Ontario Running Totals

[niman]

Thread started for vaping cases in Ontario, Canada

[niman]

The Middlesex-London Health Unit will hold a news conference this afternoon, Wednesday, September 18th at 2:00 p.m. as part of its involvement in the case of a youth who has been diagnosed with severe respiratory illness that has been linked to the individual’s use of vaping products.

https://www.healthunit.com/news/media-advisory-respiratory-illness-linked-to-vaping

[niman]

A high-school-aged youth from London, Ont. was on life support because of using e-cigarettes but has since been released according to the Middlesex-London Health Unit in London, Ont.

The unit says it was notified of the youth with severe respiratory illness last last week.

https://montrealgazette.com/cannabis-health/cannabis-medical/vaping-related-illness-sends-youth-to-hospital-in-london-ont-reportedly-first-case-in-canada/wcm/b6d398c5-28c1-4a22-875a-304805e64bca

[niman]

Quebec has reported its 1st case of severe lung disease linked to vaping, the provincial health ministry has confirmed.

A man in his 50s who started vaping in April [2019] developed chest pain and had trouble breathing. However, the man has since recovered, Dr. Mylene Drouin of the Montreal Public Health Department told reporters at a news conference on Friday [27 Sep 2019]. He chose to vape as a means to stop smoking.

The Quebec case is the 2nd to be reported thus far in Canada. On [18 Sep 2019] a high-school student from London, Ontario, was placed temporarily on life support after using e-cigarettes but was later released from hospital, according to the local health authority in the province.

Dr. Horacio Arruda, Quebec's top public health officer, reiterated the risks associated with vaping at Friday's news conference. "Following the confirmation of this 1st case in Quebec, it is necessary to reiterate the importance of remaining vigilant," Arruda said in a statement.

"People with health concerns should tell their health-care professional if they are vaping or have been vaping, as well as the devices and substances used. Every case is taken seriously and the Health Ministry continues to monitor developments in Quebec closely."

In a [10 Sep 2019] warning, Arruda urged young people, pregnant women and non-smokers to refrain from using electronic cigarettes. "It is important to remember vaping is not without risk, and its long-term effects are not yet known," Arruda said at the time. "In this context, the population is encouraged to be vigilant."

On [4 Sep 2019], Health Canada issued a statement about a possible link between the use of vaping products and cases of a potentially deadly pulmonary disease in the USA.

The American Medical Association on Monday [23 Sep 2019] advised US residents to stop vaping of any sort until scientists gain a better understanding of the cause of more than 530 lung illnesses and at least 12 deaths they believe are related to the use of the products.

Once activated, the e-cigarette heats a liquid to turn it into an aerosol, allowing vaping. Unlike conventional cigarettes, electronic cigarettes do not involve combustion or tobacco. Most liquids in e-cigarettes contain nicotine, propylene glycol or vegetable glycerin, as well as artificial flavours. Several other chemical components can be found in the liquids or in the aerosol.

E-cigarettes are also known by other names like mods, pods, vaping pens, sub-ohm, tank devices, electronic nicotine inhaler and vape.

The Quebec health ministry has noted in some of the cases, people had used vaping products that contained cannabinoids such as tetrahydrocannabinol (THC).

"It should be noted that products from illegal or unregulated sources are particularly avoidable, as they carry additional risks," the ministry added. "Vaping devices and liquids should also not be modified or used in a manner not intended by the manufacturer."

Should authorities identify a clearly noxious substance in the products shown to be responsible for severe lung disease, a ban could be enforced, but no decision has been reached. Last week [24 Sep 2019], the state of Massachusetts announced a 4-month ban on vaping products.

[Byline: Aaron Derfel]

https://www.promedmail.org/post/20190928.6699608

[niman]

Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth

Simon T. Landman, Inderdeep Dhaliwal, Constance A. Mackenzie, Tereza Martinu, Andrew Steele and Karen J. Bosma

CMAJ November 20, 2019 cmaj.191402; DOI: https://doi.org/10.1503/cmaj.191402

 

https://www.cmaj.ca/content/early/2019/11/20/cmaj.191402

[niman]

Abstract

Background: Although electronic cigarettes (e-cigarettes) were initially marketed as a potential smoking-cessation aid and a safer alternative to smoking, the long-term health effect of e-cigarette use (“vaping”) is unknown. Vaping e-liquids expose the user to several potentially harmful chemicals, including diacetyl, a flavouring compound known to cause bronchiolitis obliterans with inhalational exposure (“popcorn worker’s lung”).

