published in October, the CDC went into great detail about the symptoms of vaping disease. In patients diagnosed with EVALI, 95% of patients experienced respiratory symptoms such as cough, shortness of breath, and chest pain. Other patients have reported gastrointestinal symptoms such as nausea, diarrhea and vomiting; and even others have reported chills, weight loss and fever, according to the CDC. A report from the New England Journal of Medicine, published in September, looked at these symptoms of vapor-related diseases. The report analyzed cases of 53 patients with "unexplained serious respiratory illness" in Wisconsin and Illinois, who were again the first cases of severe pulmonary disease associated with vaping in late July and early August. . All patients were admitted to the hospital and had respiratory, gastrointestinal and constitutional symptoms such as nausea, vomiting, cough, chest pain, shortness of breath, fever and weight loss. All had reported the use of electronic cigarettes 90 days before His symptoms began. The CDC noted that a significant percentage of people admitted to using THC-containing products in electronic cigarettes or vaping devices before they became ill with EVALI. Of the 573 patients who provided information on the use of their e-cigarette or vape machine, 76% reported using THC-containing products in the 90 days prior to the onset of EVALI symptoms. Nearly one third of these 573 patients reported using only products containing THC in their devices. "Available evidence suggests that THC-containing products play a role in this outbreak, but the specific chemist or chemists responsible for EVALI have not yet been identified, and products containing nicotine have not been excluded. as a possible cause, "the CDC said.

Vaping can also damage the lungs and the respiratory system in other ways. Since vaping is still relatively new, research on its long-term effects (such as how smoking can cause cancer) is not available. But with respect to the short-term effects of spraying, especially the spray-related disease, the risk is real. "We know a lot of the short-term effects [on the lungs]," says Dr. Carl, explaining that vaping increases inflammation in the lungs. Vaping can also paralyze eyelashes, "hairy" projections into the airways of the lungs that remove germs and debris, says Dr. Carl. When these eyelashes become paralyzed, they can no longer protect the lungs, increasing the risk of infection, such as pneumonia. (Both lipoid pneumonias, a lung infection caused by the presence of lipids or fats in the lungs, and chemical pneumonitis, a pulmonary infection caused by inhalation of chemicals, have been associated with vaping.) According to a research article published in 2019 in the BMJ, the vape has also been associated with an "increased risk of wheezing and associated respiratory symptoms". The report's authors analyzed data from nearly 30,000 people who smoked cigarettes, vapes, or both. According to the findings, "compared to non-users, the risks of wheezing and associated respiratory symptoms have increased significantly in current vapers". This is mainly due to inflammation of the airways of the users.

