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Vaping-related lung problems Puzzle doctors



When investigators examine more than 450 cases of people who became ill after vaping, doctors work to identify the nature of their mysterious lung problems.

"We have not identified an agent or agents that cause these diseases," said Jonathan Meiman, medical director at the Wisconsin Department of Health Services. "The other side is just being able to clearly describe what is happening from a medical perspective. Much of that work still needs to be done. "

Hundreds of patients in 33 states and one US territory have suffered from respiratory symptoms such as chest pain, shortness of breath and cough after vaping, with some also experiencing gastrointestinal problems, fatigue, fever and weight loss. The patient's CT scans showed hazy abnormalities in the lungs, and many patients appeared to suffer from acute respiratory distress syndrome, a condition where fluid fills the small air sacs in the lungs and makes it difficult to get oxygen into a person's blood. The diseases are believed to be some kind of inflammation or damage to the lungs due to chemical exposure.

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"We see what we believe is a recently occurring lung disease associated with e-cigarette products," said

Jennifer Layden,

chief physician at the Illinois Department of Public Health.

Many researchers and caregivers have long been concerned about the health risks of e-cigarettes and vaping, especially when young adults and teens increasingly took to the products. Users weaponize a number of substances from nicotine-laced liquids that may come in fruity flavors like mangoes to marijuana-based products. Patients are often young and relatively healthy.

On Wednesday, the Trump administration said it plans to ban all non-flavored steam products from the market, as health officials continue to investigate the illnesses.

The Food and Drug Administration has received more than 1

20 product samples linked to vaping disease for analysis. Many of the samples tested so far have contained tetrahydrocannabinol, or THC, a chemical in marijuana known for its psychoactive effects, rather than nicotine. Most samples with THC also contained added vitamin E acetate, an oil sometimes found in supplements and skin products, the agency says.

But no product or device has been associated with all cases according to the Centers for Disease Control and Prevention and the FDA.

Altria, the manufacturer of Marlboro cigarettes, invested nearly $ 13 billion in the e-cigarette company Juul. Some experts say that Juul in his early days mirrored the tobacco industry's advertising playbook in an attempt to connect young people. Photo: Natalia V. Osipova / The Wall Street Journal

The FDA has warned consumers to avoid THC-containing steam products. The CDC, like other health officials, suppliers and organizations, has warned people to avoid steam altogether.

Many of the symptoms reported are usually a sign of infection or pneumonia, so some clinics are starting patients on antibiotics to try to fight an infection. But often patients do not get better at antibiotics, or sometimes they get worse. According to a report on 53 patients in Illinois and Wisconsin, all patients receiving antibiotics such as outpatients had progressive symptoms and eventually hospitalized.

“They feel sore everywhere and they feel awful. They say they feel like they have the flu, says Dixie Harris, pulmonologist at Intermountain Healthcare in Utah, who has seen a number of cases. "We have protocols if we think it is a bacterial infection. We immediately put them on antibiotics. If they are extremely sick, they admit. And if it is obvious that it is not an infection of blood work or cultures, we put them on steroids. . "

Steroids are usually used to stop inflammation or allergic reactions in patients, and the drugs seem to clear the inflammation in the patients for a few days after administration, doctors say.

Although there are common clinical symptoms among the patients, the cases are not Most patients appear to develop rapid symptoms, but others are more chronic over a number of weeks or months, and the severity also varies.

Melodi Pirzada, director of pediatric pulmonary monology at NYU Winthrop Hospital, saw two patients within the range of one week One was an 18-year-old man who developed rapid symptoms and needed to be intubated and put on a ventilator to help The other was a 19-year-old man who had more chronic symptoms, including losing 25 pounds over three months, but he did not need extra oxygen. Both reported on vaping products containing THC.

The differences between patients are not just external. A New England Journal of Medicine report looked at breast CT scans in 19 cases and looked at imaging patterns that matched acute eosinophilic pneumonia, diffuse alveolar injury, pneumonia organization, and lipid pneumonia, without a pattern across all scans.

cases have been diagnosed as acute lipid pneumonia, which is an inflammatory response to inhalation of fat or oils and has noted fat buildup in the lungs. But once again, it does not apply to all patients, and fat build-up is not necessarily a sign of this condition.

"There are several different injuries," says Travis Henry, an associate professor of clinical radiology at the University of California, San Francisco and an author of the magazine. "Not every patient has the same response or reaction to it."

The CDC worked with state health departments and released a case definition of symptoms to help officials investigate probable and confirmed cases related to vaping. A confirmed case describes a person who has weapons in the past 90 days who have exhibited danger or opacity in their chest examinations, and no evidence of an infection or other probable diagnosis.

It's important not to assume that every person who comes in with respiratory symptoms and a reported history of gunshots is suffering from a gun-related illness, Dr. Pirzada. "We must rule out all possibilities before we call it."

The majority of the 450 patients have been hospitalized and many have been intubated. Six have died.

Write to Brianna Abbott at brianna.abbott@wsj.com

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