U.S. scientists join effort to solve mysterious vaping-related illnesses

UNTV News   •   September 20, 2019   •   330

The U.S. investigation into hundreds of cases of life-threatening lung illnesses related to vaping is turning up new clues and helping researchers across the country trying to make sense of the situation.

Robert Tarran, a physiologist and vaping expert at the University of North Carolina School of Medicine, is one of a group of researchers studying collections of lung cell samples, looking for answers about the outbreak.

“In my lab we study real world vapers who vape normally. So we’ve been collecting people who’ve been vaping for six months to a couple of years and then taken their lungs as they are. So I think the people we’ve been studying are representative of people being hospitalized. And I think it’s important to say that in the all the vapers that we’ve studied we’re seeing changes in their lungs,” he told Reuters.

Many of the victims had pockets of oil clogging up cells responsible for removing impurities in the lungs.

The answer to where that oil comes from will help explain whether these cells play a key role in the vaping-related outbreak that has killed atleast seven people and sickened 530 so far.

It may also reveal whether some of these cases have been occurring all along, undetected.

A group of researchers who have been studying the long-term effects of vaping told Reuters they have taken up the challenge. They have begun to re-examine lung cell samples they have collected in recent years for evidence of these oil-filled immune cells in people who vaped but didn’t get sick.

One possibility: The deposits are residue from inhaling vaping oils, such as those containing the marijuana ingredient tetrahydrocannabinol (THC) or vitamin E acetate. Both are considered possible contributors to the current illnesses.

Some researchers suspect the oils are formed inside the lungs as part of the body’s natural response to chemicals found in many commercial vaping devices. One theory is that vaping these chemicals may impair the immune system, and make people who vape more vulnerable to respiratory distress, they say.

“One of the things we found there is a wide variety some liquids are more toxic than others and we found there is a correlation the more flavors in a liquid the more likely it was to be toxic. But there’s also an incredible diversity of flavors. So in 150 e-liquids we found about 200 different chemical constituents. And so really the flavors e-liquid really are all over the map,” Tarrant said.

A study published in the Journal of Clinical Investigation earlier this month has fueled the latter theory.

It found that mice exposed to aerosols of propylene glycol and vegetable glycerin – common solvents used in conventional nicotine vaping devices – developed these same fat-clogged immune cells even though they were never exposed to vaping oils. These mice also had impaired immune systems compared to mice exposed to room air.

The study set off alarm bells for Thomas Eissenberg, co-director of the Center for Tobacco Products at Virginia Commonwealth University. For years, doctors have reported isolated cases of pneumonia-like illnesses in people who vaped. In many cases, patients also had these fat-filled immune cells – called lipid-laden macrophages.

Now, these same abnormalities have been found in mice, and in at least some of the people who have fallen ill recently.

They want to help determine is whether these abnormalities have been present for years, and whether they have made vapers generally more vulnerable to severe disease, possibly triggered by some new vaping substance.

The group’s members say they have been in regular contact with officials at the CDC and the National Institutes of Health on how they can best help with the multistate investigation.

They include Tarran, a physiologist and vaping expert at the University of North Carolina School of Medicine, and Dr. Peter Shields, a lung cancer specialist at The Ohio State University Wexner Medical Center, who has one of the country’s largest sets of lung samples from vapers, smokers and never-smokers.

Investigators at the CDC and the U.S. Food and Drug Administration (FDA) have pointed to THC vaping oils or vitamin E, a substance used in some THC products, as a possible cause of these illnesses. But they have not ruled out anything yet, including conventional nicotine liquids.

“So we’ve been able to break some of our studies down to study just the nicotine or the solvent the propane glycol vegetable glycerin. And we’ve been finding changes due to both of these components. So we can help identify things in any liquids which are having these effects and then potentially we could extend these studies and study cannabinoids or the vitamin E oils,” Tarrant said.

CDC pathologists are examining hundreds of lung cell samples gathered from patients in the outbreak. Meanwhile, forensic chemists at the FDA are testing more than 120 products to determine whether there is a common ingredient that may explain the illnesses. (REUTERS)

(Production: Gershon Peaks, Kevin Fogarty, Andrew Hofstetter, Rollo Ross, Temis Tormo)

DOH halts implementation of e-cigarette, vaping regulations

Marje Pelayo   •   October 18, 2019

MANILA, Philippines – The Department of Health (DOH) has put on hold the implementation of its regulation on the use of e-cigarettes and vapes across the country.

According to the DOH, the decision was prompted by an injunction order issued by the Pasig City Regional Trial Court following a petition filed by e-cigarette companies.

The Department said e-cigarette firms are opposing the implementation of the regulation citing negative impacts on their income.

“Ayaw nilang mag-rehistro (They do not want to register),” said DOH spokesman Undersecretary Eric Domingo.

“Ayaw nilang ma-limit natin iyong nicotine content noong mga produkto, iyong volume na ibenta (They do not want to limit the products’ nicotine content and the volume),” he added.

Based on the administrative order issued by the DOH in June, all distributors, manufacturers, and sellers of e-cigarettes and vapes need to register to ensure that their use is properly regulated.

“Gusto natin may health warning. Gusto natin strictly kailangan ng ID (We want to include health warnings in the packaging. We strictly want an identification),” Domingo said.

