User:QuackGuru/Sand 22
https://www.eurekalert.org/news-releases/975669
https://pubmed.ncbi.nlm.nih.gov/36584985/ [1]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274878/ Vaping epidemic: challenges and opportunities
Later-generation devices deliver more nicotine and toxicants to the user than previous models, which may exacerbate the health risks related to vaping.[2]
Add to https://commons.wikimedia.org/wiki/File:Side_effects_of_nicotine.png#Summary
- Stimulation of cancer initiation and growth[4]
- Because it can form nitrosamine compounds (particularly N-Nitrosonornicotine (NNN) and nicotine-derived nitrosamine ketone (NNK)) through a conversion process, nicotine itself exhibits a strong potential for causing cancer.[5]
Add to https://commons.wikimedia.org/wiki/File:Effects_of_vaping_compared_to_smoking_(raster).png
- Short-term use is more dangerous than smoking.[6]
- Short-term use may lead to death.[6]
- Short-term use increases risk for lung injury.[6]
- Independent risk factor for vaping-associated pulmonary injury.[6]
https://en.wikipedia.org/wiki/Atrial_fibrillation#Tobacco Needs update. Vaping is linked to an increased threat of adverse events, such as atrial fibrillation.[7]
https://en.wikipedia.org/wiki/American_Cancer_Society_Cancer_Action_Network#Tobacco_regulation Needs update.
Smoking combusted tobacco products is less dangerous in the short-term than vaping.[6]
10 years subsequent to the US Congress giving the authority to the US FDA to regulate tobacco products such as e-cigarettes, the US federal government has persistently obstructed or impeded activities that could have safeguarded youth.[8] Over the following years, as the US FDA gradually expanded regulations to govern every kind of tobacco product, such as cigars and vaping products, "the market became flooded with products that Congress never intended to be on the market at all without F.D.A. review," said Gregg Haifley, the lobbying arm to the federal government at the American Cancer Society Cancer Action Network.[8] There is currently research which shows a relationship with electronic cigarettes with cancer[4] and lung cancer.[9] Nicotine poses an array of health risks[10] such as the stimulation of cancer development and growth.[4] Although the International Agency for Research on Cancer does not consider nicotine to be a carcinogen, several studies demonstrate it is carcinogenic.[10] There is a failure of sufficient regulation of e-cigarettes in the US, as of 2019.[11]
https://phil.cdc.gov/ https://phil.cdc.gov/QuickSearch.aspx
Upload Fig. 1 along with the text underneath of the images. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732835/ and see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732835/figure/Fig1/ This one has a white background.
https://www.tiktok.com/@chocolatecandle26/video/7055675828709149998?is_copy_url=1&is_from_webapp=v1
At 58 seconds into the video there is an image of Justin Wilson on a hospital bed. Portland man shares warning about vaping after being hospitalized wherman@tegna.com
https://www.youtube.com/watch?v=8BdK_6cUng8&list=PLgf1d4CujVYZ6eMDdezsmQrcgfBSlfBQ5&index=2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751518/ flavor wheel
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263459/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312781/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552728/
https://pubmed.ncbi.nlm.nih.gov/35368062/
https://en.wikipedia.org/wiki/Wikipedia:WikiProject_Medicine/Resources/Useful_resources
https://en.wikipedia.org/wiki/2019%E2%80%932020_vaping_lung_illness_outbreak#Hospitalized_patients
https://en.wikipedia.org/w/index.php?title=2019%E2%80%932020_vaping_lung_illness_outbreak&diff=prev&oldid=941973697 Review other edits.
https://www.youtube.com/watch?v=tAL6bnHvovo Dangers of Vaping | It Goes Fast (the link between vaping and lung illness) Proposed video to upload from YouTube.
https://www.youtube.com/watch?v=BDo0POGBqHc Dangers of Vaping | Hit CA (how a vaping-related lung illness hit California) Proposed video to upload from YouTube.
https://www.youtube.com/user/TobaccoFreeCA/search?query=vaping More videos.
https://tobaccofreeca.com/topics/e-cigarettes/ Video.
https://pubmed.ncbi.nlm.nih.gov/?term=vaping+lung+illness+outbreak&filter=years.2020-2021&size=200
https://pubmed.ncbi.nlm.nih.gov/32599069/ https://pubmed.ncbi.nlm.nih.gov/33194204/
https://commons.wikimedia.org/wiki/File:2019_US_vaping_lung_disease_outbreak_-_fatalities.svg
Videos appear to be in the public domain and can be uploaded to Wikipedia Commons. https://commons.wikimedia.org/wiki/Main_Page
https://tobaccofreeca.com/topics/e-cigarettes/ https://www.youtube.com/user/TobaccoFreeCA?app=desktop
https://pubmed.ncbi.nlm.nih.gov/32599069/ Cited by reviews.
https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed_citedin&from_uid=32805203 Cited by reviews.
https://pubmed.ncbi.nlm.nih.gov/34532191/
https://pubmed.ncbi.nlm.nih.gov/34810278/ Wait for review.
| 2019–2020 vaping lung illness outbreak | |
|---|---|
.jpg) Some of the cannabis vaping products were found to contain large amounts of vitamin E acetate, including Dank Vapes, pictured here.[12] | |
 Map of reported hospitalized cases or deaths in the US and US territories.[13] | |
| Disease | Vaping-induced lung illness[13] |
| Location | US;[13] Canada[14] |
| First outbreak | Cases of a cluster of lung injuries were first identified in Illinois and Wisconsin in April 2019.[15] |
| First reported | In September 2019, the US Centers for Disease Control and Prevention (CDC) announced an outbreak of severe lung disease linked to vaping.[16] |
| Confirmed cases | 2,807 in the US;[13] 20 in Canada;[17] sporadic cases occurred outside of North America[18] |
Deaths | 68 confirmed in US;[13] one confirmed in Europe[19] Prevalence of lung disease attributable to vaping is likely under reported as cases brought to the CDC are some of the most severe.[20] |
| Fatality rate | 50% of hospitalized cases needed management in the intensive care unit, 20% needed intubation and ventilation, and 2% of hospitalized cases resulted in death.[21] |
In 2019 and 2020, an outbreak of severe vaping-induced lung illness (called e-cigarette, or vaping, product use-associated lung injury[22]) had affected certain users of vaping products in the US[13] and Canada.[17] Cases involved in a cluster of lung illnesses were first identified in Illinois and Wisconsin in April 2019.[15] Published case reports of vaping-related lung illnesses can be traced back to 2012.[23] Similar cases of vaping-induced lung injuries were reported in the UK and Japan before the outbreak occurred.[24][25] The prevalence of vaping-induced lung injuries ocurring worldwide remains unclear.[24] As of February 18, 2020, a total of 2,807 hospitalized cases have been reported to the Centers for Disease Control and Prevention (CDC) from all 50 states, the District of Columbia, and two US territories (Puerto Rico and US Virgin Islands).[13] 68 deaths in the US have been confirmed in 29 states and the District of Columbia, as of February 18, 2020.[13] Cases peaked in September 2019, and a slow decline followed.[note 1][13] Chief Public Health Officer of Canada announced on October 11, 2019 that they are aware of the initial cases of vaping-induced lung injury.[26] As of August 14, 2020, 20 cases of lung injuries have been reported to the Public Health Agency of Canada.[17] The majority of cases in Canada involving lung injuries do not seem to have been connected with the use of THC-infused products.[17]
Of the 2,807 reported cases, 2,022 hospitalized persons had data on substance use, as of January 14, 2020.[13] 82% reported THC use, 33% reported exclusive THC use, 57% reported using nicotine-containing products, and 14% reported exclusive use of nicotine-containing products.[13] Many of the samples tested by the states or by the US Food and Drug Administration (FDA) as part of the 2019 investigation have been identified as vaping products containing tetrahydrocannabinol (or THC, a psychoactive component of the cannabis plant).[27] Most of those samples with THC tested also contained significant amounts of vitamin E acetate.[27] The CDC reported that their findings suggest vaping products containing THC are linked to most of the cases and play a major role in the outbreak.[13] The CDC stated that the chemical vitamin E acetate is a very strong culprit of concern in the lung illnesses related to THC-based vaping products, but did not rule out other chemicals as possible causes.[note 2][28] The majority of those affected were young adults aged 18 to 34, which is the group with the greatest prevalence of cannabis use in the US.[29] Nicotine has been linked to the vaping-induced lung injury cases in a small subset of users.[30]
Thickening agents were used to dilute vape oils.[31] There has been an increase in attention to companies that sell diluent products that are made with vitamin E acetate.[31] Previously, vitamin E acetate was used in low concentrations, or lower than 20% of the formula in vape cartridges.[31] As a result of a limited availability of cannabis in California as well as high demand, illicit sellers had used about 50% or higher of diluent thickeners in their formulas to bulk up tiny potency vape cartridges.[31] In September 2019, New York Governor Andrew Cuomo instructed the state health department to issue subpoenas against three sellers of thickening agents used in illicit vaping products.[32] The use of vitamin E acetate in vaping products is not banned in the US,[20] though Colorado,[33] Ohio,[33] and Washington have banned it in vaping products,[34] and Oregon has banned it in cannabis vaping products.[35] Health Canada does not permit vitamin E acetate in cannabis vaping products in Canada.[36] On November 18, 2022, six people involved in an elaborate criminal THC vape cartridge ring were convicted, and each one received fines or probation.[37] Jacob and Tyler Huffhines, and their mom Courtney, were convicted of criminal charges related to THC vape cartridges without receiving a prison sentence.[38] Wesley Webb, Hannah Curt, and Daniel Graumenz, were all fined.[37] Both Jordan Lynam and Tarail King were anticipated to be sentenced in November 2022.[39]
The e-cigarette industry was placing the blame on illicit vaping liquids for the lung injuries.[40] Juul Labs stated that some news agencies report that several cases of lung illness are associated with vaping THC, found in cannabis, "a Schedule 1, controlled substance that we do not sell."[41] The CDC and US FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers, as of February 18, 2020.[13] The US FDA considers it prudent to avoid inhaling vitamin E acetate.[27] On September 6, 2019, the US FDA stated that because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.[27] The Public Health Agency of Canada recommends for adults and parents or guardians who are smoking or vaping to contact a health care provider for guidance on ways to stop.[17] The vaping-induced lung injuries has led to concern around the world.[42] In 2020, the first uptick in vaping-induced lung injury cases had occurred in Utah since the decline of 2019.[43]
Background
This is the first time that vaping products has been linked to an outbreak of lung illness,[46] though an initial investigation by Bloomberg News found 15 incidents of vaping-related lung illnesses had been reported across the world prior to 2019.[47] Prior to this outbreak, sporadic cases of vaping-induced acute lung injuries were reported in the medical literature.[48] A lipoid pneumonia-related death in the UK was associated with e-cigarettes in 2010.[49] The first case of e-cigarettes inducing lipoid pneumonia was documented in the medical literature in 2012.[50] Doctors believed the glycerin in the e-liquid attributed to the 42-year-old woman developing lipoid pneumonia in 2012.[51] A 2014 case report involving e-cigarettes states that the person who experienced acute eosinophilic pneumonia was described as being previously healthy.[52] A 2018 study suggests that breathing in glycerin can result in lipoid pneumonia as observed in people exhibiting respiratory conditions.[53]
Published case reports of vaping-related lung illnesses can be traced back to 2012,[23] with an escalation in reported cases during the past three years leading up to 2019.[54] From 2012 to August 30, 2019, there were at least 30 publications describing a wide assortment of vaping-related lung illnesses before the outbreak occurred.[54] From September 1, 2019, to October 30, 2019, an additional 13 publications had described in the medical literature of reports of vaping-related lung illnesses.[54] A review of the medical literature in 2020 showed 216 patient cases that spread over 41 reports of lung damage stemming from vaping.[23]
After vaping for around three months in an attempt to quit smoking cigarettes, a 31-year-old women from West Virginia was hospitalized for a persistent cough and then a short time later she developed pneumonia and had to be put on a ventilator.[51] Doctors at West Virginia University Health Sciences Center stated that the Hawaiian Blast flavor from MaddCatt was probably what caused her to get sick.[51] A 60-year-old man from Vermont developed hypersensitivity pneumonitis (farmers lung) in 2014 and was hospitalized following the use of cinnamon flavored e-cigarettes in 2014.[51] He was hospitalized again a month later.[51] His doctors thought diacetyl which is found in e-liquid may have contributed to his illness.[51] Doctors stated the two cases were attributed to e-cigarettes or other vaping products.[51]
An 18-year-old Caucasian man went to emergency department in January 2019 for evaluation of sudden-onset right-sided chest pain while sleeping.[44] He received medical attention at a hospital for recurrent right-sided spontaneous pneumothoraces in which each episode occurred within 2 weeks.[44] He reported a history of vaping prior to the onset of each pneumothorax.[44] The pneumothorax was resolved following pigtail chest tube placement.[44] To the best of the researchers' knowledge, this is the first report to correlate recurrent pneumothoraces and vaping.[44]
Vaping devices aerosolize a liquid aerosol, which is then inhaled.[55] This aerosol contains chemical compounds such as nicotine, flavorings, and tetrahydrocannabinol (THC).[55] Some of these chemicals have irritative, toxic, and carcinogenic properties.[55] When inhaled these can alter the immune responses critical for normal lung function.[55] Vaping has been connected with a wide array of lung diseases[56] and it can cause significant lung injury, particularly among teenagers.[57] Before the outbreak occurred, vaping has been linked to a diverse range of pulmonary manifestations such as lipoid pneumonia, acute respiratory distress syndrome, and pulmonary hemorrhage.[43] Similar cases of vaping-induced lung injuries were reported in the UK and Japan before the outbreak occurred.[note 4][24][25] This suggests the phenomenon has the possibility of being more pervasive.[24] However, the prevalence of lung injuries in various countries resulting from e-cigarette use is not clear.[note 5][24] Prior to February 2021, published case reports of vaping-induced lung injuries outside of the US was 17 from 13 countries.[59] There is probably under-reporting and possibly a lack of diagnosing of vaping-induced lung injuries outside of the US.[59] The number of people who got sick with a mild case of a vaping-induced lung injury is not clear.[25] The number of nonhospitalized vaping-induced lung illness cases remains ill-defined.[60] Other substances of vaping devices may induce lung injury, as corroborated by a case in 2019 of giant-cell interstitial pneumonia caused by cobalt from a heating coil.[61]
