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Outbreak of lung injury associated with vaping

The Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of e-cigarette, or vaping, product-use-associated lung injury. As of Nov. 5, 39 deaths have been confirmed in 24 states and the District of Columbia.

All patients in the investigation have reported a history of using e-cigarette, or vaping, products.

Electronic cigarettes, or e-cigarettes, work by heating a liquid to produce an aerosol that users inhale into their lungs. The liquid can contain nicotine, THC and cannabinoid (CBD) oils, and other substances, flavorings and additives. E-cigarettes are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems. Using an e-cigarette is commonly called vaping.

Tetrahydrocannabinol, or THC, is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing products. The latest national and state findings suggest products containing THC, particularly from informal sources like friends, family, or in-person or online dealers are linked to most of the cases and play a major role in the outbreak.

No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. Many different substances and product sources are still under investigation.

While it appears that vitamin E acetate is associated with product-use-associated lung injury, evidence is not yet sufficient to rule out contribution of other chemicals of concern.

Patients in this investigation have reported symptoms such as cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhea, fever, chills or weight loss.

Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks. A lung infection does not appear to be causing the symptoms.

The CDC recommends that you should not use e-cigarette, or vaping, products that contain THC. Additionally, it recommends that people should not buy any type of e-cigarette or vaping products, particularly those containing THC, from informal sources such as friends, family or in-person or online dealers.

The recommendations also say people should not modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.

Since the specific compound or ingredient causing lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products.

Adults using e-cigarettes to quit smoking should not go back to smoking; they should weigh all risks and benefits and consider utilizing FDA-approved nicotine replacement therapies.

If you continue to use an e-cigarette, or vaping, product, carefully monitor yourself for symptoms and see a health care provider immediately if you develop symptoms like those reported in this outbreak.

Irrespective of the ongoing investigation e-cigarette products should never be used by youths, young adults or women who are pregnant.

Adults who do not currently use tobacco products should not start using e-cigarette products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.

THC use has been associated with a wide range of health effects, particularly with prolonged heavy use. The best way to avoid potentially harmful effects is to not use THC. Persons with marijuana use disorder should seek evidence-based treatment by a health care provider.

It is important for parents to communicate with their child about the risks of nicotine, THC or other substance use. CDC offers a Talk With Your Teen About E-cigarettes tip sheet to help parents talk with their children about why e-cigarettes are harmful for them. It is available at http://bit.ly/2qLR093.

If you are currently vaping marijuiana/THC for medical use, the CDC recommends talking with your health care provider about other treatment options for the conditions. It is not known if there are different health effects of using different forms of marijuana, such as smoking, vaping and edibles, or whether transitioning from one form to another might reduce harm.

Both THC-containing and nicotine-containing e-cigarette, or vaping, products purchased legally might also contain harmful substances. It is difficult to know what is in these products and full ingredient lists are typically not available. It is difficult to know what substances the products contain and the products’ potential for harm.

If you are concerned about your health after using an e-cigarette, or vaping, product, contact your health care provider or local poison control center at 1-800-222-1222.

To Your Health is provided by the staff of Boulder City Hospital. For more information, call 702-293-4111, ext. 576, or visit bouldercityhospital.org.

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