This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2019/09/11/health/is-vaping-safe.html

The article has changed 3 times. There is an RSS feed of changes available.

Version 1 Version 2
Is It Time to Quit Vaping? What You Need to Know About Vaping-Related Lung Illness
(32 minutes later)
Public health officials have long been wary of e-cigarettes, also known as vape pens. But after an outbreak of serious lung illnesses this summer, those concerns became much more urgent. Hundreds of people across the country have been sickened by a severe lung illness linked to vaping, and a handful have died, according to public health officials. Many were otherwise healthy young people, in their teens or early 20s. Investigators from numerous states are working with the federal Centers for Disease Control and Prevention and the Food and Drug Administration in an urgent effort to figure out why.
Last week, federal health officials announced that e-cigarettes — which people can use to vaporize and inhale liquids containing nicotine or T.H.C., the high-inducing chemical in marijuana — could be behind at least 450 cases of severe lung disease in 33 states. The number of reported deaths reached six on Tuesday.
On Wednesday, Trump administration officials said they would move toward a ban on the sale of most flavored e-cigarettes.
Public health officials are still trying to figure out why so many people have gotten sick, and have recommended that people cut back on vaping in the meantime.
Here’s what we know so far.Here’s what we know so far.
The lung illness associated with vaping starts with symptoms that can include nausea, vomiting, fatigue, coughing and fever, escalating to shortness of breath that can become so extreme as to require hospitalization. Some patients have needed supplementary oxygen. [Read more: The Trump administration is weighing a ban on some flavored e-cigarettes.]
On lung scans, the illness looks like bacterial or viral pneumonia, but no infection has been found in testing. Anyone who uses e-cigarettes or other vaping devices, whether to consume nicotine or substances extracted from marijuana or hemp, may be at risk because investigators have not determined whether a specific device or type of vaping liquid is responsible.
The Centers for Disease Control and Prevention released an official health advisory regarding the illness last month. It said people concerned about the disease should “consider refraining from using e-cigarette products.” The Food and Drug Administration is warning that there appears to be a particular danger for people who vape THC, the psychoactive chemical in marijuana. The F.D.A. said a significant subset of samples of vaping fluid used by sick patients included THC and also contained a chemical called vitamin E acetate.
There are also broader concerns about the safety of e-cigarettes. The F.D.A. issued this statement: “Because consumers cannot be sure whether any THC vaping products may contain vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores.”
Although e-cigarettes do not contain the tar and other carcinogens of traditional tobacco products, questions remain about the effects nicotine may have — especially on young people. Some experts say that nicotine may have harmful effects on a developing teenager’s brain, and some research has suggested that ingesting nicotine can affect the heart and arteries. But some of the patients who have fallen severely ill said they did not vape THC. In 53 cases of the illness in Illinois and Wisconsin, 17 percent of the patients said they had vaped only nicotine products, according to an article published on Friday in The New England Journal of Medicine.
The researchers who wrote the journal article cautioned, “e-cigarette aerosol is not harmless; it can expose users to substances known to have adverse health effects, including ultrafine particles, heavy metals, volatile organic compounds and other harmful ingredients.”
Vaping gained popularity in recent years as an alternative to tobacco cigarettes. According to a history compiled by the Consumer Advocates for Smoke Free Alternatives Association, modern e-cigarettes did not make their way to the United States until 2006. The health effects of some of those chemicals are not fully understood, the researchers wrote, even though the products are already on the market.
By 2014, “vape” was the Oxford Word of the Year. The early symptoms include fatigue, nausea, vomiting, coughing and fever, escalating to shortness of breath, which can become so extreme it can prompt an emergency room visit or require hospitalization.
E-cigarette users can inhale nicotine without the deadly tar found in tobacco products, and many smokers use vape pens as a quitting aid. Some patients have needed supplementary oxygen, including a ventilator in as many as a third of cases analyzed in The New England Journal of Medicine.
But some American public health experts, led by the C.D.C., have been suspicious of e-cigarettes. And regulations have largely banned vaping product companies from making broad claims about health and harm as compared with tobacco products — at least not without extensive data. On lung scans, the illness looks like a bacterial or viral pneumonia that has attacked the lungs, but no infection has been found in testing.