Vaping can wreak havoc throughout your cardiovascular system. The nicotine content of electronic cigarettes is largely responsible for its negative effects on the cardiovascular system, especially the heart. "The cardiovascular effects of nicotine are well known and include an increase in the number of cardiovascular events, including heart attacks, strokes, sudden cardiac death, just to name a few," he says. Dr. Singh. He adds that nicotine causes high blood pressure and abnormal cholesterol, "which is linked to increased cardiovascular morbidity and mortality". Research published in 2017 in Nature Reviews Cardiology goes in this direction, explaining that "to date, most of the cardiovascular effects of [electronic cigarette] demonstrated in humans are compatible with the known effects of nicotine." Electronic cigarettes, electronic cigarette liquids with a specific flavor, can spread beyond the heart and damage the endothelial cells of the body. These are "cells that form the innermost wall of our blood vessels and are extremely important for controlling the relaxation and contraction of our blood vessels, as well as for blood clotting," says Dr. Singh. A 2019 study in the Journal of the American College of Cardiology concluded that the liquids of the electronic cigarette, ie the liquids with cinnamon, as well as five other flavors, led to cell dysfunction endothelial, which can ultimately lead to cardiovascular disease. Electronic cigarettes can explode during use. Until now, vaping solutions (and the steam they produce) were largely responsible for the health problems of electronic cigarettes, but the devices themselves can also cause harm. In June 2019, the New England Journal of Medicine published a case report telling the story of a 17-year-old boy whose electronic cigarette exploded in his mouth while he was using it. The patient was fractured in the jaw, chin, and suffered from "major lacerations," according to the case report. The patient also had to readjust his jaw. The FDA has also published a guide to avoid an electronic cigarette explosion, recommending that people store loose electronic cigarette batteries in a case so they do not come into contact with metal objects. In addition, the FDA states that you should not charge your electronic cigarette with a charger that is not made for it, such as a tablet or iPhone charger, and that you should replace the batteries of the electronic cigarette if they are wet or damaged. Vaping has been linked to seizures. An April statement by the FDA revealed that "some people who use electronic cigarettes, especially young people and young adults, have convulsions after using drugs." The statement notes that seizures, 35 of which were reported between 2010 and 2019, are side effects of nicotine intoxication, resulting from a person exposed to too much nicotine. The standard lethal dose of nicotine for adults is 30 to 60 milligrams, resulting in the ingestion of five consecutive cigarettes or "10 milliliters of a dilute solution containing nicotine," according to a 2014 article from the Archives of Toxicology . However, the FDA notes that it still does not know a clear or direct relationship between the use of electronic cigarettes and the risk of seizure. According to the press release, seizures related to the use of e-cigarettes may be related to varying levels of nicotine, users who inadvertently inhale more nicotine than expected, or users with underlying health problems. or have used other substances. Although vaping research is still in its infancy, one thing is clear: it's just not good for your health, and if the last few months are an indication of what the vaping epidemic has over , advice to stop vaping should be taken seriously (adsbygoogle = window.adsbygoogle || []).push({}); via Blogger https://ift.tt/2MFr0V4

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Massachusetts Governor's Emergency Order Protects Drug Dealers at the Expense of Hundreds of Life-Saving Small Businesses