Vaping-induced deaths declined, but families in the US were still trying to understand what happened to their family members that resulted in death.[62] The families were trying to obtain information on their deceased family members such as submitting records requests in their home state.[62]
History
United States
Cases involved in a cluster of severe lung injuries associated with vaping products were first identified in Illinois and Wisconsin in April 2019.[15] As of February 18, 2020, a total of 2,807 hospitalized cases of lung illness associated with the use of vaping products have been reported to the Centers for Disease Control and Prevention (CDC) from 50 states, the District of Columbia, and two US territories (Puerto Rico and US Virgin Islands).[13] The potential cases of severe lung illness have been associated with the use of vaping products such as devices, liquids, refill pods, and cartridges.[65] On September 12, 2019, the CDC no longer reported possible cases.[66] The CDC changed its reporting methodology from counting possible cases, to reporting probable and confirmed cases that where patients recently vaped, developed a breathing illness, and either had some tests were performed to rule out infection, or testing did not show an infection.[66] In September 2019, the CDC stated the possible cases had still been under investigation at the state level.[66]
As of December 3, 2019, the CDC is only reporting hospitalized vaping-induced lung illness cases and vaping-induced lung illness deaths. regardless of hospitalization status.[13] As of January 14, 2020, the CDC has reported on 2,668 hospitalized cases or deaths with data on age and gender: 66% were male.[13] The median age of patients was 24 years. and ranged from 13 to 85 years.[13] 15% of persons were under 18 years old; 37% of persons were 18 to 24 years old; 24% of persons were 25 to 34 years old; and 24% of persons were 35 years or older.[13] Prevalence of lung disease attributable to vaping is likely under reported, as cases brought to the CDC are some of the most severe.[20]
Symptoms typically develop over a period of days, but can sometimes manifest over several weeks.[67] In many cases, patients reported a gradual start of symptoms, including: breathing difficulty, shortness of breath, and/or chest pain before hospitalization.[68] Based on reports from several states, patients have experienced respiratory symptoms (cough, shortness of breath, or chest pain), while some have also experienced gastrointestinal symptoms (nausea, vomiting, or diarrhea) or non-specific symptoms (fatigue, fever, or weight loss).[13] Some cases reported mild to moderate gastrointestinal illness.[68] Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks.[13] Some patients have reported that their gastrointestinal symptoms began before their respiratory symptoms.[13] Fever, elevated heart rate, and elevated white blood cell count have been reported, even though no infectious disease has been identified.[13] Many patients sought medical care in ambulatory settings, sometimes over several visits, before they were admitted to the hospital.[13]
Many patients have required medical treatment with supplemental oxygen, including some who required assisted ventilation.[13] Some patients have been treated with corticosteroids with demonstrated improvement.[13] Evidence does not suggest an infectious disease is the cause of the severe pulmonary disease.[13] Antibiotic therapy alone has not consistently been associated with clinical improvement.[13] A handful of individuals have been re-admitted for clinical care after discharge for lung injury.[69] The CDC does not know whether individuals who were re-admitted continued or restarted use.[69] The range of time that the CDC is aware of for these re-admissions ranges from approximately five days after discharge, to 55 days after discharge.[69] The diagnosis of this vaping-induced lung injury remains one of exclusion.[55]
As of September 5, 2019, the New York State Department of Health reported 34 cases of severe lung illness in patients who were reportedly using different vaping products.[12] Tests conducted by the Wadsworth Center found exceedingly high amounts of vitamin E acetate in most of the cannabis e-cigarette products.[12] "At least one vape product containing vitamin E acetate has been linked to each patient who submitted a product for testing," the New York State Department of Health stated.[70] None of the nicotine-based product samples contained vitamin E acetate.[12] In the reports from Illinois and Wisconsin, the onset of respiratory findings appeared to have occurred over several days to several weeks before hospitalization.[65] As of September 5, 2019, the Illinois Department of Public Health reported 42 cases of lung illness, seven that were still being investigated, and one death.[71] Severe lung illness among young adults and youth who used vaping products required hospitalization in 11 cases in Wisconsin, and others were being investigated in August 2019.[72] Symptoms were difficulty breathing, tiredness, chest pain, cough, and reduced weight.[72] Some required aid to breathe.[72]
On August 9, 2019, the California Department of Public Health issued a statement regarding a cluster of seven healthy adults in Kings County, California, all of whom required hospitalization.[73] Since June 2019, at least seven cases of severe acute pulmonary illness in previously healthy adults were reported from a hospital in Kings County, California.[73] Cases were among residents of multiple counties.[73] The patients presented with progressive respiratory distress, sometimes initially diagnosed with pneumonia or bronchitis, and some with preceding fevers and gastrointestinal symptoms.[73] All cases failed to respond to an initial course of antibiotic treatment.[73] All patients required admission to the hospital with significant respiratory support, including high-flow oxygen, bilevel positive airway pressure (BIPAP), or intubation with mechanical ventilation.[73] Diagnoses included pneumonitis and acute respiratory distress syndrome.[73] Several cases of vaping-induced lung injury and acute respiratory distress syndrome in California in 2019 were connected to vaping cannabis products that were traced back to pop-up retailers.[74] Patients have improved with systemic steroids.[73] Evaluation for infectious etiologies has been negative to date in all patients.[73] All patients reported vaping in the weeks prior to hospital admission, and a reported common exposure among these patients is that they have been vaping cannabis or CBD oils.[73] The majority of people with vaping-induced lung injuries in California stated they used products that contained THC from informal sources, which indicates that people may still obtain unregulated products in places where recreational cannabis use is legal.[75] There is a subgroup of patients in California who stated that they did not use any product containing THC.[75] 247 people in California who have a history of vaping were hospitalized for severe breathing problems and lung damage, as of January 4, 2022.[76] The average hospitalized person's age in California was 25.[76] Vaping-induced lung injury cases among people with mental health problems were prevalent in the US.[77]
United States deaths
August 2019 to September 2019 US death cases
In August 2019, the Illinois Department of Public Health (IDPH) reported the first death in the US linked to vaping products.[78] The deceased individual had been recently vaping and was hospitalized with serious respiratory sickness.[78] On September 6, 2019, the Minnesota Department of Health announced the death of a Minnesota resident that appears to have been related to illicit THC vaping products.[79] The second vaping-induced lung illness death in the US and the first death of its kind in Oregon had used a vaping product containing cannabis oil that was legally purchased from a cannabis shop.[80] It is the first death in the US linking a vaping product to a purchase from a licensed dispensary.[80]
On September 10, 2019, the Kansas Department of Health and Environment announced the death of a Kansas resident that was related with the cases of severe lung illness linked to vaping products.[81] The patient was admitted to the hospital with symptoms that worsened rapidly.[81] On September 16, 2019, the Tulare County Health & Human Services Agency in California announced the death of a Tulare County resident that resulted from complications linked to vaping.[74] On September 19, 2019, the Missouri Department of Health and Senior Services announced the death of a Missouri man that was due to vaping.[82] He began vaping in May 2019 for his chronic pain.[82] On August 22, 2019, he required hospitalization.[82] He developed acute respiratory distress syndrome which resulted in his death.[82] On September 23, 2019, Kansas governor Laura Kelly announced the second death in Kansas due to vaping.[83] On September 26, 2019, Oregon Health Authority announced the second death in Oregon which was the result of vaping cannabis products.[84]
October 2019 to November 2019 US death cases
On October 3, 2019, the Connecticut State Department of Public Health announced the first death in Connecticut that was associated with vaping.[85] On October 9, 2019, the Utah Department of Health announced the first death in Utah that was associated with vaping.[86] The Salt Lake County resident was less than 30 years old and died at home.[86] On October 24, 2019, the District of Columbia Department of Health announced the first death in the District of Columbia that was caused by vaping.[87] On October 24, 2019, the Tennessee Department of Health reported the second death in Tennessee that was caused by vaping.[88] On October 30, 2019, the Massachusetts Department of Public Health (DPH) reported the second death in Massachusetts due to nicotine vaping.[89] Earlier in October 2019 they reported the first death due to nicotine vaping in Massachusetts.[89] On October 24, 2019, the Illinois Department of Public Health (IDPH) reported the second death in Illinois due to vaping.[90] On October 31, 2019, the Illinois Department of Public Health (IDPH) reported the third death in Illinois due to vaping.[91]
On November 6, 2019, the Massachusetts Department of Public Health (DPH) reported the third death in Massachusetts due to vaping.[92] The Worcester County resident in his 50s was vaping both nicotine and THC.[92] The fourth death linked to vaping in California occurred on November 7, 2019.[93] On November 14, 2019, the Missouri Department of Health and Senior Services reported the second death in Missouri due to vaping.[94] On November 14, 2019, the Illinois Department of Public Health (IDPH) reported the fourth death in Illinois due to vaping.[95] On November 20, 2019 New York governor Andrew Cuomo reported the second death in New York state connected with vaping.[96] On November 21, 2019, the Illinois Department of Public Health (IDPH) reported the fifth death in Illinois linked to vaping.[97]
Total reported US death cases
As of February 18, 2020, 68 recorded deaths linked to vaping products have been confirmed in 29 states and the District of Columbia: Alabama, California (4), Connecticut, Delaware, District of Columbia, Florida (2), Georgia (6), Illinois (5), Indiana (6), Kansas (2), Kentucky, Louisiana (2), Massachusetts (5), Michigan (3), Minnesota (3), Mississippi, Missouri (2), Montana, Nebraska, New Jersey, New York (4), Oregon (2), Pennsylvania, Rhode Island, South Carolina, Tennessee (2), Texas (4), Utah, Virginia and Washington (2).[13] The median age of deceased persons was 49.5 years, and ranged from 15 to 75 years, as of February 18, 2020.[13]
Due to the subsequent identification of the primary cause of cases in the US, and the considerable decline in cases and deaths since a peak in September 2019, the CDC stopped collecting these data from states as of February 2020.[13]
Asia
At least three cases of vaping-induced lung injury occurred in Asia.[18]
Argentina
At least one case of a vaping-induced lung injury occurred in Argentina.[18]
Brazil
At least three cases of vaping-induced lung injury occurred in Brazil.[18] Allegedly all of them used e-liquid from the US.[18]
Canada
On September 18, 2019, the first reported case of severe lung illness associated with vaping was identified in Canada.[98] A high school student in Ontario needed to be put on life support.[98] The person had been vaping every day.[99] He was on life support but his health improved and is no longer in the hospital.[98] He vaped intensively, adding THC to his devices.[20] He initially showed symptoms aligning with bronchiolitis, which is a lung condition normally caused by a bacterial or viral infection, but many patients that have vape-related illnesses in the US have experienced damage to the pulmonary alveoli; this type of injury was not found.[20] Instead, his case aligned more with an injury called popcorn lung, an ailment most commonly seen in factory workers of microwave popcorn plants nearly 20 years ago, as of 2019.[20]
On September 27, 2019, the first confirmed case of a vaping-induced lung injury was announced in Canada.[100] A Montreal resident in Quebec in their 50s was admitted to a hospital with breathing difficulties.[100] The person had been vaping to help them give up smoking.[100] Chief Public Health Officer of Canada announced on October 11, 2019 that they are aware of the initial cases of vaping-induced lung illness and they stated that a few other occurrences are being investigated.[26] Three probable cases have been reported in British Columbia as of November 7, 2019[101] and other cases had been under investigation in British Columbia.[102] Two probable cases have been reported in New Brunswick as of October 16, 2019.[103]
A case in Newfoundland and Labrador was reported as a probable case of a lung illness tied to vaping in January 2020.[104] A person became sick in late 2019 following the use of a cannabis product, and has since been released from the hospital.[104] On January 2, 2020, Alberta confirmed its first case of severe vaping lung illness.[105] The case involves an adult being exposed to legal nicotine products.[105] The person initially had symptoms of difficulty breathing and coughing.[105] As symptoms worsened, the person sought medical attention at a hospital where they received treatment and were later discharged.[105] By January 2, 2020, 15 people had severe vaping lung injuries in Canada.[105]
As of August 14, 2020, 20 cases of lung injuries have been reported to the Public Health Agency of Canada.[17] Reported cases were from Alberta (1), British Columbia (5), New Brunswick (2), Newfoundland and Labrador (1), Ontario (5), and Quebec (6).[17] Confirmed cases in the outbreak involve a history of e-cigarette use or dabbing (breathing in especially high temperature aerosols from heating cannabis oils, concentrates, or extracts) in the 3 months before the initiation of symptoms.[14]
Of the 20 cases involving eight females and 12 males, five were from 15 to 19 years old, five were from 20 to 34 years old, five were from 35 to 49 years old, and five were over 50 years old.[17] Of the 20 cases, 11 were nicotine users only, 5 were THC users only, one was using a flavored vaping product only, and 3 were using nicotine, THC and other substances.[17] The majority of cases in Canada involving lung injuries do not seem to have been linked with the use of THC-infused products.[17] Vitamin E acetate was not detected in adequate quantities in any of the products analyzed that were associated with the vaping-induced lung injuries cases in Canada.[106]
