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      Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury

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          Abstract

          New emerging tobacco products, especially electronic cigarettes (E-Cig) or electronic nicotine delivery systems (ENDS), have gained a huge popularity, particularly in younger populations. The lack of sufficient evidence-based health effect studies has promoted widespread use/abuse with the assumption that E-Cig or ENDS and/or vaping products are safer and less toxic than conventional tobacco smoking. However, the recent escalation in acute lung injuries and their associated fatalities among ENDS or vaping product users has now brought attention to this silent epidemic via investigation into the constituents of ENDS/vaping products and their toxic effects on pulmonary health. Accordingly, CDC has declared an “outbreak” of the e-cigarette or vaping product use associated lung injury (EVALI). EVALI is characterized by sterile exogenous pneumonitis like reaction with substantial involvement of innate immune mechanisms. Vitamin-E acetate (VEA) is found in counterfeit cartridges and bronchoalveolar lavage fluid of EVALI patients. Other reports implicated the presence of aromatic/volatile hydrocarbons and oils consisting of medium-chain triglycerides (MCT oil), including terpenes and mineral oil in tetrahydrocannabinol (THC) containing counterfeit vaping products. These compounds are involved in oxidative stress and inflammatory responses in the lung. Here, we provide the perspectives on the recent case reports on EVALI, etiology, and discuss pulmonary toxicity as well as the mechanisms underlying EVALI susceptibility and lung pathophysiology.

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          Most cited references50

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          Neutrophil extracellular traps in immunity and disease

          Neutrophils are innate immune phagocytes that have a central role in immune defence. Our understanding of the role of neutrophils in pathogen clearance, immune regulation and disease pathology has advanced dramatically in recent years. Web-like chromatin structures known as neutrophil extracellular traps (NETs) have been at the forefront of this renewed interest in neutrophil biology. The identification of molecules that modulate the release of NETs has helped to refine our view of the role of NETs in immune protection, inflammatory and autoimmune diseases and cancer. Here, I discuss the key findings and concepts that have thus far shaped the field of NET biology.
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            Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

            New England Journal of Medicine
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              Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018

              Introduction Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood. Methods CDC, the Food and Drug Administration, and the National Cancer Institute analyzed data from the 2011–2018 National Youth Tobacco Surveys to estimate tobacco product use among U.S. middle and high school students. Prevalence estimates of current (past 30-day) use of seven tobacco products were assessed; differences over time were analyzed using multivariable regression (2011–2018) or t-test (2017–2018). Results In 2018, current use of any tobacco product was reported by 27.1% of high school students (4.04 million) and 7.2% of middle school students (840,000); electronic cigarettes (e-cigarettes) were the most commonly used product among high school (20.8%; 3.05 million) and middle school (4.9%; 570,000) students. Use of any tobacco product overall did not change significantly during 2011–2018 among either school level. During 2017–2018, current use of any tobacco product increased 38.3% (from 19.6% to 27.1%) among high school students and 28.6% (from 5.6% to 7.2%) among middle school students; e-cigarette use increased 77.8% (from 11.7% to 20.8%) among high school students and 48.5% (from 3.3% to 4.9%) among middle school students. Conclusions and Implications for Public Health Practice A considerable increase in e-cigarette use among U.S. youths, coupled with no change in use of other tobacco products during 2017–2018, has erased recent progress in reducing overall tobacco product use among youths. The sustained implementation of comprehensive tobacco control strategies, in coordination with Food and Drug Administration regulation of tobacco products, can prevent and reduce the use of all forms of tobacco products among U.S. youths.
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                Author and article information

                Contributors
                Journal
                Front Pharmacol
                Front Pharmacol
                Front. Pharmacol.
                Frontiers in Pharmacology
                Frontiers Media S.A.
                1663-9812
                14 January 2020
                2019
                : 10
                : 1619
                Affiliations
                [1] 1Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University , Miami, FL, United States
                [2] 2Department of Environmental Medicine, University of Rochester Medical Center , Rochester, NY, United States
                [3] 3Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University , Miami, FL, United States
                Author notes

                Edited by: Paolo Montuschi, Catholic University of the Sacred Heart, Italy

                Reviewed by: Dhyan Chandra, University at Buffalo, United States; Narasaiah Kolliputi, University of South Florida, United States; Monica Goldklang, Columbia University, United States

                *Correspondence: Irfan Rahman, irfan_rahman@ 123456urmc.rochester.edu

                This article was submitted to Respiratory Pharmacology, a section of the journal Frontiers in Pharmacology

                Article
                10.3389/fphar.2019.01619
                6971159
                31992985
                ac472be4-f9b2-4035-a50b-bbaeed37bc1c
                Copyright © 2020 Chand, Muthumalage, Maziak and Rahman

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 November 2019
                : 11 December 2019
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 50, Pages: 7, Words: 3373
                Funding
                Funded by: National Institutes of Health 10.13039/100000002
                Categories
                Pharmacology
                Perspective

                Pharmacology & Pharmaceutical medicine
                e-cigarettes,vaping,tetrahydrocannabinol (thc),lipoid pneumonia,evali

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