Pulmonary diseases related to Vaping Puzzle Doctors

"We have not identified any agents or agents responsible for these diseases," said Jonathan Meiman, head of medical services at the Wisconsin Department of Health Services. "The other side is simply able to clearly describe what is happening from a medical point of view. There is still a lot of work 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 coughing after being vaped, some also with gastrointestinal problems, fatigue, fever, and weight loss. . Computed tomography in the patients revealed abnormal lung abnormalities and many patients appeared to be suffering from acute respiratory distress syndrome. This liquid filled the tiny alveolar sacs of the lungs and made oxygenation of the blood difficult. It is thought that the disease is a kind of inflammation or injury to the lungs due to chemical exposure.

"We are seeing what we believe to be a recent lung disease associated with electronic cigarette products," he said.

Jennifer Layden,

Chief Medical Officer of the Illinois Department of Public Health.

Many researchers and health care providers have long been concerned about the health risks posed by electronic cigarettes and vaping, particularly as young adults and adolescents become more and more interested. to products. Users ingest a range of substances, ranging from liquids to nicotine, which may have fruity flavors such as mango or marijuana products. Patients are often young and relatively healthy.

On Wednesday, the Trump administration announced plans to ban the market for all tobacco-free vaping products, as health authorities continue to investigate these diseases.

The Food and Drug Administration has received more than 120 samples of vaping-related products for analysis. Many of the samples tested to date have contained tetrahydrocannabinol, or THC, a chemical found in marijuana known for its psychoactive effects, rather than nicotine. Most samples containing THC also contain vitamin E acetate, an oil that is sometimes found in dietary supplements and skin products, the agency added.

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

The FDA has warned consumers to avoid vaping products containing THC. The CDC, along with other health officials, service providers and organizations, warned people against vaping.

Many of the reported symptoms are usually a sign of infection or pneumonia. Some clinicians are starting to administer antibiotics to patients trying to fight an infection. But often, patients do not get better with antibiotics, or sometimes they get worse. According to a report on 53 patients in Illinois and Wisconsin, all patients who received antibiotics on an outpatient basis had progressive symptoms and were eventually hospitalized.

"They feel bad everywhere and they feel terrible. They tell us that they feel like they have the flu, "said Dixie Harris, a pulmonologist at Intermountain Healthcare in Utah, who has witnessed several cases. "We have protocols if we think it's a bacterial infection. We put them immediately on antibiotics. If they are extremely sick, they are admitted. And if it is obvious that it is not an infection due to blood tests or cultures, we take them on steroids. "

Steroids are generally used to soothe inflammation or allergic reactions in patients, and medications seem to erase inflammation in patients a few days after their administration, say doctors.

Although the clinical symptoms are common to all patients, the cases are not identical. Most patients seem to develop rapid symptoms, but others are more chronic over several weeks or months and the severity level also differs.

Melodi Pirzada, head of pediatric pneumology at New York University's Winthrop Hospital, examined two patients in one week. One of them was an 18 year old man who developed rapid symptoms and who had to be intubated and put under ventilation to help him breathe. The second was a 19-year-old man who had more chronic symptoms, including a 25-kilogram weight loss in three months, but he did not need extra oxygen. Both reported having sprayed products containing THC.

Differences between patients are not just external. A report from the New England Journal of Medicine examined 19 chest CT scans and observed imaging schemes consistent with acute eosinophilic pneumonia, diffuse alveolar lesions, the organization of pneumonia and pneumonia. lipoid, without any motive on the set of exams.

Some cases have been diagnosed as acute lipoid pneumonia, which is an inflammatory reaction when inhaling fat or oils, and have resulted in an accumulation of fat in the lungs. But again, this does not apply to all patients and fat accumulation is not necessarily a sign of this disease.

"There are multiple types of injuries," said Travis Henry, an associate professor of clinical radiology at the University of California at San Francisco and author of the journal. "Not all patients have the same response or the same reaction."

In collaboration with state health services, the CDC has published a symptom case definition to assist authorities in investigating probable and confirmed cases related to vaping. A confirmed case describes a person who has been vaping in the last 90 days and who had flickering in the chest with opacity or opacities, and no signs of infection or other plausible diagnosis.

It is important not to assume that each person with reported respiratory symptoms and a history of vaping is suffering from a spray-related illness, said Dr. Pirzada. "We must exclude all possibilities before making this call."

The majority of the 450 patients were hospitalized and many were intubated. Six are dead.

Write to Brianna Abbott at [email protected]