Of the 20 cases, 16 needed hospitalization.[17] Five people had difficulty breathing and were coughing, while 15 had respiratory, gastrointestinal, and/or nonspecific symptoms such as increase in body temperature or drop in weight.[17] Other symptoms such as back pain, numbness or tingling, and sore throat were reported.[106] Of the 20 cases, 11 needed respiratory treatment.[106] Six needed oxygen support through the nasal cannula, whereas others needed more rigorous treatments such as a ventilating system, continuous positive airway pressure or extracorporeal membrane oxygenation.[106] Additional medical assistance was given to several people.[106] This included medicare care with antimicrobials and/or steroids.[106]
Ecuador
At least one case of a vaping-induced lung injury occurred in Ecuador.[18]
Israel
At least one case of a vaping-induced lung injury occurred in Israel.[18] The product used was allegedly a cannabinoid vape from the US.[18]
Europe
What has occurred in the US has not occurred in other places where vaping is frequent such as the UK, John Britton, the director of the UK Centre for Tobacco and Alcohol Studies, stated in October 2019.[107] In European countries such as France, there is no evidence of an outbreak of the vaping-induced lung illness that occurred in the US.[108]
18-year-old Raphaël Pauwaert from Brussels died on November 6, 2019,[109] after developing pneumonia[110] and being placed in a medically induced coma because he was unable to breathe on his own.[111] He received an e-cigarette as a gift for his 18th birthday.[110] His doctor stated Pauwaert's lung infection probably resulted from the CBD aerosol.[112] This was considered the first death related to vaping in Belgium.[112][113] A friend of Pauwaert's was also hospitalized with the identical symptoms after using the same type of e-cigarette, but the young man survived.[114] In March 2020, Europe announced its first confirmed death of a vaping-induced lung injury.[19]
The Medicines and Healthcare products Regulatory Agency of the UK, as of January 2020, "is aware of two potential cases of e-cigarette or vaping associated lung injury in the UK (one reported as a Yellow Card), both of which were reported as having a fatal outcome."[115] A minor from the UK developed hypersensitivity pneumonia in 2019 following the use of a flavored e-cigarette.[116] At least one case of a vaping-induced lung injury occurred in Barcelona, Spain.[18] Three people in Germany had acute lung damage following vaping.[6] The cases involved eosinophilic inflammation, alveolar bleeding, and acute ground-glass lung opacities along with fibrosis.[117]
Mexico
At least one case of a vaping-induced lung injury occurred in Mexico.[18] The product used was an import from the US.[18]
Philippines
The first case of a vaping-induced lung injury in the Philippines was reported in November 2019.[118] A 16-year-old girl from central Philippines was vaping e-cigarettes for half a year.[118] She had difficulty breathing and was admitted to the hospital in October 2019.[118] She was discharged after she received treatment from a pediatric pulmonologist.[118]
Thailand
At least two cases of vaping-induced lung injury occurred in Thailand.[18] Allegedly all of them used a cannabinoid vape from the US.[18]
Investigation
Investigators from multiple states in the US are collaborating with the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) to determine the cause of the lung illnesses associated with the use of vaping products.[121] The ubiquitous use of e-cigarettes including products that enable tetrahydrocannabinol (THC) use likely contributed to the outbreak.[29]
On September 6, 2019, Dr. Dana Meaney-Delman, serving as the incident manager of CDC's response to this outbreak, said that "Based on the clinical and laboratory evidence to date, we believe that a chemical exposure is likely associated with these illnesses. However, and I really want to stress this, more information is needed to determine which specific products or substances are involved. We are aware that some laboratories have identified vitamin E acetate in product samples, and we have connected those laboratories with the FDA Forensic laboratories to compare results. At this time, no one device, product, or substance has been linked to all cases. Continued investigation is needed to better understand if a true relationship exists between any specific product or substance and the illnesses observed in patients. To find the answer we will need to combine information about e-cigarette use, and product sample testing and the clinical information from patients."[122]
Patients have acknowledged recent use of THC-containing e-cigarette products while speaking to health care personnel, or in follow-up interviews by health department staff.[68] On September 6, 2019, The New England Journal of Medicine reported that "Information on product use is based on reports by the patients, and patients may be reluctant to report illicit drug use."[15] On October 2, 2019, The New England Journal of Medicine reported that the histologic evidence suggests that the "vaping-associated lung injury represents a form of airway-centered chemical pneumonitis from one or more inhaled toxic substances rather than exogenous lipoid pneumonia as such, but the agents responsible remain unknown."[123] They also stated that this "finding should be interpreted with caution."[123] On October 17, 2019, the American Journal of Clinical Pathology reported that lung biopsies from eight patients with vaping-induced lung injury show acute lung injury patterns, not exogenous lipoid pneumonia.[124]
Of the 2,807 reported cases, 2,022 hospitalized persons had data on substance use, as of January 14, 2020.[13] 82% reported THC use, 33% reported exclusive THC use, 57% reported using nicotine-containing products, and 14% reported exclusive use of nicotine-containing products.[13] The CDC reported that their findings suggest vaping products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, or illicit dealers), are linked to most of the cases, and play a major role in the outbreak.[13] In 2019, some people diagnosed with a vaping-induced lung injury reported using only nicotine-containing products.[125] Nicotine has been linked to the vaping-induced lung injury cases in a small subset of users.[30]
On November 8, 2019, Dr. Anne Schuchat, principal deputy director of the CDC, said, "for the first time we have detected a potential toxin of concern — Vitamin E acetate — in biologic samples from patients with lung injuries associated with the use of e-cigarette or vaping products."[28] The sample types were bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs).[13] The chemical was found in samples collected from ten different states, from the lungs of 29 patients with the disease.[28] "These findings provide direct evidence of Vitamin E acetate at the primary site of injury within the lungs," said Dr. Schuchat.[28] The CDC tested for a wide range of substances that might be found in e-cigarette or vaping products including plant oil, petroleum distillates like mineral oil, medium-chain triglyceride oils – or MCT oils – and terpenes which are compounds found in or added to THC products. No other potential toxicants were detected in the testing conducted so far.[28] The CDC did not rule out other possible compounds or ingredients that may be causing the lung injuries.[28] Evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products, in some of the reported vaping-induced lung illness cases.[13]
Many of the samples tested by the states or by the US FDA, as part of the 2019 investigation, have been identified as vaping products containing tetrahydrocannabinol (or THC, a psychoactive component of the cannabis plant) and further, most of those samples with THC tested also contained significant amounts of vitamin E acetate.[27] Vitamin E acetate is a substance present in topical consumer products or dietary supplements, but data is limited about its effects after inhalation.[27] While the US FDA does not have enough data presently to conclude that vitamin E acetate is the cause of the lung injury in these cases, the agency believes it is prudent to avoid inhaling this substance.[27] The US FDA's Forensic Chemistry Center serves as the FDA's national laboratory, and is playing a critical role in fact-gathering and analysis for the incidents of lung illnesses following vaping product use.[120] In Canada, vitamin E acetate was not found in products analyzed by Health Canada.[126]
Illicit vaping
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All people who acquired the lung illness were vaping which resulted in the inhalation of chemicals.[70] Counterfeit cannabis cartridges are being sold to users at a reduced cost.[128] Dank Vapes is an illicit brand that uses a cartridge.[129] There is no singular company that owns Dank Vapes and there is no formal quality control with this kind of a brand.[130] As a result, what is in each box can be ambiguous.[130] The same Dank Vapes flavor from various suppliers can have a different concentrate.[130] Dank Vapes appears to be the most prominent in a class of largely counterfeit brands, with common packaging that is easily available online, and that is used by distributors to market THC-containing cartridges with no obvious centralized production or distribution.[127] Some of the vaping products that contained exceedingly high amounts of vitamin E acetate include Chronic Carts and Dank Vapes.[12]
Illicit vape brands have been sold across multiple states in the US.[131] As of August 27, 2019, the most frequently used product reported by patients experiencing respiratory, gastrointestinal, and/or constitutional symptoms in Illinois and Wisconsin was the THC product called Dank Vapes.[15] Dank Vapes was the most commonly reported product brand used by patients nationwide, although there are regional differences.[13] While Dank Vapes was most commonly reported in the Northeast and South, TKO and Smart Cart brands were more commonly reported by patients in the West, and Rove was more common in the Midwest.[13] The composition of THC based oils is, to a large extent, not known.[15]
Various diluent thickening products were sold online via wholesale suppliers.[132] There has been an increase in attention to companies that sell diluent products that are made with vitamin E acetate.[31] Cannabis oils are diluted for financial gain.[133] A lot of speculation has focused on Honey Cut.[134] Honey Cut, used as a diluent thickener, became widely used in Los Angeles' vape pen manufacturing plants in late 2018.[129] After Honey Cut became widely used in THC vape cartridges many other similar products from other companies were introduced into the market in early 2019.[135] The maker of Honey Cut's product is not known, and the only way to purchase the product was from the company's website.[136] In early September 2019, the Honey Cut website went offline[31] and Honey Cut told sellers in the Toy District, Los Angeles area to discontinue offering its products for sale.[137] Counterfeit products from China that look like Honey Cut products were being sold, which increased the confusion in regard to which products people may have been vaping.[138]
The company Floraplex in Michigan has shutdown the buyers page for their Uber Thick brand.[136] The diluent products called Clear Cut were sold by Connoisseur Concentrates from Tigard, Oregon.[132] Clear Cut is no longer available from the company's website.[132] The company acknowledged the products contained vitamin E acetate.[132] The company stated that it began selling the products in May 2019 and was reviewed by the Oregon Liquor Control Commission.[132] As of September 10, 2019, Mass Terpenes' Pure Thickener diluent is no longer available on its website.[31] A cache of the product on its website stated, "a proprietary formula composed simply of flavorless terpenes and a derivative of Vitamin E (to preserve color and consistency)."[31]
Aaron Riley, CEO of CannaSafe, stated that likely about 75-80% of illicit vapes use some type of diluent agent.[31] Drew Jones of Mr Extractor stated in September 2019 that as high as 70% of illicit cannabis vape cartridges in the US contain vitamin E acetate.[139] It is estimated that at least 40 companies in the US sold a cutting agent containing vitamin E acetate.[135] Thickening agents have been sold online as a less costly and safer substitute.[140]
Thickening agents were used to water down and bulk up vape oils.[31] Thickening agents were used mostly in THC vape products.[31] Vitamin E acetate was used to cut THC oil to dilute it.[141] Vitamin E acetate dilutes vape oil without making it look like the oil was watered down.[142] Previously, vitamin E acetate was used in low concentrations, or lower than 20% of the formula in vape cartridges.[31] As a result of a limited availability of cannabis in California as well as high demand, illicit sellers had used about 50% or higher of diluent thickeners in their formulas to bulk up tiny potency vape cartridges.[31] Illicit cartridges were made up of between 23% and 88% of vitamin E acetate.[18] Thomas Whitten, a consultant at WeedRAR, said to Rolling Stone that "there's so much cutting agent even the people who made the cutting agent didn't expect it to be cut that much."[31] Some cannabis laboratories began making arrangements in September 2019 to provide testing services for vitamin E.[143] In 2019, a Massachusetts testing lab offering two initial free tests to consumers found vitamin E acetate in nine of the 109 products examined but not in licensed products.[144]
Regulations in legal markets for cannabis use allow the use of many additives such as tocopherols (various forms of vitamin E).[135] As a result of the outbreak, regulators may have thought about banning such substances.[135] Although vitamin E acetate is not banned in the US and has not been officially declared as a deadly substance, many states had been making advances to ban the use of the chemical in vape products.[20] Colorado,[33] Ohio,[33] and Washington have banned vitamin E acetate in vaping products[34] and Oregon has banned vitamin E acetate in cannabis vaping products.[35] Health Canada does not permit vitamin E acetate in cannabis vaping products in Canada.[36]
Legal proceedings
Subpoenas
In September 2019, New York Governor Andrew Cuomo instructed the state health department to issue subpoenas against three sellers of thickening agents used in illicit vaping products.[32] The subpoenas were served in 2019 against Honey Cut Labs in Santa Monica, California, for its Honey Cut product; Floraplex Terpenes in Ypsilanti, Michigan, for its Uber Thick product; and Mass Terpenes in Amherst, Massachusetts, for its product.[145] All three firms sell a product used as a thickener in vape liquids.[146] The thickeners from all three firms were found to contain mostly vitamin E acetate, according to test results from the Wadsworth Center.[140]
Criminal cases
On September 5, 2019, Tyler Huffhines and Jacob Huffhines were arrested.[147] Search warrants were served on a house at their place of residence and at a leased condominium.[147] In September 2019, an investigation in Kenosha County, Wisconsin, was underway to determine whether a major operation ran by the Huffhines brothers for purportedly making illicit THC vape cartridges, which were packed in containers to resemble candy and were thought to have been marketed to youth, could be related to a series of vaping-induced lung illness and deaths in the US.[147] The purportedly candy-themed containers used names such as Sour Patch.[148] In January 2018, Tyler Huffhines purportedly began the operation.[148] The vape cartridges purportedly contained as high as 1,000 milligrams of THC,[148] when the packaging stated it was just 5 milligrams.[149] Roughly $1.5 million worth of THC products were seized during the raid.[150] 57 mason jars containing THC oil were also seized during the raid.[151] Each jar was worth about $6,000.[151] Nearly $60,000 in cash as well as guns and drugs were found in their residency in Paddock Lake, Wisconsin.[152]
