What do the numbers show about vaping in the US?
What do the numbers show about vaping in the U.S.? (Getty Images) E-cigarettes and other vaping products are facing heavy scrutiny as federal authorities investigate hundreds of reported cases of vaping-related lung illness, including some that have resulted in death.
Is e-cigarette or vaping product use associated with lung injury?
Carroll BJ, et al. Impaired lung function following e-cigarette or vaping product use associated lung injury in the first cohort of hospitalized adolescents. Pediatr Pulmonol. 2020;55(7):1712–1718. doi: 10.1002/ppul.24787. [PubMed] [CrossRef] [Google Scholar] 36. Corcoran A, Carl JC, Rezaee F.
Is there any clinical research on vaping toxins?
Many of the clinical research studies available focus on aspects of vaping such as the amount of nicotine or marijuana delivered but there’s not a great deal of evidence on the analysis of other toxins released both from vaporizing tobacco leaf products and marijuana.
What does the current evidence say about vaping and smoking cessation?
What does the current evidence say about vaping and smoking cessation? ACSH has previously reported that vaping very likely helps smokers quit cigarettes, and maybe even nicotine, for good. Citing some of the same literature we have, Barton reached a similar conclusion about smoking cessation.
Does vaping count as smoking on medical forms?
There is currently no formal way for doctors to report vaping behavior separate from smoking.
Can a doctor tell if you vape?
Medical tests can detect nicotine in people's urine, blood, saliva, hair, and nails. Nicotine is the addictive substance in tobacco, cigarettes, and vapes or e-cigarettes.
How do you code vaping in ICD 10?
Effective with 4/1/2020 discharges, ICD-10-CM code U07. 0 is used to report vaping -related disorders. ICD-10-CM code U07. 0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping.
What is vape medical?
“Vaping is a delivery system similar to a nebulizer, which people with asthma or other lung conditions may be familiar with,” says Broderick. “A nebulizer turns liquid medicine into a mist that patients breathe in. It's a highly effective way of delivering medicine to the lungs.”
Can Dentists tell if you've Vaped before?
The answer is yes. While some people switch from smoking to vaping because they may think vaping is a safer alternative to smoking, studies show that it is just bad for your teeth and gums. Vaping has the same adverse effects on your oral health as smoking and your dentist WILL be able to tell.
How long is nicotine detox?
Nicotine withdrawal symptoms usually begin a few hours after your last cigarette. They are usually strongest in the first week. For most people, nicotine withdrawal fade and are gone after about 2 to 4 weeks.
Is vaping a tobacco?
1: Vaping is less harmful than smoking, but it's still not safe. E-cigarettes heat nicotine (extracted from tobacco), flavorings and other chemicals to create an aerosol that you inhale. Regular tobacco cigarettes contain 7,000 chemicals, many of which are toxic.
Is nicotine a vape?
Most e-cigarettes (vapes) contain nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products. A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine.
What is the ICD-10 code for smoking?
ICD-10 code F17. 210 for Nicotine dependence, cigarettes, uncomplicated is a medical classification as listed by WHO under the range - Mental, Behavioral and Neurodevelopmental disorders .
Can your lungs heal from vaping?
Breathing in the harmful chemicals from vaping products can cause irreversible (cannot be cured) lung damage, lung disease and, in some cases, death.
How long does it take for your lungs to heal from vaping?
After two weeks: your circulation and lung function begin to improve. After one to nine months: clear and deeper breathing gradually returns; you have less coughing and shortness of breath; you regain the ability to cough productively instead of hacking, which cleans your lungs and reduce your risk of infection.
How long does vape smoke stay in the air?
Even in a poorly ventilated area with windows shut, any smells from vaping should be gone in only ten minutes or so, instead of lasting around for hours like smoking.
Does vaping show up on xray?
Based on this group, researchers discovered that the two most common findings of EVALI on imaging studies are ground-glass opacity and consolidation. Ground-glass opacity is a term used to describe the hazy gray areas that can show up in CT scans or X-rays of the lungs.
How long is nicotine in your urine?
People also process nicotine differently depending on their genetics. Generally, nicotine will leaves your blood within 1 to 3 days after you stop using tobacco, and cotinine will be gone after 1 to 10 days. Neither nicotine nor cotinine will be detectable in your urine after 3 to 4 days of stopping tobacco products.
Can doctors tell if you smoke from a blood test?
Nicotine in your blood can be detected using tests that are qualitative (whether or not nicotine is present) and quantitative (how much nicotine is present). These tests can detect nicotine, cotinine, and another breakdown product called anabasine.
Will vaping affect my blood test?
Smoking can also affect blood test results. If a person has been asked to fast before a blood test, they should avoid smoking. If you vape, it's fine to continue doing this during your fast.
What is the digit for toxic effect of other tobacco and nicotine?