In a move that is a huge victory for the state's drug dealers, Massachusetts Governor Charlie Baker has instituted a 4-month ban on the sale of all vaping products in the state, including both nicotine-containing electronic cigarettes sold at retail stores and vape shops and cannabis vaping products sold at legal cannabis dispensaries. The ban, which was approved by the state Public Health Council on Tuesday, goes into effect immediately and was motivated by the recent emergence of an outbreak of vaping-associated respiratory illness (VARI) that has affected more than 530 people across the United States and has resulted in nine deaths. The primary suspected cause of this outbreak of severe, acute respiratory failure which often takes the form of lipoid pneumonia or an eosinophilic chemical pneumonitis is the widespread black market sale of illicit marijuana vape cartridges, many of which contain a viscous oil that is used as a thickening agent to help drug dealers obtain a higher price for the THC vape carts they are selling. There were recently two major drug busts which recovered thousands of oil-laden THC vape carts, and testing of THC vape carts provided by numerous case patients in New York State revealed that all of them contained high levels of vitamin E acetate oil, the thickening agent that has recently come into widespread use by illicit drug manufacturers (as well as some legal manufacturers). Although the CDC has misled the public into thinking that nicotine-containing e-cigarettes like JUUL are causing the outbreak, the application of basic epidemiology principles should tell us that this cannot be the case. Since JUUL and many other nicotine-containing e-cigarettes sold at retail stores have been on the market for at least several years, it does not make sense that we would all of the sudden see these products causing severe respiratory failure. Moreover, since there are millions of adult JUUL users, we would be seeing a lot more adult cases of this disease if it were being caused by JUUL or similar products. Clearly, whatever is going on is affecting primarily youth and primarily males. What kind of vaping products are used primarily by youths? The answer is black market products. Since adults can legally access cannabis vaping products in states with legalized recreational or medical cannabis, it is primarily going to be youth who use the black market THC oils that are being distributed by the drug dealers. The strongest evidence that the primary culprit is black market THC oils is the fact that the most common presentation of the illness is a lipoid pnemonia. This is a disease that is known to be caused by oil inhalation. Virtually all, if not all, nicotine-containing electronic cigarettes sold at stores are made with water/alcohol-based e-liquids, which do not cause lipoid pneumonia. In contrast, the THC vape carts that are in wide circulation are loaded with a viscous oil. When this oil is heated and then cools when it reaches the lungs, it solidifies and basically cakes the alveoli and also induces severe inflammation (as the body's immune cells try to get rid of the oil). This explains the typical radiographic appearance in the cases, which is actually part of the case definition. If there are any nicotine-containing e-liquids that are using an oil-base, they are almost certainly being sold online, not by retailers or vape shops. But Governor Baker's order focuses on the latter. The Rest of the Story So why, in the face of this severe epidemic of respiratory disease that has been associated with the widespread use of oil-laden THC vape cartridges sold on the black market, is the governor banning the sale of legally produced and sold nicotine-containing e-liquids that have not been confirmed to be causing any cases? The answer, I believe, is that this is an easy political victory. It looks great to upper middle class suburban parents (voters) that politicians are stepping in to protect their children. And it takes no political courage to go after hundreds of small business owners who don't have the political power to put up a legal fight. It would be far more difficult to actually confront the real problem, which would require the governor to go after the drug dealers who are distributing illicit THC vape carts that are winding up in the hands of youth throughout the state. Sadly, Governor Baker's action is going to make this problem much worse, not better. Eliminating nicotine-containing e-liquids is not going to prevent further cases from occurring because those are not the products which appear to be causing the outbreak in the first place. Moreover, the kids who are selling e-liquids in our middle schools and high schools are not going to simply shut down their operations. They are going to switch over to selling the e-liquids that remain available, which will be the black market THC vape carts that are actually causing this outbreak. This emergency order is also going to have other severe adverse health consequences. It is going to shut down hundreds of vape shops which are literally life-saving businesses: they are helping tens of thousands of smokers to quit smoking and to remain off of cigarettes. Essentially, vape shops are smoking cessation clinics. Most of the owners have themselves quit smoking by switching to e-cigarettes, and they can provide personal advice and counseling to their customers. This is much more effective smoking cessation counseling than most physicians can provide. And that's why it's been so widely successful. Don't be fooled. A four-month temporary suspension of e-cigarette sales is, for most small businesses, a permanent ban because they are going to have to shut down. Most small businesses can simply not survive having no revenue for four months. And if they have a large supply of e-liquids in inventory, they could be out hundreds of thousands of dollars. They will never recover. This ban is also going to lead many ex-smokers to return to smoking as their e-liquids disappear and it becomes too inconvenient to obtain them. In addition, this order is going to create a new, unregulated black market for e-liquids. But the worst outcome, by far, will be the misdirection caused by this move. It takes our attention off the widespread problem of marijuana vaping among middle and high school youth in Massachusetts. That is the public health emergency we face, but apparently, we're not willing to face up to it because it's a lot more politically expedient to go after small businesses than drug dealers. Massachusetts Governor's Emergency Order Protects Drug Dealers at the Expense of Hundreds of Life-Saving Small Businesses was originally posted by E-Sigaret Nieuws

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CDC Investigation into Respiratory Disease Outbreak Has Contributed Absolutely Nothing to the Public's Knowledge So Far

