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Vaping-Related Lung Diseases Puzzle Doctors



While investigators are examining more than 450 cases of people ill after vaporizing, doctors are working to determine the cause of their mysterious lung disease.

"We have identified no or more pathogens that cause these diseases. Said Jonathan Meiman, chief physician of the Wisconsin Health Services Division, "The other side is only able to clearly describe what is going on from a medical perspective. Much of this work has yet to be done. "

Hundreds of patients in 33 states and US territories suffered from respiratory ailments such as chest pain, shortness of breath and coughing after vaporizing, some also suffering from gastrointestinal problems and fatigue, fever and weight loss. Patient CT scans showed cloudy anomalies in their lungs, and many patients appeared to be suffering from acute respiratory distress syndrome, a condition in which fluid fills the tiny air sacs in the lungs and makes it difficult to deliver oxygen to a person's blood. It is believed that the diseases are a kind of inflammation or injury to the lungs by chemical action.

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"We see what we think is a new-onset lung disease associated with e-cigarette products."

Jennifer Layden,

Chief Medical Officer at the Illinois Department of Public Health.

Many researchers and healthcare providers have long been concerned about the health risks of e-cigarettes and vapors, especially as young adults and adolescents increasingly use the products. Users take a variety of substances, ranging from nicotine-containing liquids with fruity aromas like mango to marijuana-based products. Patients are often young and relatively healthy.

On Wednesday, the government told Trump it wanted to ban all non-tobacco-flavored steam products from the market as health authorities continue to investigate the disease.

Drug Administration has received more than 1

20 product samples for analysis associated with Vaping Disease. Many of the samples tested so far contained tetrahydrocannabinol or THC, a chemical in marijuana more known for its psychoactive effects than nicotine. Most samples containing THC also contained Vitamin E acetate, an oil sometimes found in dietary supplements and skin products.

According to the Centers for Disease, however, no product or device has ever been associated with all cases of 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 in its beginnings Juul reflected the tobacco industry's advertising book to appeal to young people. Photo: Natalia V. Osipova / The Wall Street Journal

The FDA has warned consumers to avoid THC-containing steam products. The CDC and other health authorities, providers and organizations have directed people to stay away from vapors.

Many of the reported symptoms are usually indicative of infection or pneumonia, which is why some clinicians try to treat patients with antibiotics to fight an infection. But often antibiotics do not get better or sometimes even worse in patients. 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 have pain everywhere and feel terrible. They tell us that they feel they have flu, "said Dixie Harris, a pulmonologist at Intermountain Healthcare, Utah. "We have protocols if we believe that it is a bacterial infection, we immediately put them on antibiotics, if they are extremely ill, they will be admitted and if it is obvious that they are not an infection by blood tests or cultures, we use them against steroids. "

Steroids are typically used to suppress inflammation or allergic reactions in patients Some days after administration, doctors say.

Although patients often experience clinical symptoms The cases are not identical: most patients appear to develop rapid symptoms, but others are more chronic over weeks or months, and the severity is also different.

Melodi Pirzada, chief physician for pediatric pulmonology at the NYU Winthrop Hospital, saw two patients within the span of a week, one was an 18-year-old man who developed rapid symptoms and had to be intubated and ventilated so that he could breathe better. The second was a 19-year-old man who had more chronic symptoms, including a weight loss of 25 pounds over a three-month period, but did not need additional oxygen. Both reported THC-containing evaporation products.

The differences between patients are not just external. A report from the New England Journal of Medicine examined chest CT scans for 19 cases and found imaging patterns consistent with acute eosinophilic pneumonia, diffuse alveolar damage, organized pneumonia, and lipoid pneumonia.

Cases were diagnosed as acute lipoid pneumonia, which is an inflammatory reaction to the inhalation of fats or oils, and accumulations of fat in the lungs were noted. But even here, this is not true for all patients, and fat is not necessarily a sign of this condition.

"There are several different patterns of injury," said Travis Henry, an associate professor of clinical radiology at the University of California at San Francisco and author of the journal paper. "Not every patient has the same reaction or reaction to it."

In collaboration with state health departments, the CDC published a case definition of symptoms to help officials investigate probable and confirmed cases related to vaporizing. A confirmed case describes a person who has been experiencing cloudiness or cloudiness in their breast examinations and no evidence of infection or other plausible diagnosis for the past 90 days. Pirzada suffer from respiratory symptoms and a reported vaping history of vaping disease. "We have to rule out any possibility before making this call."

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

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

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