An initial appearance in Kenosha County court was held for both brothers on September 16, 2019.[153] Tyler Huffhines had been facing multiple drug-related charges including possession with intent to deliver THC.[153] Jacob Huffhines had been facing charges including being a felon in possession of a firearm and possession of THC.[153] Bond for Tyler Huffhines was set $500,000.[153] Bond for Jacob Huffhines was set at $50,000.[153] Both were scheduled to return to court on September 26, 2019.[153] The Huffhines brothers pleaded not guilty on October 23, 2019.[154]
Courtney Huffhines, the mother of Jacob and Tyler Huffhines, was charged with assisting her sons run the illegal THC vape operation.[155] A woman was arrested in connection with the THC vape operation.[155] On October 3, 2019, Hannah Curty was charged with making THC, as a party to an offense against the law.[156] She is scheduled to return to court on October 11, 2019.[156] Courtney Huffhines and Hannah Curty were in court on October 11, 2019.[157] Both women are due to return to court on October 23, 2019.[157] Courtney Huffhines and Hannah Curty pleaded not guilty on October 23, 2019.[154]
On October 17, 2019, 22-year-old Jordan Lynam was charged with making THC vape cartridges in relation to the Huffhines's purportedly illicit vaping operation.[158] Daniel Graumenz, Wesley Webb, and Tarail King were facing charges in relation to the illicit vaping operation.[159]
On June 12, 2020, attorneys for the Huffhines brothers and the five workers charged in the enterprise appeared in court via video.[160] Prosecutors had provided plea offers for each defendant.[160] Waukesha County deputy district attorney Lesli Boese is the acting prosecutor on the case.[160]
Close to two years following Tyler Huffhines' arrest on drug-related charges, he posted bond on July 1, 2021, and was released.[161] Jacob Huffhines was on probation when he was arrested, and his probation was rescinded.[161] Courtney Huffhines was released on bond in October 2019.[161] The remaining five defendants had been released on bond.[161]
On November 18, 2022, six people involved in the criminal THC vape cartridge ring were convicted, and each one received fines or probation.[37] Jacob and Tyler Huffhines, and their mom Courtney, were sentenced.[38] While each one was not sent to prison, each agreed to a plea deal.[38] 23-year-old Tyler Huffhines received three years of probation.[38] 26-year-old Jacob Huffhines got a $10,000 fine and received two years of probation.[38] 46-year-old Courtney Huffines was fined the sum of $15,000.[38] 23-year-old Wesley Webb was fined $2,500.[37] 23-year-old Hannah Curt was fined $2,500.[37] 22-year-old Daniel Graumenz was fined $2,500 for assisting with filling vape cartridges.[37]
Both Jordan Lynam and Tarail King were anticipated to be sentenced in November 2022,[39] but the charges against them, involving an illegal THC vape operation, were reported in mid-November 2022 to be still ongoing.[162]
Civil lawsuits
Lawsuits over respiratory lung injuries purportedly resulting from vaping have been filed in California, Washington State, and Florida.[163]
On September 23, 2019, a product liability lawsuit, Charles Wilcoxson v. Canna Brand Solutions LLC et al., was filed in Superior Court of Pierce County, Washington, against makers of THC vape cartridges.[164] Wilcoxson, a peace officer, had used THC vape products between January 2018 and September 2019.[164] He bought cannabis products that included Conscious Cannabis, Rainbows Aloft, Leafwerx, MFused, and Jane's Garden, all of which were cited as defendants[164] Canna Brand Solutions which is a reseller of the plaintiff's vaporizer called C-Cell, is also cited as a defendant.[164] The plaintiff was severely wheezing in September 2019 and was hospitalized for three days with lipoid pneumonia as a result of his vaping, according to the complaint.[164]
In May 2019, 21-year-old Connor Evans was hospitalized for more than two weeks and was in a medically induced coma for eight days.[165] He initially thought he had the flu.[166] He had fluid in his lungs and he had trouble breathing.[165] He had purportedly developed an addiction to Juul mint pods, which he had been using since March 2018.[167] In October 2019, Evans sued Juul, for purportedly not disclosing the dangers of its pod system and deceptively advertised its products as being safer than combustible cigarettes.[165] Evan's attorney stated that Juul is selling pods in the US with high concentrations of nicotine.[165] The suit also claimed Juul marketed their products to intentionally entice underage individuals and young adults, as well as individuals who had never been frequent smokers.[165]
In September 2019, a lawsuit was brought on behalf of 18-year-old Adam Hergenreder from Illinois who had been hospitalized in August 2019 with lung damage from vaping.[168] He was in the intensive care unit at Advocate Condell Medical Center[169] and was unable to breath without being given oxygen.[170] He began vaping when he was 16 and the Juul flavors he liked most were mint and mango.[170] According to the suit, he fell prey to Juul's misleading marketing.[168] Juul used social media to target young people, according to his lawyers.[171] The suit also claimed Juul did not inform the public what they were selling contained toxic substances.[172] The gas station where he said he bought the Juul pods when he was a minor is also named as a defendant in the lawsuit.[168]
In September 2019, 35-year-old Erin Gilbert from Virgin Islands filed a lawsuit against Just CBD in a Broward County, Florida court while she was in critical condition at the Jackson Memorial Hospital, contending that her sickness was the result of a CBD vape oil containing mango flavor that she had purchased from a merchant in Saint Croix.[163] After just a few days of using the vape oil in August 2019, she had severe respiratory problems, multiple organ failure, and deficient supply of oxygen, resulting in necrosis of her legs, both of which had to be amputated.[163]
On July 12, 2021, a personal injury lawsuit, Simah Herman, et al. vs Juul Labs, Inc., et al., was filed in Superior Court of Los Angeles, California, against Juul Labs Inc., Altria Group, Inc., Altria Client Services LLC, Altria Enterprises LLC, Altria Group Distribution Company, Philip Morris USA Inc., Adam Bowen, James Monsees, Hoyoung Huh, and Nicholas J. Pritzker.[173] The case is still pending.[173]
Responses
E-cigarette industry
The e-cigarette industry was placing the blame on illicit vaping liquids for the lung injuries.[40] "Each day of this crisis brings more evidence that street vapes containing THC or other illegal drugs are responsible for these illnesses, not nicotine vaping products," said Gregory Conley of the American Vaping Association, in August 2019.[40] "Like any health-related events reportedly associated with the use of vapor products, we are monitoring these reports," Juul Labs stated to Reuters in August 2019.[41] The company also stated that some news agencies report that several cases of lung illness are associated with vaping THC, found in cannabis, "a Schedule 1, controlled substance that we do not sell."[41]
United States
The CDC and US FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers.[13] The CDC recommends that vitamin E acetate should not be added to any e-cigarette, or vaping, products.[13] Additionally, people should not add any other substances not intended by the manufacturer to products, including products purchased through retail establishments.[13] According to the CDC, adults using 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.[13] The CDC advices to contact a health care professional if a person needs help quitting tobacco products or e-cigarettes.[13]
The US FDA considers it prudent to avoid inhaling vitamin E acetate.[27] On September 6, 2019, the US FDA stated that because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.[27] On October 4, 2019, the US FDA strengthened its warning to consumers to stop using vaping products containing THC amid more than 1,000 reports of lung injuries—including some resulting in deaths—following the use of vaping products.[174]
"The legal vapes have been actively regulated by FDA since Aug 2017. FDA has conducted thousands of inspections of manufacturers and vape stores, published manufacturing guidance, sought product removals etc. These tragedies point to illegal vapes and THC," former FDA Commissioner Scott Gottlieb tweeted in August 2019.[175] During an interviewed on CNBC's Squawk Box on September 9, 2019, Gottlieb said that "the current belief is the illnesses are linked to illegal vapes containing vitamin E oil."[176] He also stated that cannabis products in the US should be regulated.[176]
"The e-cigarette-related lung illnesses currently sweeping across the country reaffirm our belief that the use of e-cigarettes and vaping is an urgent public health epidemic that must be addressed. We must not stand by while e-cigarettes continue to go unregulated. We urge the U.S. Food and Drug Administration (FDA) to speed up the regulation of e-cigarettes and remove all unregulated products from the market. We also call on the FDA to immediately ban flavors, as well as marketing practices, that enhance the appeal of e-cigarette products to youth," Patrice A. Harris, the president of the American Medical Association, stated on September 9, 2019.[177] On November 19, 2019, the American Medical Association urged for a complete ban on all types of vaping products that are not approved by the US FDA as quitting smoking aids.[178]
On September 10, 2019, the American Lung Association issued a statement in light of the upsurge in reported illnesses and deaths associated with vaping: "E-cigarettes are not safe and can cause irreversible lung damage and lung disease. No one should use e-cigarettes or any other tobacco product. This message is even more urgent today following the increasing reports of vaping-related illnesses and deaths nationwide."[179]
"Vaping has become a very big business, as I understand it. Like, a giant business. In a very short period of time. But we can't allow people to get sick and we can't have our youth be so affected. And I'm hearing it. And that's how the first lady got involved. She's got a son, together, that is a beautiful young man and she feels very, very strongly about it. She's seen it, and we're both reading it. A lot of people are reading it. But people are dying, from vaping. So we're looking at it very closely," Donald Trump said to news reporters on September 11, 2019.[180] On January 2, 2020, the Trump administration announced a limited ban on some flavored vaping products.[181]
On September 17, 2019, New York state passed a law that prohibited the sale of flavored vaping products on the heels of seven people dying and hundreds more being struck by a vaping-induced lung injury.[182] The flavored vaping ban in New York was implemented on May 14, 2020, despite being challenged in court by the vaping industry.[183]
The governor of Massachusetts declared a public health emergency on September 24, 2019, and ordered a 4-month moratorium on the sale of all vaping products, both for nicotine and THC.[184] After courts determined it had sole jurisdiction over THC products, the Massachusetts Cannabis Control Commission quarantined all THC vape products until they could be screened for vitamin E acetate.[185] The nicotine vaping ban was also challenged and ended early,[186] but before the ban expired the state legislature passed a law banning the sales of flavored nicotine vaping products to reduce underage vaping,[187] and subsequently a new bill restricting the sales of nicotine vaping products among other measures was signed into law by governor Charlie Baker on November 27, 2019.[186] In 2020, seven states passed permanent restrictions on flavored e-cigarettes.[note 6][188]
In May 2020, the California Department of Public Health issued a health alert provisionally updating California's vaping-induced lung injury case definition to require a negative SARS-CoV-2 nucleic acid test and suspending the probable case definition.[189] The California Department of Public Health states that it is important that health care providers ask patients with symptoms consistent with vaping-induced lung injury, especially teenagers and young adults, about e-cigarette use, or vaping, during COVID-19 evaluations.[189] The California Department of Public Health urges everyone to refrain from using all e-cigarette, or vaping, products and recommends not using THC-containing products obtained from informal sources such as social contacts, online dealers, and unlicensed retailers.[189]
Canada
Health Canada, the responsible government agency, responded to the US cases of potentially deadly lung illness by issuing a warning on September 4, 2019.[190] They advise that Canadians consider not using vaping products, monitor for symptoms, get a medical attention quickly if they have concerns, tell their doctor if and what they vape or have vaped, avoid the illegal and unregulated markets, avoid modifying vaping products, report adverse reactions, and monitor their advisory for updates.[190] They stated for those who are vaping to watch for symptoms such as cough, shortness of breath, or chest pain.[190] The Public Health Agency of Canada recommends for youth who are vaping who believe that discontinuing use is hard, to contact a health care provider for guidance on ways to stop.[17] On October 11, 2019, Chief Public Health Officer of Canada recommended to Canadians to consider holding back from vaping.[26] Health Canada started a $766,000 advertisement campaign to curb underage vaping in part in response to the US and Canadian outbreak.[191]
Europe
"What little we know of recent reports from the U.S. is that the devices used appear to be linked to 'home brews' of illicit drugs and not legitimate vaping products," Martin Dockrell, overseer of tobacco control at Public Health England, stated in September 2019.[108]
Australia
As a result of a potential link between vaping and lung illness in the US, the Australian Medical Association stated on September 18, 2019 that they reiterate a precautionary approach for the use of vaping products.[192]
India
Following a string of deaths tied to vaping in the US, India has banned the sales of vaping products in September 2019.[193]
World Health Organization
Dr. Vinayak Prasad, overseer of tobacco control at World Health Organization, told CNN on September 12, 2019, that WHO was observing the events in the US and abroad and will provide information to governments at the appropriate time.[194] Prasad also stated that its member states have not made any announcements of lung illnesses that resemble those that were observed in the US.[194]
Hospitalized patients
June 2019 to August 2019 cases