“Hindi siya pwedeng ibenta sa mga menor de edad (They shouldn’t be sold to minors) and I think these are the things that the industry is trying to stop us from enforcing,” he added.

Based on DOH’s records, a total of 152 e-cigarette and vape manufacturers and retailers have already registered.

But the DOH is determined to stand by its regulation especially since the World Health Organization (WHO) has proven vapes’ harmful effects on human health.

“We are really very upset about this development but we will have to fight in the court for why we issued that administrative order,” Domingo noted.

Meanwhile, health experts are encouraging e-cigarettes and vape users to have themselves check as they might have developed illnesses associated with vaping.

Based on records of the U.S. Center for Disease Control and Prevention and the US Food Drug Administration, 26 individuals have already died from a total of 1,300 cases of vaping-related illnesses.

“[That’s confirmed.] Therefore since [there are proofs] we have to do something about it,” Dr. Maria Encarnita Limpin, Secretary of the Philippine College of Physicians, concluded. MNP (with reports from Aiko Miguel)

FDA orders DOH-controlled hospitals to report vape-related injuries

Aileen Cerrudo   •   September 11, 2019

The Food and Drug Administration (FDA) has ordered Department of Health (DOH)-controlled hospitals to report cases that are related to using vape.

This was after health officials in the United Stated confirmed on Tuesday (September 10) that a 50-year-old man died of lung disease linked to vape use.

According to Dr. Anton Javier, project manager of Product Research and Standards Development Division Center for Cosmetics in the FDA, they might not monitor any illnesses related to using vape just yet because of the latency period.

“Because of the latency period nga po baka po wala pa tayo makita just yet. Pwede po kasing nagve-vape ka ngayon pero iyong mga magiging sakit niyo down the line pa, (Because of the latency period, we might not see [incidence] just yet. You can actually use vape now but your illness might appear down the line)” he said.

However, an expert said the confirmed case in the United States should not be a cause of alarm.

“It’s been well proven by laboratories in the US that deaths in Kansas whatever it is, has got nothing to do with e-cigarettes its what these people has put in e cigarettes that contains adulterated contaminants of cannabis,” according to Harm Reduction Expert Dr. Tikki Pang.

The FDA had previously released a regulation on using vape or e-cigarettes. Manufacturers or retailers were given until October 25 to register their products to the FDA.

The FDA has also warned against the dangers of the chemicals found in vape products. This include cynemaldehide which causes blockage in the lungs which can lead to difficulty in breathing.

Another dangerous chemical, according to the FDA, is diacetyl which causes bronchylitis or inflammation of the lungs.—AAC (with reports from Mai Bermudez)

FDA asks hospitals to report vaping-related illnesses amid rising cases abroad

Robie de Guzman   •   September 9, 2019

MANILA, Philippines – The Food and Drug Administration (FDA) is calling on hospitals under the Department of Health (DOH) to report any cases of illness or injury related to the use of electronic cigarettes (e-cigarette) and vaping amid rising number of such cases in other countries.

“The FDA requests all DOH-retained hospitals to immediately communicate relevant case reports of injuries and illnesses documented arising from the use of these devices,” the agency said in an advisory.

***FDA Advisory No. 2019-258***-Surveillance for injuries and illness arising from the use of electronic nicotine and…

Posted by Food and Drug Administration Philippines on Sunday, 8 September 2019

The FDA said this is in the interest of evidence-based policy development, and in line with the emerging report of electronic cigarette-related injury and illnesses from Europe and North America.

The agency said the use of electronic nicotine and non-nicotine delivery systems (ENDS/ENNDS) are under the purview of the agency based on Republic Act 9711, the FDA said.

“In compliance with the Data Privacy Act of 2012, it is expected that the information provided will be anonymized in as much as they are thorough and extensive,” the agency said.

The U.S. Centers for Disease Control and Prevention (CDC) in August issued an advisory, cautioning the public against the purchase and use of vaping ingredients from the street and to stop modifying either nicotine or cannabis e-cigarette in an effort to curb the reportedly rising cases of vaping-related sicknesses in 25 U.S. states.

As of August 27, U.S. health authorities have monitored 215 possible cases of pulmonary illnesses, all patients have reported using e-cigarette products.

According to the USCDC, e-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals such as lead, volatile organic compounds, and cancer-causing chemicals.

Additionally, some e-cigarette products are used to deliver illicit substances, which may be acquired from unknown or unauthorized sources.

“Based on reports from several states, patients have experienced respiratory symptoms (cough, shortness of breath, or chest pain), and some have also experienced gastrointestinal symptoms (nausea, vomiting, or diarrhea) or non-specific constitutional symptoms (fatigue, fever, or weight loss). Symptoms typically develop over a period of days but sometimes can manifest over several weeks,” the advisory stated.

The USCDC have recommended some steps for clinicians, including the reporting of cases of severe pulmonary disease of unclear etiology and history of e-cigarette use within the past 90 days, to help determine the cause of these sicknesses.

READ: WHO: Tobacco kills 8 million each year, e-cigarettes not a proven alternative

The World Health Organization (WHO) earlier said the use of e-cigarettes should be regulated as there is no evidence proving they were a safer alternative to cigarettes, warning that it normalizes smoking and hooks young people.

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