[niman]

Case description: We report the case of a 17-year-old male youth who presented with intractable cough, progressive dyspnea and malaise after vaping flavoured e-liquids and tetrahydrocannabinol intensively. Initial physical examination showed fever, tachycardia, hypoxemia, and bibasilar inspiratory crackles on lung auscultation. Computed tomography of the chest showed diffuse centrilobular “tree-in-bud” nodularity, consistent with acute bronchiolitis. Multiple cultures, including from 2 bronchoalveolar lavage samples, and biopsy stains, were negative for infection. He required intubation, invasive mechanical ventilation and venovenous extracorporeal membrane oxygenation (ECMO) for refractory hypercapnia. The patient’s condition improved with highdose corticosteroids. He was weaned off ECMO and mechanical ventilation, and discharged home after 47 days in hospital. Several months after hospital discharge, his exercise tolerance remained limited and pulmonary function tests showed persistent, fixed airflow obstruction with gas trapping. The patient’s clinical picture was suggestive of possible bronchiolitis obliterans, thought to be secondary to inhalation of flavouring agents in the e-liquids, although the exact mechanism of injury and causative agent are unknown.

[niman]

Interpretation: This case of severe acute bronchiolitis, causing near-fatal hypercapnic respiratory failure and chronic airflow obstruction in a previously healthy Canadian youth, may represent vaping-associated bronchiolitis obliterans. This novel pattern of pulmonary disease associated with vaping appears distinct from the type of alveolar injury predominantly reported in the recent outbreak of cases of vaping associated pulmonary illness in the United States, underscoring the need for further research into all potentially toxic components of e-liquids and tighter regulation of e-cigarettes.

[niman]

Vaping linked to teen's 'popcorn lung' type injury

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Media captionVaping fears: 'A new generation of nicotine addicts'

A Canadian teenager has developed a vaping-related lung injury similar to "popcorn lung", his doctors say.

The condition was previously seen in workers who were exposed to the chemical flavouring diacetyl as they packaged microwave popcorn.

The Canadian case may be the first to show a new type of damage linked to vaping, distinct from lung injuries seen in the US and elsewhere.

It is documented in the Canadian Medical Association Journal.

• What's behind a vaping illness outbreak in the US?
• Switch to vaping 'helps smokers' hearts'
• 'Popcorn lung' man in $7m payout

Six doctors from London, Ontario, who treated the 17-year-old published the report on Thursday.

Their patient, a previously healthy teenager, sought medical treatment after he developing persistent cough and a fever.

What happened to the patient?

The boy had vaped daily for five months using flavoured cartridges and regularly added THC - the psychoactive ingredient in cannabis - to his vaping fluid. His parents told the doctors he also had a habit of inhaling deeply when vaping.

As his condition deteriorated, he was taken to intensive care. He spent 47 days in hospital and narrowly avoided needing a double lung transplant, though there may be severe long-lasting lung damage, his doctors say.

After his physicians ruled out other causes for his illness they began suspecting flavoured e-liquids were the cause.

Image copyrightGETTY IMAGES

Image captionA man died in the US last year after his vape pen blew up

"This patient had severe, acute bronchiolitis, possibly related to inhalational injury from vaping, with several features suggestive of subsequent early bronchiolitis obliterans ['popcorn lung']," they write.

What are 'popcorn lung' and diacetyl?

"Popcorn lung" is a rare form of irreversible obstructive lung disease that scars the smallest airways in the lung - the bronchioles - and makes it difficult for air to flow.

The disease was so named because a cluster of popcorn factory workers in the early 2000s were found to have the condition, eventually linked to a vapour from butter flavouring.

Research has found many e-liquid vaping flavours tested contain some level of diacetyl.

It is an agent that gives a butter flavour to food and is found in a wide range products, from butter to cocoa, coffee and alcoholic beverages. It is considered safe for ingestion.

The chemical has been banned as an ingredient from e-cigarettes and e-liquids in Europe since 2016. Health Canada also notes that steps have been taken to reduce its use and it is less common in vaping products than before.

While there has been concern about the use of diacetyl in e-liquid, Cancer Research UK said in 2018 there was "no good evidence" that vaping might cause "popcorn lung".

The boy's doctors say there is a need for further research and tighter regulation of the vaping industry.

Health Canada, the country's government health department, told the BBC that the patient's symptoms were consistent with the definition of vaping-associated lung illness.

"Rapid recognition of vaping associates lung illness by health care providers is critical to reduce severe outcomes," said spokesperson Eric Morrissette.

The health authority dismissed the medical journal's call for more regulation, noting that vaping products containing nicotine or cannabis were already regulated in Canada.

What about the US cases?

E-cigarettes are battery-powered smoking devices filled with a liquid that contains nicotine, which is then heated into vapours that users inhale.

More than 2,000 Americans have been affected by lung injuries attributed to vaping, according to the Centers for Disease Control (CDC).

Some 42 deaths have been confirmed in 24 states and more are under investigation. There have also been seven confirmed or probable cases in Canada.

The symptoms people have reported include severe pneumonia, shortness of breath, coughing, fever, fatigue and respiratory failure - where your body either can't break down oxygen, produce carbon dioxide, or both. Lung function declines and breathing becomes difficult.

https://www.bbc.com/news/world-us-canada-50494871

[niman]

https://www.cmaj.ca/content/cmaj/early/2019/11/20/cmaj.191402.full.pdf

[niman]

tonight at 9 PM ET

Dr. Henry Niman PhD
CDC Recommends Complete Stopping
Of ALL Vaping And E-Cigs

CDC Vaping Lung Damage Update
Now 47 Deaths