Vaping products were iintially intended to get smokers to stop using tobacco but have caused millions of minors in the US to become addicted to nicotine.[195] Young people were hospitalized as a consequence of vaping and they shared their stories about their vaping-related lung injuries.[195] The hospitalized young people believe vaping was the cause of their lung injuries.[195] The long-term consequences of hospitalized vaping individuals with severe respiratory failure such as needing veno-venous extracorporeal membrane oxygenation is unclear.[11] A small percentage of hospitalized vaping individuals who had been released from the hospital had needed to be rehospitalized as well as several of them died following hospital release.[11] E-cigarettes can cause other conditions that result in hospitalization, such as vaping-induced spontaneous pneumomediastinum.[196]
In June 2019, a women from Texas was taken to hospital.[197] She was unable to hold down fluids and was dehydrated.[197] She was put in a medically induced coma and was diagnosed with multifocal pneumonia, sepsis, and acute respiratory failure with hypoxemia.[197] Her lungs filled with fluids and she had blood clots.[197] She had low oxygen and blood pressure readings.[197] She never smoked, though she had used e-cigarettes and was attracted to the flavors.[197]
In June 2019, a 20-year-old from Provo, Utah was admitted to a local hospital with nausea, chest pains, and shortness of breath[198] after a round of antibiotics failed to clear up his symptoms.[199] He was eventually airlifted to the University of Utah hospital in Salt Lake City in order to place him on a life-supporting system called extracorporeal membrane oxygenation (ECMO) because his lungs stopped working.[198] After his health improved he was sent home on July 7, 2019.[198] He has since stopped vaping.[200]
In June 2019, a 52-year-old from New York felt sick after returning home from traveling to China and California.[137] In August 2019, his cough was painful.[137] After visiting his doctor for a second time, he was diagnosed with double pneumonia.[137] Days later, he felt very sick and went to the emergency room at the North Shore University Hospital.[137] After a pulmonologist noticed on his medical record that he began vaping THC a few months prior, he was treated with steroids.[137]
 - Utah Teen Says Her Vaping Put Her in a Coma, Worst Case Doctors Had Seen |
In July 2019, a teen from Nephi, Utah needed to be put into a medically induced coma after 3 years of vaping every day.[201] She said she began with a no-nicotine e-liquid, though at some point progressed to using 3 mg of nicotine.[201] "I had fat particles growing inside my lungs that were related to the glycerin in vape juice. So then my lungs were full of fluid. They said that my chest X-rays were one of the worst they've ever seen," she said.[201]
In August 2019, a 19-year-old from Marion, Indiana was admitted to the hospital with two collapsed lungs[202] after more than a week of experiencing shoulder and back pain.[203] He had four surgeries and was in the hospital for 17 days.[202] His doctors believe his ailment was triggered by his vaping,[203] which the patient then quit.[203]
An 18-year-old student from Florida was using about half a Juul mint pod a day[note 7][204] for about 18 months.[205] He arrived at the hospital with intense pain on his side[204] and had multiple surgeries to repair a collapsed left lung.[206] In August 2019, on Twitter he stated that the black dots on his lungs were from strictly Juul use.[206]
—18-year-old Simah Herman who was hospitalized due to vaping-induced lung complications, news.com.au[207]
In August 2019, 18-year-old Simah Herman was taken to the UCLA Medical Center after she had trouble breathing.[208] At 15, she started vaping and within two years her health deteriorated.[208] After being hooked up to a ventilator and waking up from a medically induced coma, she wrote: "I want to start a no-vaping campaign."[208] She posted on Instagram about the risks of vaping[209] and started an anti-vaping campaign from her hospital bed.[210] Following her complications with vaping, she quit.[209] Before ending up in the hospital, doctors were unable to tell her the reason she felt sick even though she told them she was vaping, she said.[208]
September 2019 to December 2019 cases
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In September 2019, a 45-year-old from Shreveport, Louisiana, was struggling to stay alive after he says he was sickened from a vaping-induced lung illness.[211] On September 13, 2019, it was reported that Goldstein, in his hospital bed, said, "Now I have oil and water in my lungs that my lungs can't get rid of. Making them crystallize. They're rock hard."[211] He stated that he did not have any symptoms other than not being able to keep food down.[211]
After a 25-year-old male from Portland, Oregon ceased smoking and began vaping around a year ago, he had trouble breathing and fell down while having supper with his buddies.[212] His lips appeared blue, and his face appeared purple.[212] After his dad seen his son go through his horrifying ordeal, his dad stopped believing that vaping is less harmful than smoking.[212] He needed to be placed in s medically induced coma and needed a ventilator.[212] Eventually he was released from a hospital and in September 2019 was recuperating at home.[212] He mainly vaped Juul pods and other pods, and also vaped THC periodically.[212]
In September 2019, a 16-year-old from Ellwood City, Pennsylvania was admitted to the hospital[213] after vaping for approximately a year and a half.[214] She had difficulty breathing and needed supplemental oxygen.[214] She was dizzy when she stood up and subsequently was vomiting.[214] She felt pain in her stomach which turned out to be her lungs,[213] a scan of which showed white spots.[213] She was in the hospital for 10 days,[213] and started using a nicotine patch instead of vaping.[214]
In September 2019, a 22-year-old from Queens, New York was hospitalized for vaping-related breathing problems.[215] His blood oxygen had dropped so low that it could result in organ failure, or cause trauma to his heart.[216] He was hooked up to a machine called ECMO for four and a half days and his condition improved.[216] He became ill following vaping about one cartridge a day, of various brands, including the illicit brand Dank Vapes.[215]
In October 2019, a 16-year-old had received medical attention at the intensive care unit at Phoenix Children's Hospital as a consequence of being found unresponsive in her bedroom resulting from vaping.[217] Her mother stated, "I tried to do CPR but I couldn't because there was so much mucus and fluid coming from her mouth."[218] She was initially placed on life support.[218] Her mother stated that she gone into cardiac arrest, her heart is working at just 30%, and was bleeding in the lungs.[218] In October 2019, doctors stated she will stay in the hospital for not less than the next 35 days as they attempt to evaluate the extent of the harm that had happened.[218]
| - 17-year-old speaks out after double lung transplant due to vaping | GMA |
On October 15, 2019 a 17-year-old from Michigan received a double lung transplant[219] after his lungs were destroyed following vaping.[220] This is believed to be the first such procedure due to vaping.[221] Following the transplant, he had to take 20 pills daily[222] and has since stopped vaping.[223]
A Kentucky mom stated that vaping Juul since her daughter was 15 for over a year was the cause of her daughter being admitted into the Cincinnati Children’s Hospital Medical Center in October 2019.[224] At first, it appeared she had a stomach flu and was taken to urgent treatment, and her symptoms got worse.[224] She had a vaping-induced lung ailment and was released from the hospital after close to a week.[224] Her mom wants others to learn from their experience.[225] Her mom stated, "she is spreading the word to families like theirs in hopes of preventing others from suffering serious injuries or even death after using e-cigarette products."[225]
It was reported in November 2019, a 15-year-old from Desert Hot Springs spent over a month in the hospital, following life-threatening injuries thought to be induced by a few months of vaping.[226] He said he was vaping a wax cartridge containing THC.[226] He said he liked the doughnut flavor.[226] He underwent eight surgeries[226] and several of his friends had stopped vaping after finding out he was admitted to the hospital.[227]
After vaping Juul and other devices, a 19-year-old female from Maryland ended up in a hospital in December 2019 with lung damage.[228] Doctors initially thought she had an infection such as pneumonia.[228] Her chest X-rays showed that both her lungs were hazy and white, rather than black like healthy lungs.[228] Further testing indicated that she did not have an infection.[228] She posted on Instagram, "The scariest part is that even with the extent of the damage, I never once felt any of it. I never experienced any shortness of breath, coughing, wheezing, chest pain, or ANY signs respiratory distress or issues. It is truly a SILENT killer."[228]
Vaping prevalence
After The New York Times stated that the vaped-induced lung injuries are an "epidemic", an upsurge of people began tweeting about giving up Juuling within a 24-hour period.[229] Following an outbreak connected to vaping-induced lung illnesses in 2019, vaping among middle and high school students in the US dropped significantly in 2020.[230] From 2019 to 2020, nicotine vaping on a daily basis dropped considerably.[231] Teenagers who use e-cigarettes are also more likely to use cannabis when compared with non-e-cigarette users and it is commonly added to vaping products.[77]
Flavored e-cigarettes are popular among youth and young adults.[231] The high prevalence of youth and young adult use of nicotine and cannabis e-cigarettes remains a source of concern.[55] As of 2019, vaping has exceeded cigarette smoking as the most popularly used method to obtain nicotine among youth in the US.[23] As of 2022, cannabis policies are rapidly changing worldwide, and with this, the frequency of cannabis vaping rising.[55] One study quoted a doubling of cannabis vaping frequency amongst high school seniors from 2018 to 2019.[55] Youth vaping habits suggest that e-cigarettes are as popular as ever, and the fear is that cannabis vaping may act as a gateway to experimentation with vaping of illicit and black-market products, especially amongst curious high-school students and young adults.[55] These users are not only at risk of harm from other potential mechanisms of vaping-induced injury but also the added uncertainty around the consequences of vaporizing unknown substances or chemicals.[55]
In contrast with a consistent decline in smoking prevalence among youth, over the past few years leading up to 2022 e-cigarettes have rapidly gained popularity to the point of becoming the most common tobacco product in this age group.[232] Their social acceptance, together with their widespread availability, contributed to drastically increase primary use by adolescents and second-hand exposure in children.[232]
The vast numbers of youth and young adults afflicted with vaping-induced lung injuries motivated then President Trump to sign legislation amending the Federal Food, Drug, and Cosmetic Act to increase the legal age for sale of tobacco products to 21.[233] Along with this law was the revised US FDA rules overseeing e-cigarette flavors.[233] This new rule stated that the US FDA would emphasize the ban of flavored cartridges or pod-based vaping products to curb their appeal to youth, but this rule did not apply to tobacco flavored or menthol flavored cartridges, tobacco flavored or menthol flavored pod-based vaping products, flavored non-reusable vaping products, or refillable flavored e-liquids.[233] For this reason, numerous flavored e-cigarette products were still in the marketplace, which has resulted in a surge in the utilization of non-reusable e-cigarettes among middle and high school students in the US from 2019 to 2020.[233] The US National Youth Tobacco Survey reported a 1000% increase in the use of disposable products from 2019 to 2020.[234] In addition, a 2020 study of internet searches reported a sharp increase of searches pertaining to disposable products, like Puff Bar.[234]
Beliefs and perceptions
The vaping-induced lung injuries resulted in a worsening of people's perceptions of the effects of vaping compared with smoking.[42] Views of the harm of frequent vaping rose considerably.[231] Following the vaping-induced lung injury outbreak, a greater number of youth and young adults viewed vaping as dangerous.[231] A mother whose teenage son almost died from vaping, chastised two US FDA investigators in 2019 who came to her home for allowing these vaping devices to be available for sale.[235] "I just don't understand how they could allow this company to start putting these products on the market without first testing them," said his mother.[235] Similar to numerous other parents throughout the US, she was upset and disturbed that vaping products—which are marketed as being less toxic than smoking—are for sale, even though they are not considered to be safe by the US FDA.[235]
In August and September 2019, two cross-sectional online surveys indicated that the harm perceptions about e-cigarettes increased overall after the news coverage of the outbreak, though the change among never e-cigarette users was small.[236] Moreover, never e-cigarette users already had higher perceptions of harm, and the perceptions of harm among current e-cigarette users after the news coverage of the outbreak are still lower than never e-cigarette users and former e-cigarette users prior to the news coverage.[236] A Morning Consult poll conducted in mid-September 2019 indicated that 34% of adults believed that the lung disease deaths were related to cannabis and THC-containing vapes, while 58% stated nicotine e-cigarettes such as Juul were to blame.[236]
Effects of vaping
Nicotine as well as cannabinoid aerosols contain toxic substances.[18] Regardless of whether the device is counterfeit or authentic, the exact content of the inhaled aerosol is unknown.[18] The long-term effects of vaping is unknown.[6] Although they are marketed and viewed as being safer than smoking,[9] the short-term consequences of vaping can be severe[237] and the short-term toxicity of vaping is greater than combusted tobacco products.[6] A 2020 review noted, "although there is overlap with the toxicity of tobacco, vaping introduces exposures and has effects which are not seen with tobacco. Thus the idea that vaping is a safer, watered-down version of smoking, is scientific nonsense."[6] Nicotine is a well-established respiratory irritant, but other chemicals in e-cigarettes such as diacetyl, propylene glycol, and formaldehyde, also have detrimental effects for lung function including respiratory volume.[77] Additionally, the sweet-flavoring additives, such as candy or fruity flavoring, have also been reported to be hazardous to the lung.[77] The cinnamon-flavoring cinnamaldehyde has been identified as being one of the main constituents capable of damaging immune cells in the lungs (macrophage-phagocytosis impairment) even without nicotine as a co-additive.[77] Vaping itself has no proven benefits.[6]
Rapid evolution of the vaping industry coupled with unpredictable trending preferences of end users can have devastating consequences such as the vaping-induced lung illness outbreak, which was quickly correlated to ill-conceived modifications in Dank Vape juices.[238] However, severe respiratory distress syndromes linked to vaping-induced lung injury are increasingly seen in the clinical setting involving vapers using commercially sourced devices and vape fluid.[238] A February 2022 research article on aerosol from commercially sourced Juul flavored products showed profound pathological changes to upper airway, lung tissue architecture, and cellular structure are evident within 9 weeks of exposure to mice.[238] This vaping-induced pulmonary injury model demonstrates mechanistic underpinnings of vaping-related pathologic injury.[238] Puff Bar use can result in a greater chance of a vaping-induced lung injury.[239]
