Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping Products

(FDA) Drug Administration, the State, local health departments, CDC, other clinical and public health partners, as well as the U.S. Food, are investigating a national outbreak of e-cigarette products use associated with lung injury. Overview *The cause for EVALI has made progress thanks to the CDC, FDA, and State health authorities. *In August 2019, the […]

(FDA) Drug Administration, the State, local health departments, CDC, other clinical and public health partners, as well as the U.S. Food, are investigating a national outbreak of e-cigarette products use associated with lung injury.

Overview

*The cause for EVALI has made progress thanks to the CDC, FDA, and State health authorities.

*In August 2019, the emergency department visits related to vaping products continue to increase but a sudden decline set in from September 2019.

*Friends and online dealers play a paramount role in the rise of EVALI cases owing to a report from the national and state data. Their research shows patient reports and product sample testing indicating tetrahydrocannabinol (THC)-that is contained in e-cigarette products.

* Evidence isn’t sufficient to conclude this, but the contribution of other chemicals like THC or non-THC products in some of the reported EVALI cases shows some evidence that people that do not have EVALI are free from Vitamin E acetate.

About the Outbreak:

* 68 deaths are in 27 states and as of February 18 2020, a total of 2,800 EVALI cases in the hospital are reported to CDC from all U.S.A states.

* After sharply increasing in August 2019, the emergency department visits related to the e-cigarette or vaping products continue to decline.

* Active case reporting from state health departments around the country and National ED data show an increase in EVALI cases since August 2019 and a steady decline in September 2019.

Reasons for the decline is likely multifactorial and is related to the following:

* The positive rapid public health response is a result of increased public awareness of the risk associated with THC-contained in e-cigarette products.

* The EVALI pandemic is strongly linked to vitamin E acetate, an ingredient in some THC vaping products according to Lab data.

Samples of 52 EVALI cases from 16 states, and a comparison made from another group of samples from 99 individuals without EVALI for vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes and this were the findings;

Samples of 47 out of 50 Evali patients displayed vitamin E acetate in bronchoalveolar lavage fluid samples, but not in the BAL fluid from the healthy group. 

Apart from coconut oil and limonene, no other toxicants were found in BAL fluid from either group.

* This release is the final CDC update on the number of hospitalized EVALI cases and deaths nationally due to continued declines in new EVALI cases since September 2019, and the identification of vitamin E acetate as a primary cause of EVALI. CDC will continue to assist states, as needed, concerning EVALI.

What CDC Recommends

* Informal sources like friends, family, or online dealers should be avoided as a recommendation from the CDC and FDA because they’re an easy source of THC-containing e-cigarette or vaping products.

* People should not add any other substances not intended by the manufacturer especially vitamin E acetate should not be added to any e-cigarette or vaping products. 

*Adults using a nicotine-containing e-cigarette, or vaping products as an alternative to cigarettes should not go back to smoking; they should weigh all available information and consider using FDA-approved smoking cessation medications external icon. 

One should completely switch from cigarettes to e-cigarettes and not partake in an extended period of dual-use of both products that delay quitting smoking completely if they choose to use e-cigarettes as an alternative to cigarettes.

If they need help quitting tobacco products, including e-cigarettes, as well as if they have concerns about EVALI they should contact their healthcare professional.

* Youths, young adults, or women who are pregnant should never use E-cigarette or vaping products.

* Do not start using an e-cigarette or vaping products especially if you’re an adult who doesn’t use these products. The best way to avoid potentially harmful effects is to stay away from an e-cigarette or vaping products. THC is associated with a wide range of health effects, particularly with prolonged frequent use.

* Healthcare professionals should assist persons engaging in ongoing cannabis use that leads to significant impairment or distress.

Key facts about Use of E-Cigarette, or Vaping Products

Vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems are all titles given to electronic cigarettes.

* E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs. This practice is known as vaping.

*THC is the psychoactive mind-altering compound of marijuana that gives it the highness. Finally, the vaping liquid inside an e-cigarette contains cannabinoid oils, nicotine, and other substances.

Key facts about smoke inhalation of  Vitamin E Acetate

* E-cigarette or vaping products containing THC use Vitamin E acetate as an additive. 

* Lots of foods, including vegetable oils, cereals, meat, fruits, and vegetables contain vitamin E. It is also available as a dietary supplement and in many cosmetic products. 

* Previous research show that when vitamin E acetate is inhaled, it may interfere with normal lung functions. Vitamin E acetate does not cause harm when ingested as a vitamin or applied to the skin.

Latest updates

* CDC has removed non-hospitalized cases from previously reported case counts. As of December 3, 2019, CDC is only reporting hospitalized EVALI cases and EVALI deaths regardless of hospitalization status. 

See Public Health Reporting for more information on acute lung injury.

*According to CDC, a report from 50 states as of February 18, 2020, a total of 2,807 hospitalized EVALI cases or deaths got reported. 

*24 years was the median age of the patients and ranged from 14–85 years. Among the 2,667 hospitalized EVALI cases 67% were male.

By age group category 15% of patients were under 18 years old; 37% of patients were 19 to 24 years old. 24% of patients were 25 to 34 years old, and 24% of patients were 35 years or older.

*55% reported using nicotine-containing products, 16% reported exclusive use of nicotine-containing products, and 34% reported exclusive use of THC products. 2,022 hospitalized patients had data on substance use of whom 82% reported using THC products.  

*16% reported acquiring products only from commercial sources while 51% of EVALI patients who reported using THC products provided data on different product sourcing.

*7% reported acquiring products from both commercial and informal sources. 77% reported acquiring products only from informal sources.

*69% reported acquiring products only from commercial sources. 54% of EVALI patients who reported using nicotine-containing products provided data on product source. 

*15% reported acquiring products from both commercial and informal sources. 17% reported acquiring products only from informal sources.

 

Lung burn and Lung injury

It is reported lung damage after vaping marijuana or nicotine products resembles a chemical burn.

Lung injury symptoms

  • shortness of breath
  • fever & cough
  • vomiting or diarrhea
  • headaches, dizziness and chest pain

People who experience lung symptoms after vaping should avoid vaping products and seek clinical care as continued use only leads to worsening the condition.

Acute lung injury

This is a widespread type of lung injury associated with noncardiogenic pulmonary edema, widespread capillary leakage, low lung compliance, and low oxygen levels in the blood. ALI (Acute lung injury )is brought about by any event resulting in the triggering of local or systemic inflammation, principally vaping.

Chemical burn in lungs

Inhaling ingredients found in e-cigarettes exposes individuals to toxins that cause lung damage that resembles a chemical burn in the lungs according to the American lung Association.  Studies also showed that the lungs and airways of vapers with a vaping-related illness appeared damaged like they were exposed to harmful gases or chemical spills. This habit puts them at health risk related to vaping and research shows that nicotine is not the only thing to blame.

 

 

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