Vaping Illness: A New Name and Expanded Clinical Guidance "EVALI" cases will become increasingly mix

[Shadowe]

Not sure if anyone else is reading the actual Medical informational sites but I am subscribed to several, and this came through this morning...worth the read...

Vaping Illness: A New Name and Expanded Clinical Guidance

 

[Rossum]

EVALI is considered a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis

In other words there's correlation, but no evidence at all of causation.

13% of EVALI has been in exclusive tobacco vapers

I don't know anyone who vapes tobacco, do you? How is it that ostensibly respectable medical sources conflate tobacco and nicotine in this manner? Oh wait..

Really no safe tobacco product

Could it be that they don't want "FDA approved" NRTs, which are also made from to nicotine extracted from tobacco to be thought of as tobacco products?

 

[Eskie]

Well that’s a lousy acronym. And flu season will confuse things. But it opens the door to labeling flu as EVALI if the person happens to be a vaper. That should make the case count go up dramatically.

 

[Opinionated]

Here's my question for the CDC..

even if we assume that 13% of cases are nicotine related and not lying, that's 13% of 1299 who fell ill which is 168 total persons.

In the U.S. there are approximately 10 million adult vapers for smoking cessation.. that means .0017% of all vapers have reacted negatively to the point of hospitalization over the past two years (I think we can safely assume this is two years worth of data since they are going back in time to add more possible cases)

This is not an unacceptable number, and I don't actually see that small a number as being enough for the CDC to recommend that ecigarettes use for smoking cessation when all other methods failed be discontinued for the general public looking to quit smoking..

The majority of FDA approved drugs have a higher rate of severe side affects than that..

 

[classwife]

After reading that...

And with flu season upon us...
I can just see a bunch of money grubbing doctors and clinics greedily rubbing their hands together thinking about all the extra tests they can run and make more money.


But...

While "EVALI is considered a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis," the agency suggested measuring oxygen saturation and vital signs, a respiratory viral panel, and complete blood count and urine toxicology testing, including tests for THC.

and

In the document published in Morbidity & Mortality Weekly Report, the CDC recommended asking patients with such symptoms about vaping along with what types of substances were used (most EVALI has been found in people who vaped THC) and as many specifics about it as possible

...at least they have THAT ^


Moving this to Media and General News

 

[icepickmaker84]

The majority of FDA approved drugs have a higher rate of severe side affects than that..[/QUOTE]

Suicidal thoughts and actions being a pretty common side affect, smh.

 

[Opinionated]

Suicidal thoughts and actions being a pretty common side affect, smh.

From the approval of Chantix in May 2006 until July 2009, the drug was linked to reports of approximately 100 suicides, 200 suicide attempts, and almost 5,000 serious psychiatric events.

Drugs to Quit Smoking Can Affect Mental and Physical Health: the Truth About Chantix and Zyban | National Center for Health Research

Doctors are not required to report deaths or serious complications to the companies that make the medication or the FDA, although drug companies are required to do so. Because most doctors don’t report, it is assumed that the numbers are much higher and that those problems have continued since 2009. In fact, in May 2011, the Institute for Safe Medication Practices (ISMP) revealed that hundreds of cases of suicides, psychotic reactions, hostility, aggression and other serious problems tied to Chantix had not been properly reported to the FDA by Pfizer, the drug’s manufacturer

 

[United States]

I wonder if it's as simple as mold spores. They're everywhere. And if folks are pre-packaging little tanks in less than sterile conditions, could a few mold spores be getting into the cartridges? I kinda rule that out since I reload my tanks in my kitchen, which is far from lab conditions yet I don't have mustard gas like symptoms. Just a seasonal allergy slight cough.

Not wanting to go all tin hat here but… could it be the Goon Squad CIA wants to do their part to scare the bejesus out of Americas youth? Great Britain isn't plagued by it. Nor is Pakastan or Bejing……

Could it simply be an accidental situation where somebody added a thickener outside of our favorite VG sauce?

But my main question would be is it only pre-packaged products getting people sick? Has anyone who "refills" been taken down by this thing?

It seems the CDC is just now getting around to analyzing samples. Samples of what? Me personally I aint scared but I do want to know if my vaping friends or colleagues are in potential harms way.

 

[CarolT]

Claiming that "13% of EVALI has been in exclusive tobacco [sic] vapers" is automatically a Big Lie. As Michael Siegel points out:

"The CDC has been insisting that a small proportion of cases have occurred among patients who did not use THC. The truth is that they have no way of knowing that. Unless the patients have been tested for THC, it simply cannot be said that cases have occurred among patients who only used nicotine-containing e-liquids. This is why I believe it is so irresponsible that the CDC has repeatedly given the impression that it knows that a substantial proportion of cases do not involve THC. They actually have no way of verifying their contention that "no single product" ties together all the cases. It is entirely possible that a single product - marijuana and counterfeit vapes - does tie together all the cases."

The Rest of the Story: Tobacco and Alcohol News Analysis and Commentary: CDC's Failure to Demand Urine THC Testing of All Outbreak Patients is Inexcusable and is Putting the Entire Nation at Risk

 

[stols001]

Me and my husband just determined that we both started smoking fairly young and we are incredibly intelligent and resourceful.

We plan on massaging the data a bit and sending it to the CDC because at this point, we figure they might publish it,

Anna

 

[iVapeDIY]

even if we assume that 13% of cases are nicotine related and not lying, that's 13% of 1299 who fell ill which is 168 total persons.