Effects of cannabis
Cannabis itself is generally considered low risk compared to tobacco, alcohol, and other illicit drugs.[240] However, with increasing availability due to state legalization, increasing percentages of THC in botanicals and newly developed cannabis concentrates, this may be changing.[240] Because of the new higher concentrated products, which can be in the hundreds to low thousands of milligrams of THC, our understanding of the effects due to ingestion and inhalation is still not well studied or understood.[240] Unfortunately, due to the requirements placed by new state regulations in the US driving up the price in the regulated market, there will always be a cheaper black market for both cannabis (particularly that which has bypassed state regulations requiring seed to sale tracking—e.g., remember vaping-induced lung injury) and synthetic cannabinoids.[240] Cannabidiol vaping liquids sold in the US is hardly regulated.[241] Vaping synthetic cannabinoids has been an area of public health concern.[242]
Consumer end products are being made using ACRCC-∆8-THC, which contain variable quantities of isomeric and breakdown by-products in large quantities in excess of 30%, but they are being offered to people, as stated on their packaging, as just being made with ∆8-THC (delta-8-Tetrahydrocannabinol[243]).[244] There is a multitude of synthetic THC isomers created in the acid-catalyzed ring closure of the cannabidiol (ACRCC) transformation reaction.[244] The manufacturing of ACRCC-∆8-THC involves using flammable solvents such as benzene, acidic reagents like boron trifluoride, sulfuric acid, and hydrochloric acid, and heat to finalize the cyclization reaction.[244] The manufacturing of ACRCC-∆8-THC creates many additional THC isomers, which may include ∆7-tetrahydrocannabinol, ∆10-tetrahydrocannabinol, ∆9,11--tetrahydrocannabinol, and ∆9--tetrahydrocannabinol.[244] The harmfulness of these other THC isomers in humans is unknown.[244] A significant portion of the ACRCC-∆8-THC is being sold in the vaping market, while there is a lack of data on their inhalation.[244]
Since the entrance of ACRCC-∆8-THC into the marketplace in 2019, there has been a noticeable rise in cases of vaping-induced lung injuries.[244] Toxicological information on ACRCC-∆8-THC and its by-products is also lacking, and its part in causing vaping-induced lung injuries is uncertain.[244] Due to the novelty of vaping-induced lung injuries, the possible lung-related conditions observed with products containing ACRCC-∆8-THC may be considerable, and it is usually not tested, disregarded, and eludes being diagnosed; as a result, the actual scale of the vaping-induced lung illness epidemic is not known.[244] On September 14, 2021, the US FDA stated that there may be major health issues with the use of ACRCC-∆8-THC products[244] and the CDC released a warning to public health departments, healthcare professionals, first responders, poison control centers, laboratories, and the public about the increased availability of cannabis products containing ∆8-THC and the potential for adverse events due to insufficient labeling of products containing THC and cannabidiol.[245] The US FDA's inadequate labeling policies for ACRCC-∆8-THC products, is an area of concern.[244]
A cannabis joint normally contains about 12 mg of THC, but the amount of THC breathed in during just one vaping session can be as high as 50 mg of THC.[246] The amount of THC uptake via vaping is as high as hundreds of milligrams of THC in a day.[246] In comparison to the same dosage of smoked cannabis, THC vaping produces more potent effects and greater maximum blood THC concentrations.[246] Within 30 minutes following cannabis vaping, blood THC levels reach their highest point and get back to baseline within 3 to 4 hours, though the drug-induced effects, including cognitive and psychomotor impairments, lasts for typically as long as 6 hours.[246] As the frequency and amount of THC use increases, the acute ailments related to cannabis use also increases.[246] This includes cannabinoid hyperemesis syndrome, in addition to short-term behavioral issues, like psychosis.[246] The long-term consequences of vaping cannabis on lung function is unknown.[246] In comparison to cannabis smoking, suggestive evidence indicates that cannabis or THC vaping carries unique and overlapping potential health effects and may be connected with an increased chance of acute lung damage, seizures, and acute psychiatric problems.[247] Cannabis vaping has been associated with bronchitis in youth.[77]
Vaping research debate
Inconsistent findings are undoubtedly due, at least in part, to variability in exposure protocols.[238] Relatively few studies provide compelling rationales for experimental design or acknowledge inherent limitations of their approach.[238] Critics of vaping research leverage issues of experimental interpretation and variation to challenge relevance of findings, leading to pitched debate between pro-versus anti-vaping advocacy groups.[238] Establishing reasonable approximations of human vaping behavior as well as clinical manifestations of vaping-induced lung injury is essential and desperately needed to advance research and promote consensus among all stakeholders.[238] Because vaping is a toxicological, multifaceted puzzle, rigorous quality control, crystal clear legal and moral boundaries, thorough worldwide research, and educating users is crucial to averting possible subsequent outbreaks, a 2020 review states.[18]
Public health consequences
As a result of the vaping-induced lung injuries and deaths, the health issues regarding vaping have soared to a historic level across the world, in 2020.[248] The rise in popularity of vaping cannabis along with the vaping-induced lung injury cases brings about concern.[249] The outbreak has raised concern among public health officials, and revived the debate regarding the effects of vaping.[46] The outbreak of vaping-induced lung injury raised concern in the US about the harmful effects of nicotine-containing e-cigarette products and constituents.[250] Numerous state health departments across the US have voiced their concerns in the growing number of lung injury cases from e-cigarettes and vaping.[251] The outbreak illuminates the diverseness of the substances in e-liquid and calls into question the long-term safety of e-cigarettes.[11] E-liquids or vape pods may contain unknown substances and the composition of the emissions may vary significantly because a vaping device can use different types of voltages and coils.[18]
10 years subsequent to the US Congress giving the authority to the US FDA to regulate tobacco products such as e-cigarettes, the US federal government has persistently obstructed or hindered activities that could have safeguarded youth.[8] Further, extending over the Obama administration and Trump administration, the US federal government permitted the escalation of a mostly unregulated industry that may have resulted in a new generation to become addicted to nicotine.[8] The US FDA's shortcomings of action has puzzled some families of the individuals who became sick.[8] In 2009, the US FDA announced that the e-cigarettes were illegal drugs mixtures — such as a nicotine patch — that had not received approval.[8] The US FDA banned imports and cautioned that they contained toxic substances and enticed minors with flavors such as chocolate.[8] E-cigarette companies took legal action in court.[8] The court's overruling in 2010 "set the agency back significantly," said Joshua Sharfstein, who was the deputy commissioner of the US FDA at that time.[8] He also said, "It can be very hard for a regulator to address potential risks when there is an aggressive industry on the other side.”[8] Over the following years, as the US FDA gradually expanded regulations to govern every kind of tobacco product, such as cigars and vaping products, "the market became flooded with products that Congress never intended to be on the market at all without F.D.A. review," said Gregg Haifley, the lobbying arm to the federal government at the American Cancer Society Cancer Action Network.[8]
A 2020 review states, "e-cigarette industries innovate to bring newer and more potent delivery systems with little to no regulation and/or standardization of production."[11] There is a failure of sufficient regulation of e-cigarettes in the US, as of 2019.[11] A 2020 review states that "Globally, tighter regulation on electronic cigarettes (e-cigarettes) in some countries may have prevented greater incidence of VALI [vaping associated lung injury], but universal and adequate global regulation of these devices and products is yet to be met. The occurrence of global cases of VALI does however strengthen the need for global support in raising awareness of this novel and avoidable lung condition."[9] The outbreak that coincided with a surge in youth vaping, generated a movement in the research community to establish research priorities and address challenges to support the US FDA and World Health Organization efforts to regulate and control nicotine-containing e-cigarette products.[250]
Vaping of THC products poses a significant public health risk.[252] The long-term effects of vaping-induced lung injury is unclear.[58] The long-term effects on the lungs of people diagnosed with vaping-induced lung injury is unknown.[253] The effects of vaping vitamin E acetate on human health have not been sufficiently studied.[254] The possible neurotoxic effects from breathing in vitamin E and vitamin E acetate is not known, though the properties of these chemicals show that they are lipophilic in nature, and their molecular weights suggest they have the possibility to pass through the blood brain barrier.[255] Vitamin E acetate might hamper the central nervous system.[255] The long-term health consequences of breathing in vitamin E acetate is not known, though the rise in coverage of vaping lung injuries raises significant health concerns.[237] The effect of vaping on public health is unclear.[237]
Cases post-outbreak
2020 cases
| - Vaping Is The New Smoking: Can We Get Youths To Quit Vaping? | Talking Point | Full Episode |
There remains a concern over future outbreaks of lung damage.[246] In 2020, the first uptick in vaping-induced lung injury cases had occurred in Utah since the decline of 2019.[43] This research indicates the recurrent nature of the vaping-induced lung illness epidemic with new occurrences continuing to be reported.[43] Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has made it more difficult to diagnose vaping-induced lung injury cases.[256] The CDC no longer records new vaping-induced lung injury cases since February 2020, making it difficult to ascertain the exact prevalence.[43] Between 2018 and 2020, there were an increase in reported hospitalized vaping-related lung injury cases outside of the US.[6] Under-reporting of vaping-induced lung injuries outside of the US is an area of a concern.[59]
In April 2020, during the early COVID-19 pandemic, eight patients hospitalized with a vaping-induced lung injury were reported to the California Department of Public Health.[189] Patients resided in five counties and were aged 14 to 50 years (median of 17 years); seven were aged under 21 years old.[189] All hospitalizations occurred in April 2020, a median of 4 days (ranging from 4 to 13 days) after symptom onset.[189] Four patients were admitted to an intensive care unit; two required mechanical ventilation.[189]
A likely case of a vaping-induced lung injury was reported in the medical literature in September 2020 of a formally healthy 44-year-old woman, with symptoms that are consistent with bronchiolitis.[257] Two months after vaping a 3rd generation e-cigarette with a base of nicotine, symptoms started to develop.[257] She was treated for several months with inhaled fluticasone propionate/formoterol, montelukast, and oral steroids, because the doctor thought her symptoms were the result of adult-onset asthma.[257] After quitting vaping and taking corticosteroid and other treatments to tackle the respiratory distress and acute airway restriction, she recovered.[257]
A case of hypersensitivity pneumonitis was reported in the medical literature in 2020.[258] The case was associated with second-hand aerosol from an e-cigarette.[258] The most probably cause of a 37-year-old presenting with hypersensitivity pneumonitis was due to being exposed to second-hand aerosol.[6]
A few vaping-induced lung injury cases were reported to the New York State Department of Health in 2020 post-outbreak in New York.[259]
2021 cases
Amid the COVID-19 pandemic, vaping-induced lung injury cases were still being reported, especially among teenagers.[260] A vaping-induced lung injury case has been reported in the medical literature of a 16-year-old male with cough and fever during the COVID-19 pandemic in 2021.[57]
In 2021, it was reported that a 19-year-old man presented to the emergency department complaining of extreme difficulty breathing and nausea for the past few days.[240] When he was asking if he smokes, he answers breathlessly, "no, but I vape."[240] On further questioning, it was learned he buys his products from "friends" and he dabs but has never been to a legal cannabis dispensary.[240] His chest X-ray shows an infiltrate, but he denies fevers or cough.[240] While the emergency department is less likely to experience cases of a vaping-induced lung injury as of 2021, the consumption of unused older and particularly illicit products may precipitate this disease.[240]
Cases of vaping-induced lung injuries were reported sporadically to the New York State Department of Health through mid-2021 in New York.[259] A 2021 case report of a 67-year-old person with a vaping-induced lung injury was reported in China.[261]
2022 cases
Subsequent to vaping for four and a half years, an 18-year-old from Mount Pleasant, Tennessee was hospitalized in January 2022 after difficulty breathing due to vaping.[262] She initially thought she had the common cold, but needed to be placed on life support.[263] After leaving the hospital, she still needed oxygen.[262]
A case of a 35-year-old female going into cardiac arrest was suspected to be caused by severe hypoxemia was reported in the medical literature in 2022.[264] The women became unresponsive at home, was pulseless, and not breathing; witnessing this, the husband started chest compressions and called 911.[264] She had been smoking conventional cigarettes for the last 11 years and recently had switched to e-cigarettes.[264] Due to CT findings of bilateral opacities, history of e-cigarette use, and worsening respiratory status despite antibiotic therapy, a vaping-induced lung injury was suspected.[264]
2023 cases
The California Department of Public Health continues to collect reports of vaping-induced lung injuries from health care providers who report cases to local health departments in California.[265] Since the start of the COVID-19 pandemic in March 2020, local health departments have reported 40 cases of vaping-induced lung injuries to the California Department of Public Health, including one associated death, as of December 14, 2023.[265]
https://digital.nhs.uk/search?query=vaping
https://pubmed.ncbi.nlm.nih.gov/37131305/ wait for review
https://www.cureus.com/articles?q=EVALI&source=homeSearch&searched=true May have good images to upload.