Before the CDC initiated its investigation of vaping-associated respiratory illness (VARI) on August 1, here is what we knew about the outbreak: This outbreak is associated with vaping. If you want to avoid getting sick, you should avoid vaping. After nearly eight weeks of CDC investigation, here is what the CDC's current conclusion is about the outbreak: This outbreak is associated with vaping. If you want to avoid getting sick, you should avoid vaping. In other words, the investigation has added nothing in terms of public knowledge. Most importantly, it has added nothing in terms of specific steps that the public can take to avoid this life-threatening illness. Frankly, it didn't take a rocket epidemiologist to issue the same warning that the CDC is now issuing. Any guy off the street could tell the public that the outbreak is associated with vaping and that to avoid it, you should refrain from vaping. After all, the name itself tells you that: "vaping-associated respiratory illness."   The Rest of the Story In distinct contrast to most of its investigations, it appears that the CDC has lost sight of the purpose of this particular investigation. It appears that the driving purpose of the investigation is to do everything possible to demonize electronic cigarettes, holding out as long as possible to continue to invoke legally sold, nicotine-containing e-liquids as being responsible for the outbreak, even in the face of contradicting information. The CDC might defend itself by arguing that until it can identify with exact certainty what all the causes of the outbreak are, it must err on the side of caution and not draw any conclusions. But that shows a misunderstanding of the purpose of an outbreak investigation. The primary purpose, beyond anything else, is to prevent further cases from occurring. By the precautionary principle, this means that you do not wait until you have a definitive and comprehensive, detailed understanding of exactly what is causing the outbreak and until you know all of the causes. Instead, it means that if you have reasonable evidence even of one particular cause, you need to explicitly warn the public to avoid that exposure. Sadly, the CDC's communications regarding the investigation have added literally nothing to the public's knowledge of how to avoid this disease. Based on the CDC's communications, the public doesn't really have any more knowledge today about how to avoid the disease than virtually any guy off the street could be telling us. The CDC's message remains: "If you're concerned, then don't vape." Any sixth-grade student, without any training in epidemiology, could have told us that all the way back on August 1. After all, the case definition requires that a patient must have a history of vaping. So by definition, every case that occurs is going to be associated with vaping, and if you don't vape, you cannot - by definition - get the disease. I think that the CDC is not doing its job if after eight weeks of investigation, it cannot tell us anything more than some guy off the street. We are trained in epidemiology for a reason. And I'd like to think that my years of training in epidemiology allows me to offer the public more specific than what some guy on the street can offer. If not, then why am I being paid all this money? Although conducting scientific research, reviewing the scientific literature, and attending scientific conferences are all a part of how I have gained specific knowledge regarding vaping that allows me to hopefully contribute something meaningful to the public's understanding of this outbreak, what has by far prepared me the most is the fact that I have spoken to thousands of actual vapers. This is something that, frankly, the CDC has simply not been doing. Instead of talking to vapers, they have dismissed the knowledge and experiences of vapers as being nothing other than "anecdotes." This is the term that previous CDC director Dr. Thomas Frieden used to describe vapers in 2014. Perhaps the CDC should have been spending less time belittling vapers and more time listening to them! One of the things I learned very early on in talking to vapers, and in reviewing the literature, is that oil-based liquids should never be vaped. This was widely known to vapers back in 2012, a full seven years ago. The CDC should have known this going into the investigation but it appears that it still doesn't understand this critical concept. In fact, the CDC has yet to issue any warning against the use of oil-based e-liquids when vaping. Both the epidemiological and clinical evidence point strongly to the likelihood that what is causing most (if not all) of the cases to become so sick is that the lungs simply cannot handle being doused with oil. Since virtually all nicotine-containing e-liquids are water/alcohol-based, not oil-based, this is not a problem with the overwhelming majority of traditional electronic cigarettes. That there may be a few rogue companies or suppliers selling oil-based nicotine e-liquids remains a possibility and cannot be ruled out. However, we do know that in the overwhelming majority of cases, the affected patients were vaping THC oils, not water-based e-liquids. And the primary manifestations of the syndrome - lipoid pneumonia and eosinophilic pneumonitis - are completely consistent with THC vape oil poisoning. Perhaps the most important principle of risk communication in outbreak investigations that the CDC is violating is being honest and open. As CDC itself writes in a manual called "Communicating During an Outbreak or Public Health Investigation": "Risk communication literature identifies four factors that determine whether an audience, including journalists, will perceive a messenger as trusted and credible, including

Empathy and caring,

Honesty and openness,

Dedication and commitment, and

Competence and expertise."

There's no question that the CDC investigation is marked by high levels of empathy and caring, dedication and commitment, and competence and expertise. However, the one thing it appears to be missing is honesty and openness. The CDC has been reluctant to tell the public that the majority of cases are associated not with vaping e-cigarettes, but with vaping marijuana. Where the agency has mentioned that "many" cases report vaping marijuana, it has immediately undermined that connection by stressing that no single cause has been identified for all cases, something that almost never happens in an outbreak investigation (not everyone remembers having eaten some of the potato salad). The rest of the story is that any guy on the street could look at the information available today and conclude that these cases of vaping-associated respiratory illness are associated with vaping and that to avoid the illness, people should consider not vaping. But I think we know a heck of a lot more than that and can do much better than that guy on the street because of our training in epidemiology. CDC Investigation into Respiratory Disease Outbreak Has Contributed Absolutely Nothing to the Public's Knowledge So Far was originally posted by E-Sigaret Nieuws