IMHO, sodium benzoate can easily account for residual (nicotine-only) VAPI cases. BT wants preservative for long shelf life and no refrigeration, for pre-filled pods/ cartridges. 25 million Americans (~8%) have asthma and are likely allergic to sodium benzoate; add non-asthmtics that are allergic to sodium benzoate and you have quite a lot.

• Asthma Facts | AAFA.org
• [Asthma and intolerance to benzoates]. - PubMed - NCBI
• Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. - PubMed - NCBI
• https://www.jacionline.org/article/S0091-6749(01)99999-3/pdf
• SAGE Journals: Your gateway to world-class research journals
• https://www.who.int/ipcs/publications/cicad/cicad26_rev_1.pdf

Asthmatic Teens Even More Likely to Vape Than Those Without the Illness

Perhaps assuming that e-cigarettes are "safer" than tobacco, teens with asthma now vape at higher rates than those without the respiratory condition, new research shows.

Why children with asthma would use products that make asthma worse is not clearly understood. However, Reid's team speculated that smoking may be one way to help these kids cope with social anxiety.

Kids who don't take their asthma medications also tend to be more rebellious and risk-taking when it comes to their health, the researchers noted. So, adopting a vaping or smoking habit may be part of that "rebellion."

Finally, some asthmatic teens may view vaping as more socially acceptable and/or less harmful than cigarettes.
​

Prior to popularity of closed-systems, inhaling sodium benzoate was rare. With high youth uptake (eg., Juul), more than 8% can easily get allergic inflammation. If hooked on high nic salts, many would persist despite mild inflammatory reactions until it got severe.

'Normal' eJuice rarely has sodium benzoate; people consumed it in a few weeks or it went bad. So, for 10+ years severe allergic reactions to eJuice were virtually non-existent.

 

[Opinionated]

...

 

[Rossum]

BT wants preservative for long shelf life and no refrigeration, for pre-filled pods/ cartridges.

Do you have some evidence that anyone is using sodium benzoate as a preservative in e-liquid?

 

[iVapeDIY]

Do you have some evidence that anyone is using sodium benzoate as a preservative in e-liquid?

Juul’s nicotine salts are dominating the market — and other companies want in

Juul uses benzoic acid, though their patent covers a wide range of other acids as well.​

 

[iVapeDIY]

I don't think anyone with asthma should vape

Neither do I but apparently there are a lot of teens that do.

 

[Opinionated]

Neither do I but apparently there are a lot of teens that do.

Is it legal in the U.S. for teens to vape?

I mean, if we are talking teens, it's against the law for them to purchase vape related products of any type..

 

[Rossum]

Juul uses benzoic acid, though their patent covers a wide range of other acids as well.

Yes, most everyone knows that, but it's not there as a preservative, and benzoic acid is not sodium benzoate. Yet you wrote:

IMHO, sodium benzoate can easily account for residual (nicotine-only) VAPI cases.

 

[iVapeDIY]

Is it legal in the U.S. for teens to vape?

I mean, if we are talking teens, it's against the law for them to purchase vape related products of any type..

Youth update is apparently being dealt with by different US jurisdictions in various ways. It would be interesting to see % of asthmatics (and others with allergies) in CDC's 1300+ VAPI cases.

 

[iVapeDIY]

Yes, most everyone knows that, but it's not there as a preservative, and benzoic acid is not sodium benzoate.

[Asthma and intolerance to benzoates]. - PubMed - NCBI

Apparently used for same purpose and is treated as a family of chemicals for similar purpose.

 

[Eskie]

Claiming that "13% of EVALI has been in exclusive tobacco [sic] vapers" is automatically a Big Lie. As Michael Siegel points out:

"The CDC has been insisting that a small proportion of cases have occurred among patients who did not use THC. The truth is that they have no way of knowing that. Unless the patients have been tested for THC, it simply cannot be said that cases have occurred among patients who only used nicotine-containing e-liquids. This is why I believe it is so irresponsible that the CDC has repeatedly given the impression that it knows that a substantial proportion of cases do not involve THC. They actually have no way of verifying their contention that "no single product" ties together all the cases. It is entirely possible that a single product - marijuana and counterfeit vapes - does tie together all the cases."

The Rest of the Story: Tobacco and Alcohol News Analysis and Commentary: CDC's Failure to Demand Urine THC Testing of All Outbreak Patients is Inexcusable and is Putting the Entire Nation at Risk

As noted, the new guidelines (not rules, guidelines, like "we think you should but we can't make you") call for THC drug screening in all cases. Without that piece of data, that 13% can only be taken at their word. If routine screening is done, we can now see if that number changes.

[Asthma and intolerance to benzoates]. - PubMed - NCBI

Apparently used for same purpose and is treated as a family of chemicals for similar purpose.

The cases you keep posting, including this one, are single case reports of one person with a possible reaction. Sodium Benzoate is routinely use as a preservative in foods, and even medications, including commonly used asthma drugs like nebulized albuterol. Given the tens of millions of asthmatics in the US, and hundreds of millions worldwide, it's doubtful this suddenly popped up in these THC vaping cases limited to the US, and scattered case(s) in Canada as the cause. If it were, there would be tens of thousands being made ever sicker by their albuterol use every month for decades while this has been used in preparations. Are there single cases of unusual sensitivity to certain chemicals? Sure. You case report shows that. But it's not the place anyone with knowledge in pulmonary and allergy/immunology would be focusing on for their top 10, or top 100 list for a cause of acute pulmonary failure and ARDS.