Notes
- ↑ Due to the subsequent identification of the primary cause of cases in the US, and the considerable decline in cases and deaths since a peak in September 2019, the CDC stopped collecting these data from states as of February 2020.[13]
- ↑ Vitamin E acetate is used as an additive, most notably in THCl-containing e-cigarette, or vaping, products.[13] Vitamin E acetate dilutes THC oil without altering the look or thickness.[11] Research suggests that when vitamin E acetate is inhaled, it may interfere with normal lung functioning.[13]
- ↑ When aerosolized e-liquids are inhaled, the particles come in direct contact with the entire respiratory system.[45] Consequently, chemicals in e-cigarette aerosols, such as menthol and ethyl maltol may lead to inflammation, which is thought to be the dominant cause or contribution to vaping-related lung injury.[45] It has also been postulated that the pro-inflammatory effects caused by vape aerosols are partially mediated by reactive oxygen species, which may lead to cellular apoptosis through reactive oxygen species-mediated autophagy; this cellular death pathway is also mechanistically attributed to emphysema.[45] In addition, pulmonary inflammation and fibrosis may result in bronchiolitis obliterans, which is characterized by hypertrophy of the bronchiolar smooth muscle, peribronchiolar inflammatory infiltrates, mucus accumulation in the bronchiolar lumen and bronchiolar scarring.[45] This scarring is irreversible and bronchiolitis obliterans has no known cure.[45] While healthy patients may achieve complete improvement, the pulmonary health of most patients progressively worsens, and some may even require mechanical ventilation or lung transplants in severe cases.[45]
- ↑ A 2020 review states that "The wide distribution of cases across the United States and reports of similar case presentations in other parts of the world support the possibility that other presentations of e-cigarette- or vaping product-associated lung injury existed prior to this outbreak, and vaping-associated lung injuries have been under-recognized by health care workers."[58]
- ↑ A 2019 review states that "similar cases have been found in the UK and Japan, suggesting that this has the potential to be a more widespread phenomenon, although the country to country variations in frequency remain to be determined."[24]
- ↑ E-cigarettes come in hundreds of flavors beyond tobacco.[188] These non-tobacco flavors (henceforth flavored e-cigarettes) are thought to appeal to youth, leading to increased e-cigarette initiation, thereby making flavors a potential driving factor in the youth vaping epidemic.[188] As a result, there is growing concern that the widespread availability of flavors may lead a new generation to nicotine addiction when youth tobacco use rates are at an all-time low.[188] These concerns were exacerbated by the emergence of the vaping-induced lung illnesses in 2019, following which eight US states imposed temporary restrictions on flavors in e-cigarettes.[188]
- ↑ In sampling multiple e-cigarette delivery systems, a 2019 study found Juul pods were the only product to demonstrate in vitro cytotoxicity from both nicotine and flavor chemical content, in particular ethyl maltol.[44]
References
- ↑ Rebuli, Meghan E.; Rose, Jason J.; Noël, Alexandra; Croft, Daniel P.; Benowitz, Neal L.; Cohen, Alan H.; Goniewicz, Maciej L.; Larsen, Brandon T.; Leigh, Noel; McGraw, Matthew D.; Melzer, Anne C.; Penn, Arthur L.; Rahman, Irfan; Upson, Dona; Crotty Alexander, Laura E.; Ewart, Gary; Jaspers, Ilona; Jordt, Sven Eric; Kligerman, Seth; Loughlin, Ceila E.; McConnell, Rob; Neptune, Enid R.; Nguyen, Tran B.; Pinkerton, Kent E.; Witek, Theodore J. (January 2023). "The E-cigarette or Vaping Product Use–Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report". Annals of the American Thoracic Society. 20 (1): 1–17. doi:10.1513/AnnalsATS.202209-796ST. PMC 9819258. PMID 36584985.
{{cite journal}}: Check|pmc=value (help) - ↑ Baraona, L. Kim; Lovelace, Dawn; Daniels, Julie L.; McDaniel, Linda (2017). "Tobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women". Journal of Midwifery & Women's Health. 62 (3): 253–269. doi:10.1111/jmwh.12616. ISSN 1526-9523. PMID 28556464.
- ↑ Espinoza-Derout, Jorge; Shao, Xuesi M.; Lao, Candice J.; Hasan, Kamrul M.; Rivera, Juan Carlos; Jordan, Maria C.; Echeverria, Valentina; Roos, Kenneth P.; Sinha-Hikim, Amiya P.; Friedman, Theodore C. (7 April 2022). "Electronic Cigarette Use and the Risk of Cardiovascular Diseases". Frontiers in Cardiovascular Medicine. 9: 879726. doi:10.3389/fcvm.2022.879726. PMC 9021536. PMID 35463745.
This article incorporates text by Jorge Espinoza-Derout, Xuesi M. Shao, Candice J. Lao, Kamrul M. Hasan, Juan Carlos Rivera, Maria C. Jordan, Valentina Echeverria, Kenneth P. Roos, Amiya P. Sinha-Hikim, and Theodore C. Friedman available under the CC BY 4.0 license.
- ↑ 4.0 4.1 4.2 Mravec, Boris; Tibensky, Miroslav; Horvathova, Lubica; Babal, Pavel (2020). "E-Cigarettes and Cancer Risk". Cancer Prevention Research. 13 (2): 137–144. doi:10.1158/1940-6207.CAPR-19-0346. ISSN 1940-6207. PMID 31619443.
- ↑ Bracken-Clarke, Dara; Kapoor, Dhruv; Baird, Anne Marie; Buchanan, Paul James; Gately, Kathy; Cuffe, Sinead; Finn, Stephen P. (2021). "Vaping and lung cancer – A review of current data and recommendations". Lung Cancer. 153: 11–20. doi:10.1016/j.lungcan.2020.12.030. ISSN 0169-5002. PMID 33429159.
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 Bhatt, Jayesh Mahendra; Ramphul, Manisha; Bush, Andrew (2020). "An update on controversies in e-cigarettes". Paediatric Respiratory Reviews. 36: 75–86. doi:10.1016/j.prrv.2020.09.003. ISSN 1526-0542. PMC 7518964. PMID 33071065.
- ↑ Peruzzi, Mariangela; Biondi-Zoccai, Giuseppe; Carnevale, Roberto; Cavarretta, Elena; Frati, Giacomo; Versaci, Francesco (September 2020). "Vaping Cardiovascular Health Risks: an Updated Umbrella Review". Current Emergency and Hospital Medicine Reports. 8 (3): 103–109. doi:10.1007/s40138-020-00219-0.
- ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 Thomas, Katie; Kaplan, Sheila (14 October 2019). "E-Cigarettes Went Unchecked in 10 Years of Federal Inaction". The New York Times.
- ↑ 9.0 9.1 9.2 McAlinden, Kielan Darcy; Eapen, Mathew Suji; Lu, Wenying; Sharma, Pawan; Sohal, Sukhwinder Singh (2020). "The rise of electronic nicotine delivery systems and the emergence of electronic-cigarette-driven disease". American Journal of Physiology-Lung Cellular and Molecular Physiology. 319 (4): L585–L595. doi:10.1152/ajplung.00160.2020. ISSN 1040-0605. PMID 32726146.
- ↑ 10.0 10.1 Chaturvedi, Pankaj; Mishra, Aseem; Datta, Sourav; Sinukumar, Snita; Joshi, Poonam; Garg, Apurva (2015). "Harmful effects of nicotine". Indian Journal of Medical and Paediatric Oncology. 36 (1): 24. doi:10.4103/0971-5851.151771. ISSN 0971-5851. PMC 4363846. PMID 25810571.
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Cao, Dazhe James; Aldy, Kim; Hsu, Stephanie; McGetrick, Molly; Verbeck, Guido; De Silva, Imesha; Feng, Sing-yi (2020). "Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury". Journal of Medical Toxicology. 16 (3): 295–310. doi:10.1007/s13181-020-00772-w. ISSN 1556-9039. PMC 7320089. PMID 32301069.
- ↑ 12.0 12.1 12.2 12.3 12.4 12.5 "New York State Department of Health Announces Update on Investigation into Vaping-Associated Pulmonary Illnesses". New York State Department of Health. 5 September 2019.
- ↑ 13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 13.34 13.35 13.36 13.37 13.38 13.39 13.40 13.41 13.42 13.43 13.44 13.45 13.46 "Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products". Centers for Disease Control and Prevention. 3 August 2021.
This article incorporates text from this source, which is in the public domain.
- ↑ 14.0 14.1 "National Outbreak Case Definitions: Severe Pulmonary Disease Associated with Vaping or Dabbing". Public Health Agency of Canada. 25 September 2019.
- ↑ 15.0 15.1 15.2 15.3 15.4 15.5 Layden, Jennifer E.; Ghinai, Isaac; Pray, Ian; et al. (5 March 2020). "Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Final Report". New England Journal of Medicine. doi:10.1056/NEJMoa1911614. ISSN 0028-4793. PMID 31491072.
- ↑ Carlos, W. Graham; Crotty Alexander, Laura E; Gross, Jane E; Dela Cruz, Charles S; Keller, Jonathan M; Pasnick, Susan; Jamil, Shazia (October 2019). "Vaping Associated Pulmonary Illness (VAPI)". American Journal of Respiratory and Critical Care Medicine. 200 (7): P13–P14. doi:10.1164/rccm.2007P13. ISSN 1073-449X. PMID 31532695.
- ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 "Vaping-associated lung illness". Public Health Agency of Canada. 20 August 2020.
- ↑ 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 Xantus, Gabor Zoltan; Gyarmathy, Anna V; Johnson, Carole Ann (2020). "Smouldering ashes: burning questions after the outbreak of electronic cigarette or vaping-associated lung injury (EVALI)". Postgraduate Medical Journal. 96 (1141): 686–692. doi:10.1136/postgradmedj-2020-137673. ISSN 0032-5473. PMID 32554544.
- ↑ 19.0 19.1 Zulfiqar, Hassam; Rahman, Omar (14 March 2021). Vaping Associated Pulmonary Injury. StatPearls Publishing. PMID 32809491.
- ↑ 20.0 20.1 20.2 20.3 20.4 20.5 20.6 Boudi, F Brian; Patel, Sonia; Boudi, Ava; Chan, Connie (2019). "Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness". Cureus. 11 (12): e6350. doi:10.7759/cureus.6350. ISSN 2168-8184. PMC 6952050. PMID 31938636. This article incorporates text by F Brian Boudi, Sonia Patel, Ava Boudi, and Connie Chan available under the CC BY 3.0 license.
- ↑ Ind, Philip W (2020). "E-cigarette or vaping product use-associated lung injury". British Journal of Hospital Medicine. 81 (4): 1–9. doi:10.12968/hmed.2019.0371. ISSN 1750-8460. PMID 32339005.
- ↑ Stefaniak, Aleksandr B.; LeBouf, Ryan F.; Ranpara, Anand C.; Leonard, Stephen S. (2021). "Toxicology of flavoring- and cannabis-containing e-liquids used in electronic delivery systems". Pharmacology & Therapeutics. 224: 107838. doi:10.1016/j.pharmthera.2021.107838. ISSN 0163-7258. PMC 8251682. PMID 33746051.
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{{cite journal}}: Check|pmc=value (help) - ↑ 31.00 31.01 31.02 31.03 31.04 31.05 31.06 31.07 31.08 31.09 31.10 31.11 31.12 31.13 Dickson, EJ (10 September 2019). "Three Companies Subpoenaed in Weed Vape Illness Investigation". Rolling Stone.