Skeptics of the devices have warned about the potential for unknown risks, as well as the dangers of opening a new door to addiction for children and teenagers. Flavored products were considered especially worrisome, especially when it became clear that vaping products were popular with minors. Health officials say that the riskiest behavior is using vaping products bought on the street instead of from a retailer, or those that have been tampered with or mixed.
The Food and Drug Administration gained jurisdiction over e-cigarettes in 2016. Last year, amid rising reports of teen use, the agency began investigating major manufacturers of vaping products that appeal to young people, focusing on Juul, the dominant brand of e-cigarette vape pods. Juul stopped selling most of its popular flavored nicotine pods in stores last fall, but some look-alikes have since popped up. Mitch Zeller, director for the Center for Tobacco Products at the F.D.A., said, “If you’re thinking of purchasing one of these products off the street, out of the back of a car, out of a trunk, in an alley, or if you’re going to then go home and make modifications to the product yourself using something that you purchased from some third party or got from a friend, think twice.”
On Monday, amid heightened concerns about the proliferation of lung illnesses, the F.D.A. said Juul had violated regulations by touting its vaping products as safer than traditional tobacco cigarettes. The C.D.C. and some state health officials have recommended that people give up vaping of any type until the cause of the lung damage is determined.
San Francisco became the first city to ban e-cigarettes in June, and other communities have similar measures in the works. Last week, Michigan said it would ban all flavored e-cigarettes, becoming the first state to do so. Several state attorneys general have called for the federal government to ban flavored e-cigarettes, and bills to stop sales of flavored vaping products have been introduced in California and Massachusetts. An editorial in The New England Journal of Medicine stated bluntly that doctors should discourage their patients from vaping.
It’s still unclear what caused the illnesses this summer. E-cigarettes and other vaping devices were developed to help cigarette smokers quit their dangerous habit by providing a way to satisfy their nicotine addiction without inhaling the toxins the come from burning tobacco. But many medical experts now think even smokers should think twice about turning to e-cigarettes — and anyone who does not smoke should not vape.
Some people who were sickened said they had vaped with oil containing T.H.C., and some doctors reported that cannabinoid oils vaporized in cartridges may have caused some of the lung inflammation. “Adult smokers who are attempting to quit should consult with their health care provider and use proven treatments,” the authors of the analysis in The New England Journal of Medicine wrote.
The F.D.A. said that a significant subset of samples of vaping fluid used by sick patients included T.H.C., and also contained a compound called vitamin E acetate, which has been a subject of further investigation. They added, “Irrespective of these findings, e-cigarettes should never be used by youths, young adults, pregnant women and adults who do not currently use tobacco products.”
But other people who got sick said they had used e-cigarettes containing only nicotine. The C.D.C. says: “If you are concerned about your health or the health of a loved one who is using an e-cigarette product, contact your health care provider, or your local poison control center at 1-800-222-1222.”
Public health officials have said it’s possible that some dangerous chemical or combination of chemicals has been recently introduced into the pipeline of vaping products, which would explain why these illnesses are happening now. Anyone who has shortness of breath that lasts more than a few hours or becomes severe should seek medical attention quickly. It is a warning that should not be ignored, doctors say.
So for the time being, it is especially risky to use vaping products that may have been tampered with or mixed, or were bought on the street instead of from a retailer. Health investigators believe the illnesses are linked to vaping for several key reasons: The patients have vaped nicotine or marijuana extracts, or both, and do not have an infection or other condition that would explain the lung disease. Patients are now characterized as having the illness only if they have reported vaping within 90 days. In many of the reported cases, the patients had vaped much more recently.
And as health officials work to understand the sudden outbreak of lung illnesses, they have recommended that people take a break from vaping altogether. There are several theories. One is that some dangerous chemical or combination of chemicals has been introduced into the pipeline of vaping products. Public health officials believe that when people vape this noxious cocktail, it sets off a dangerous, even lethal, reaction inside the lungs. These officials have said repeatedly that they do not yet know which substance or device may be causing this reaction, and that is the subject of their urgent investigation.
A second theory is that this syndrome is not, in fact, entirely new and that some people had gotten sick previously, but that the condition had not been recognized and identified as being linked to vaping. As vaping has grown in popularity — both with nicotine and marijuana — more cases may be showing up.
For the time being, though, public health officials seem to believe that the first theory is more likely and they are hunting for a substance, substances or process that might explain the surge in illnesses.