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IN MY VIEW: CDC and Health Groups' Bias Against E-Cigarettes is Putting Kids' Lives at Risk

According to the Centers for Disease Control and Prevention (CDC), there have now been 153 reported cases of severe, acute lung disease caused by "vaping" across 19 states. Tragically, one of these cases resulted in a death. Most of the cases are occurring among youth or young adults. The acute disease appears to be taking the form of lipoid pnemonia, acute respiratory distress syndrome, and/or chemical pneumonitis. Physicians, health departments, and the CDC have almost uniformly informed the public that these cases are caused by "vaping" and have advised youth and young adults to avoid using "e-cigarettes." The Rest of the Story The advice from health agencies, including the CDC, to avoid using "e-cigarettes" is irresponsible. This is such a broad category of products that it doesn't really give people any guidance whatsoever in terms of what to avoid. There are millions of people who are vaping nicotine-containing e-liquids and it would not be prudent for these millions of people to return to smoking in order to avoid the risk of this "unknown" and "mysterious" medical condition. Moreover, with such vague advice, no one is likely to change their behavior because they are not being warned about any specific, identifiable risk. The truth is that in every case so far in which a specific e-liquid has been identified, that product has been a THC-containing e-liquid, typically purchased off the street and often in open cartridges such that they could contain a contaminant or other drug. In at least some of the cases, the use of a THC oil, such as butane hash oil, has been implicated. In January of this year, there was a published case report of a severe, acute respiratory illness attributable to the use of butane hash oil. Apparently, all 21 cases in California were attributed to vaping of marijuana with all the THC e-liquids being purchased on the street. Since lipoid pneumonia is caused by oil inhalation, it seems pretty clear that those cases diagnosed as lipoid pneumonia are being caused by the use of e-liquids that are oil-based, not alcohol-based. Most nicotine-containing e-liquids are alcohol-based, meaning that they contain as excipients some combination of propylene glycol and glycerin. These products do not pose a risk of lipoid pneumonia. There are some nicotine-containing e-liquids that are oil-based, and these should absolutely be avoided. Although we do not have a single common link between all the reported cases, there are useful recommendations that the CDC could be giving. At a minimum, they should be telling the public not to vape THC oils, including butane hash oil. Second, they should be telling people not to use any oil-based vaping e-liquid product. Third, they should be telling people not to use any e-liquid unless you know what is in it -- that is, do not buy products off-the-street and stick to products being sold at retail stores, especially closed cartridges where there is no risk of contamination or the presence of unknown drugs. These would actually be useful recommendations that could possibly help prevent further cases. Instead, the CDC and other health groups are providing such generalized and vague advice that it is essentially meaningless. Sadly, the failure of CDC and other health agencies to provide appropriate recommendations is putting kids' lives at risk. Since there has been no admonition to avoid the use of THC oils, kids are going to continue to use these products. This is why the CDC's recommendations are irresponsible. The question is: why are the CDC and other health groups being so broad in their statements, warning broadly against "vaping" or using "e-cigarettes" but failing to warn against the use of THC oil? The answer, I believe, is that these organizations have such a pre-conceived conclusion that vaping is hazardous and such a bias against the use of e-cigarettes for smoking cessation that they are hoping to be able to attribute these cases to traditional nicotine vaping.   By no means are we in a position currently to be able to conclude that vaping THC oils or other oil-based e-liquids is solely responsible for the observed cases nor are we sure that street-purchased products are solely to blame. However, I think we know enough to be able to offer a specific recommendation that people not use these products. That CDC has failed to do this is irresponsible, putting lives at risk, and demonstrating the agency's bias in its views of the science around smoking and vaping. IN MY VIEW: CDC and Health Groups' Bias Against E-Cigarettes is Putting Kids' Lives at Risk was originally posted by E-Sigaret Nieuws