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- ↑ 44.0 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 Bonilla, Alex; Blair, Alexander J.; Alamro, Suliman M.; Ward, Rebecca A.; Feldman, Michael B.; Dutko, Richard A.; Karagounis, Theodora K.; Johnson, Adam L.; Folch, Erik E.; Vyas, Jatin M. (2019). "Recurrent spontaneous pneumothoraces and vaping in an 18-year-old man: a case report and review of the literature". Journal of Medical Case Reports. 13 (1): 283. doi:10.1186/s13256-019-2215-4. ISSN 1752-1947. PMC 6732835. PMID 31495337. This article incorporates text by Alex Bonilla, Alexander J. Blair, Suliman M. Alamro, Rebecca A. Ward, Michael B. Feldman, Richard A. Dutko, Theodora K. Karagounis, Adam L. Johnson, Erik E. Folch, and Jatin M. Vyas available under the CC BY 4.0 license.
- ↑ 45.0 45.1 45.2 45.3 45.4 45.5 45.6 Hofmann, Joseph J.; Poulos, Victoria C.; Zhou, Jiahai; Sharma, Maksym; Parraga, Grace; McIntosh, Marrissa J. (24 January 2024). "Review of quantitative and functional lung imaging evidence of vaping-related lung injury". Frontiers in Medicine. 11. doi:10.3389/fmed.2024.1285361. PMC 10847544. PMID 38327710.
{{cite journal}}: Check|pmc=value (help) This article incorporates text by Joseph J. Hofmann, Victoria C. Poulos, Jiahai Zhou, Maksym Sharma, Grace Parraga, and Marrissa J. McIntosh available under the CC BY 4.0 license.
- ↑ 46.0 46.1 Hammond, David (September 2019). "Outbreak of pulmonary diseases linked to vaping". BMJ. 366: l5445. doi:10.1136/bmj.l5445. ISSN 0959-8138. PMID 31506254.
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- ↑ Rodger, James (1 October 2019). "Brit suspected to be first to die from condition linked to vaping". Coventry Telegraph.
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- ↑ Eshraghian, Emily; Al-Delaimy, Wael (11 February 2021). "A review of constituents identified in e-cigarette liquids and aerosols". Tobacco prevention & cessation. E.U. European Publishing. 7 (February): 1–15. doi:10.18332/tpc/131111. ISSN 2459-3087. PMC 7873740. PMID 33585727.
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- ↑ Fonseca Fuentes, Xavier; Kashyap, Rahul; Hays, J. Taylor; Chalmers, Sarah; Lama von Buchwald, Claudia; Gajic, Ognjen; Gallo de Moraes, Alice (2019). "VpALI—Vaping-related Acute Lung Injury: A New Killer Around the Block". Mayo Clinic Proceedings. 94 (12): 2534–2545. doi:10.1016/j.mayocp.2019.10.010. ISSN 0025-6196. PMID 31767123.
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- ↑ Kelland, Kate (14 October 2019). "Vaping illness, deaths likely very rare beyond U.S., experts say". Reuters.
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- ↑ TTR ADN (14 November 2019). "Papa van gestorven Raphaël getuigt: "Hoop dat dit anderen kan redden die dit vapen"" [Dad of Raphaël's death testifies: "Hope this can save others who vape this"]. Bron: VTM Nieuws (in Dutch).
{{cite news}}: CS1 maint: unrecognized language (link) - ↑ 112.0 112.1 Thompson, Linda (2 December 2019). "Brussels prosecutor opens investigation into vaping-related death". The Daily Breaking News.
- ↑ Brichard, David (14 November 2019). "La cigarette électronique a tué Raphaël, âgé de 18 ans: "le lien est établi", affirme Maggie De Block" [The e-cigarette killed Raphael, 18 years old: "the link is established" says Maggie De Block]. Bienvenue à la RTBF (in French).
{{cite news}}: CS1 maint: unrecognized language (link) - ↑ "Gerecht start toch onderzoek naar Brusselse vape-dode" [Court starts investigation into Brussels vape-dead]. Bruzz (in Dutch). 2 December 2019.
{{cite news}}: CS1 maint: unrecognized language (link) - ↑ "E-cigarette use or vaping: reporting suspected adverse reactions, including lung injury". gov.uk. 27 January 2020.
- ↑ Marlière, Camille; De Greef, Julien; Gohy, Sophie; Hoton, Delphine; Wallemacq, Pierre; Jacquet, Luc-Marie; Belkhir, Leïla (July 2020). "Fatal e-cigarette or vaping associated lung injury (EVALI): a first case report in Europe". European Respiratory Journal. 56 (1): 2000077. doi:10.1183/13993003.00077-2020. PMID 32217651.
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- ↑ 123.0 123.1 Butt, Yasmeen M.; Smith, Maxwell L.; Tazelaar, Henry D.; Vaszar, Laszlo T.; Swanson, Karen L.; Cecchini, Matthew J.; Boland, Jennifer M.; Bois, Melanie C.; Boyum, James H.; Froemming, Adam T.; Khoor, Andras; Mira-Avendano, Isabel; Patel, Aiyub; Larsen, Brandon T. (2019). "Pathology of Vaping-Associated Lung Injury". New England Journal of Medicine. 381 (18): 1780–1781. doi:10.1056/NEJMc1913069. ISSN 0028-4793. PMID 31577870.
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{{cite magazine}}: Cite magazine requires|magazine=(help) - ↑ 231.0 231.1 231.2 231.3 Gupta, Priya Sarin; Kalagher, Kelly M. (2021). "Where There Is (No) Smoke, There Is Still Fire: a Review of Trends, Reasons for Use, Preferences and Harm Perceptions of Adolescent and Young Adult Electronic Cigarette Use". Current Pediatrics Reports. doi:10.1007/s40124-021-00240-1. ISSN 2167-4841. PMC 8107807. PMID 33996271.
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- ↑ 250.0 250.1 Quinones Tavarez, Zahira; Li, Dongmei; Croft, Daniel P.; Gill, Steven R.; Ossip, Deborah J.; Rahman, Irfan (2020). "The Interplay Between Respiratory Microbiota and Innate Immunity in Flavor E-Cigarette Vaping Induced Lung Dysfunction". Frontiers in Microbiology. 11. doi:10.3389/fmicb.2020.589501. ISSN 1664-302X. PMC 7772214. PMID 33391205. This article incorporates text by Zahira Quinones Tavarez, Dongmei Li, Daniel P. Croft, Steven R. Gill, Deborah. Ossip, and Irfan Rahman5 available under the CC BY 4.0 license.
- ↑ Deliwala, Smit; Sundus, Saira; Haykal, Tarek; Theophilus, Nikita; Bachuwa, Ghassan (April 2020). "E-cigarette, or Vaping, Product Use-associated Lung Injury (EVALI): Acute Lung Illness within Hours of Switching from Traditional to E-cigarettes". Cureus. doi:10.7759/cureus.7513. ISSN 2168-8184. PMC 7195202. PMID 32373415. This article incorporates text by Smit Deliwala, Saira Sundus, Tarek Haykal, Nikita Theophilus, and Ghassan Bachuwa2 available under the CC BY 4.0 license.
- ↑ Wetzel, Tanner J.; Wyatt, Todd A. (2020). "Dual Substance Use of Electronic Cigarettes and Alcohol". Frontiers in Physiology. 11. doi:10.3389/fphys.2020.593803. ISSN 1664-042X. PMC 7667127. PMID 33224040. This article incorporates text by Tanner J Wetzel and Todd A Wyatt available under the CC BY 4.0 license.
- ↑ Cecchini, Matthew J.; Mukhopadhyay, Sanjay; Arrossi, Andrea V.; Beasley, Mary B.; Butt, Yasmeen M.; Jones, Kirk D.; Pambuccian, Stefan; Mehrad, Mitra; Monaco, Sara E.; Saqi, Anjali; Smith, Maxwell L.; Tazelaar, Henry D.; Larsen, Brandon T. (2020). "E-Cigarette or Vaping Product Use-Associated Lung Injury: A Review for Pathologists". Archives of Pathology & Laboratory Medicine. 144 (12): 1490–1500. doi:10.5858/arpa.2020-0024-RA. ISSN 1543-2165. PMID 32401055.
- ↑ Górna, Ilona; Napierala, Marta; Florek, Ewa (2020). "Electronic Cigarette Use and Metabolic Syndrome Development: A Critical Review". Toxics. 8 (4): 105. doi:10.3390/toxics8040105. ISSN 2305-6304. PMC 7711672. PMID 33212878. This article incorporates text by Ilona Górna, Marta Napierala, Ewa Florek available under the CC BY 4.0 license.
- ↑ 255.0 255.1 Stratford, Kimberly; Kc, Prabha; Rudy, Susan; Weidner, Anna-Sophie; Callahan-Lyon, Priscilla; Valerio, Luis G. (January 2022). "Exploring the potential neurotoxicity of vaping vitamin E or vitamin E acetate". Toxicology and Applied Pharmacology. 434: 115813. doi:10.1016/j.taap.2021.115813. PMID 34838608.
- ↑ Bandara, Nilanga Aki; Jhauj, Ricky; Fernando, Jayson; Mehrnoush, Vahid; Wijesinghe, Namal (2021). "Overlapping public health crises during the coronavirus disease pandemic". World journal of emergency medicine. World Journal of Emergency Medicine. 12 (2): 151. doi:10.5847/wjem.j.1920-8642.2021.02.011. ISSN 1920-8642. PMC 7947562. PMID 33728009.
- ↑ 257.0 257.1 257.2 257.3 Hage, R.; Fretz, V.; Schuurmans, M.M. (September 2020). "Electronic cigarettes and vaping associated pulmonary illness (VAPI): A narrative review". Pulmonology. 26 (5): 291–303. doi:10.1016/j.pulmoe.2020.02.009.
- ↑ 258.0 258.1 Mastrorilli, C; Pecoraro, L; Arasi, S; Barni, S; Caminiti, L; Castagnoli, R; Giovannini, M; Liotti, L; Mori, F; Saretta, F; Marseglia, GL; Novembre, E; Rare Allergic Diseases Commission of the Italian Society of Pediatric Allergy and, Immunology. (28 March 2022). "Pediatric hypersensitivity pneumonitis: literature update and proposal of a diagnostic algorithm". Italian journal of pediatrics. 48 (1): 51. doi:10.1186/s13052-022-01239-0. PMID 35346317.
- ↑ 259.0 259.1 Lu, Shijun (Jimmy); Li, Lingyun; Duffy, Bryan C.; Dittmar, Mark A.; Durocher, Lorie A.; Panawennage, Deepika; Delaney-Baldwin, Em R.; Spink, David C. (27 October 2021). "Investigation of Vaping Fluids Recovered From New York State E-Cigarette or Vaping Product Use-Associated Lung Injury Patients". Frontiers in Chemistry. 9: 748935. doi:10.3389/fchem.2021.748935. PMC 8579054. PMID 34778204. This article incorporates text by Shijun Jimmy Lu, Lingyun Li, Bryan C Duffy, Mark A Dittmar, Lorie A Durocher, Deepika Panawennage, Em R Delaney-Baldwin, David C Spink available under the CC BY 4.0 license.
- ↑ Friedman, Jonathan; Schooler, Gary R.; Kwon, Jeannie K.; Artunduaga, Maddy (September 2022). "Pediatric electronic cigarette or vaping product use–associated lung injury (EVALI): updates in the coronavirus disease 2019 (COVID-19) pandemic era". Pediatric Radiology. 52 (10): 2009–2016. doi:10.1007/s00247-022-05454-z. PMC 9388356. PMID 35982339.
- ↑ Wang, Y; Tong, YQ; Zhou, W; Tian, ZL; Li, NN; Lyu, XX; Sun, TY; Ke, HX (12 May 2021). "[Electronic cigarette use-associated lung injury: a case report and literature review]". Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases. 44 (5): 481–487. doi:10.3760/cma.j.cn112147-20200818-00906. PMID 34865370.
- ↑ 262.0 262.1 Kingsley, Thomas (12 February 2022). "Teenager addicted to vaping on life support 'toxic' e-cigarette chemical damages lungs". The Independent.
- ↑ "Young woman put on life support after daily vaping habit sends urgent message". news.com.au. 26 January 2022.
- ↑ 264.0 264.1 264.2 264.3 Schekochikhina, Natalia; Meister, Riley; Trivedi, Kovid (15 May 2022). "E-cigarette or Vaping Product Associated Lung Injury (EVALI) Presenting As Cardiac Arrest". Cureus. doi:10.7759/cureus.25010. PMC 9198287. PMID 35719811. This article incorporates text by Natalia Schekochikhina, Riley Meister, and Kovid Trivedi available under the CC BY 4.0 license.
- ↑ 265.0 265.1 265.2 "E-cigarette, or Vaping, Associated Lung Injury (EVALI)". California Department of Public Health. 14 December 2023. This article incorporates text from this source, which is in the public domain.
External links
- "Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products". Centers for Disease Control and Prevention. 3 August 2021.
- Chadi, Nicholas; Vyver, Ellie; Bélanger, Richard E (17 September 2021). "Protecting children and adolescents against the risks of vaping". Paediatrics & Child Health. 26 (6): 358–365. doi:10.1093/pch/pxab037. PMC 8448493. PMID 34552676.
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