Risking health for 2019: Doctors do not know why hundreds of people are sick

More than 200 people across the United States have contracted a mysterious illness that appears to be related to a vaping – the latest warning about the potentially serious risks of using the electronic cigarette for health.

As of August 27, there were 215 cases of severe respiratory disease in 25 states since the end of June, the Center for Disease Control and Prevention (CDC) reported on Friday. All patients reported using electronic cigarette products. But, although officials believe their disease is related to inhaling vaping, they have not been able to determine which ingredient or device could be causing the problem.

Until now, patients have a few things in common. They suffered from respiratory symptoms, including coughing, shortness of breath, chest pain and breathing difficulties. Some became seriously ill, even ending up in intensive care units powered by oxygen through fans or intubation. Most have between the late teens and twenties, with no underlying health issues. In many cases, it was also a question of vaping liquids containing THC (although it is not clear if it came from cannabis or nicotine electronic cigarettes), and the CDC distinguished black market products as another possible commonality.

"Anyone who uses e-cigarette products should not purchase these products on the street (for example, e-cigarette products containing THC or other cannabinoids) and should not alter the products of the electronic cigarette nor add substances not covered by the law. manufacturer, warned the CDC. "Electronic cigarette products should not be used by young people, young adults, pregnant women, or adults who do not currently use tobacco products."

But this is not the only alarming health problem related to vaping lately – and that's why our vision of the safety of these devices is likely to change over the next few weeks and years. Here is what we know so far.

Doctors treat a disease of unknown origin

Patients with the mysterious disease began to experience symptoms from a few days to several weeks after using electronic cigarettes. Respiratory problems were the most common, but some people also reported nausea, vomiting, diarrhea, fatigue, fever and weight loss.

The doctors tried to find a common bacterial or viral source of the disease, but they did not reveal anything. The patients only have one vape in common, but no specific product or substance connects the cases to each other. That's why an investigation is underway and officials urge doctors and the public to report potential cases.

In the absence of a known cause, the treatment of patients has proved delicate. Doctors must consider a range of triggers, according to the CDC. Although some steroid-treated patients have shown improvement, healthcare providers are advised to only prescribe them on a case-by-case basis.

The disease caused the first known death from a vape in America – and it's scary considering what we know about who is vaping

In the coming days, there could be more cases. It is possible that the number of deaths also increases.

On August 23, authorities reported the first death related to a vaping in the midst of a series of diseases. The patient – a 30-year-old adult woman based in Illinois – suffering from a severe respiratory illness was hospitalized after a vaping and died. No other details regarding the patient, the vaping products that she used or her health condition was made public.

The potential severity of the disease is particularly frightening, given the people it seems to primarily affect: young people in their late teens and early twenties. This is not surprising since we know that vaping has jumped in this group.

According to a survey conducted in 2018 by the National Institutes of Health, which tracks substance use among US teens, the number of seniors in high school who report being asleep at nicotine in the past 30 days has doubled since 2017, from 11% to almost 21%. This is the highest increase ever recorded for a substance in the 43 years of the survey. And that means that one-quarter of Grade 12 students are now using, at least occasionally, such a recent nicotine device, we have no idea of ​​its long-term impact on health.

The number of grade 12 students who used any type of e-cigarette in the last 30 days was even higher: 27%. In 2018, we also learned that the number of high school students who have used e-cigarettes in the past 30 days has increased by about 75% since 2017. In contrast, less than 5% of adults currently use e-cigarettes.

Although respiratory diseases are new, we already know that breathing vapors in the lungs can irritate them.

Even before the onset of the mysterious disease, researchers discovered that steam could irritate the lungs.

Researchers have recently followed 28,000 adults to determine whether e-cigarettes are exacerbating their wheezing. Some of the people in the study were vapers who only used electronic cigarettes; others were only smokers; still others were double users (smokers and vapors); and finally, there were people who did not smoke or drink at all.

Compared to the latter group, non-users, the risk of wheezing in vapors has almost doubled.

When the researchers reviewed the history of vaping or smoking among the study participants, they came to even more interesting conclusions: the risk of wheezing was higher among current vapers who were also ex-smokers. than for ex-smokers who had not vaporized. In other words, it was not just the potential smoking history of a vaper that increased wheezing in the vapers. "Therefore, the authors conclude, it will be beneficial to promote the complete cessation of smoking and vaping to minimize the risk of wheezing and other respiratory symptoms."

Other studies have sought to determine whether electronic cigarette users were more likely to develop chronic obstructive pulmonary disease (COPD), a group of pulmonary complications that make breathing difficult. Research on mice and human airway cells has shown that nicotine-containing electronic cigarette vapor appears to trigger "effects normally associated with the development of COPD."

In preliminary studies on humans, researchers have also discovered associations between normal vaping and COPD. But again, this human research was observational, not experimental, so it is not yet clear that vaping has caused COPD. (For example, people with COPD may be more likely to use electronic cigarettes, such as former smokers looking for a harm reduction method.)

Vaping has been linked to other serious health problems

There is still much that we do not know about the short and long-term effects of using electronic cigarette products, mainly because they have not been on the market for a very long time (and that vapor-related diseases can take years or even decades). manifest).

Among the many health concerns, the FDA warned that nicotine seizures could be a rare side effect of spraying.

Nicotine also causes heart health problems. "Nicotine [in e-cigarettes] does the same thing as [combustible] cigarettes, "Vox said earlier, Neal Benowitz, a professor of medicine at the University of California at San Francisco, who studies the connection between electronic cigarettes and heart health. It can increase the adrenaline that circulates in our body and activate the sympathetic nervous system (our "fight or flight" response), increase blood pressure, speed up the heart rate and cause the narrowing of the arteries – the vessels that carry the blood.

Even if the vapor does not contain nicotine, it can cause other risks to the health of the heart. The heating element of electronic cigarettes emits tiny particles, sometimes including metals, which can lodge deep in the lungs and be absorbed by the circulatory system. "That's where we see potential cardiovascular toxicity," said Maciej Goniewicz, a leading e-cigarette researcher at the Roswell Park Comprehensive Cancer Center in Buffalo, New York.

Recent studies have shown that inflating e-cigarettes increases the concentration of these microscopic pollutants – especially PM2.5 and ultrafine particles – in indoor environments.

Researchers do not yet know what risks run the electronic cigarette aerosol particles, but these tiny particles have been the subject of numerous studies in the context of air pollution and smoking. In these studies, researchers have established a link between exposure to small particles and a range of adverse cardiovascular consequences, including heart attacks, high blood pressure, and coronary heart disease.

Aside from the long-term health risks, a recent New England Journal of Medicine The case study describes a 17-year-old Nevada teenager who came to the emergency room after a VGOD electronic cigarette exploded in his mouth. "He had a circular puncture on his chin, wide lacerations in his mouth, multiple disordered lower incisors and a bony incongruity in the left mandible," wrote the doctors who treated the boy.

For the moment, the wave of vaping-related diseases is a reminder that there are many products that have not been tested by public officials or regulated in any way.

"These [new] cases demonstrate the importance of effective regulation, "said David Liddell Ashley, former director of the science office at the FDA's Center for Tobacco Products. "Without tests, pre-market reports and analysis, consumers become the subjects of testing."