A seventh digit is required.
When was the E-cigarette coding released?
Official diagnosis coding guidance for 2019 healthcare encounters and deaths associated with e-cigarette, or vaping, product use associated lung injury (EVALI) was released Oct. 17.
What is the code for nicotine dependence?
If use, abuse, and dependence are documented, assign only the code for dependence (F17.29- Nicotine dependence, other tobacco product. A sixth digit is required.).
How many digits are needed for a substance use code?
A seventh digit is required. For patients with documented substance use, abuse, and/or dependence, additional codes identifying the substances used should be assigned, as such: If both use and abuse are documented, assign only the code for abuse. If both abuse and dependence are documented, assign only the code for dependence.
What is the code for EVALI?
For patients documented with EVALI, assign the code for the specific condition.#N#For patients with acute lung injury, but without further documentation identifying a specific condition, assign code J68.9 Unspecified respiratory condition due to chemicals, gases, fumes and vapors.#N#For children and adults who have been poisoned by swallowing, breathing, or absorbing-cigarette liquid through their skin or eyes, assign T65.291- Toxic effect of other tobacco and nicotine, accidental (unintentional), which includes toxic effect of other tobacco and nicotine NOS. A seventh digit is required.#N#For a patient diagnosed with acute tetrahydrocannabinal (THC) toxicity, assign code T40.7X1- Poisoning by cannabis (derivatives), accidental (unintentional). A seventh digit is required.#N#For patients with documented substance use, abuse, and/or dependence, additional codes identifying the substances used should be assigned, as such:
What is the basic design of vaping?
The basic design of the device, in the case of vaping both tobacco and marijuana, is largely unchanged from the original patent by Gilbert. There is a reservoir that holds an oil or liquid, a mouthpiece, and a heating element. Theoretically, vaporizing the liquid does not combust it and saves the person va ping from exposure to byproducts generated by high heat . However, there is no regulation of these devices and no agreed upon standard temperature. There appears to be a wide variance in the quality of the components of these devices depending on the price of purchase.2,10,11,16,28
Who invented vaping?
The invention of vaping is attributed to Herbert Gilbert, a cigarette smoker and scrap metal dealer from Pennsylvania. Gilbert’s device was battery-powered to vaporize a liquid for inhalation, very similar to modern electronic cigarettes. He admitted to the Smithsonianmagazine that he believed it to be a breakthrough alternative to cigarette smoking to save people from tobacco’s harmful effects as it did not contain nicotine. After multiple permutations, the device was never mass-produced but its patent has been cited by many companies since then. He actually proposed an alternative use for the device for people that were dieting and believed that they could vaporize the tastes of their favorite foods to quench food cravings. He initially proposed a handful of flavorings including cinnamon, rum, orange, and mint.1–2A year after the patent was submitted in 1963, the Surgeon General Luther Terry released his report “Smoking and Health” on the potential health consequences of cigarette smoking. This was the first report implicating cigarettes in a causal relationship with lung cancer and heart disease as well as laryngeal cancer and chronic bronchitis.3
What solvents are used to dissipate nicotine?
The conventional solvents for the dissolution of nicotine or THC have been propylene glycol and glycerol, and these are the best studied. Initially thought to be benign, there is now some research demonstrating that propylene glycol when vaporized causes significant respiratory irritation and even increases the incidence of asthma. The breakdown products from heating propylene glycol and glycerol to target temperatures include formaldehyde and hemiacetals such as acetaldehyde. Formaldehyde is a Group 1 carcinogen that contributes a 5–15 times higher lifetime risk of cancer. It is present in traditional smoked tobacco in much lower quantities. Hemiacetals such as acrolein and acetone have been implicated in nasal irritation, cardiovascular effects, and lung mucosal damage and these byproducts are produced in higher quantities with higher voltage devices. Basically, as the temperature of the coil increases, the carcinogenic risk of vaping approaches that of traditionally smoked cigarettes.9,10,16–18
Is vaping harmful?
Good clinical evidence is lacking regarding the potential harm of vaping or the potential benefits. There are some problems with studying something like vaping. For one thing, any research has to make a distinction between vaporizing marijuana and vaporizing tobacco and this is not always possible. Additionally, the methods by which people vaporize tobacco and marijuana differ. As far as tobacco devices go, there are many brands with many different compositions and construction designs. Regarding the vaporization of marijuana, there are no standardized devices and there are no standard formulations.
Is vaping safer than smoking?
With the current body of evidence and the outbreak of EVALI in 2019, it is incumbent upon all healthcare practitioners to advise patients that vaping should not be considered safer than smoking and that there are very real and new dangers associated with vaping that still require further study. Providers must learn more about the dangers of vaping and identify adverse health effects from this practice in patients. An evidence-based approach to smoking cessation based on established data and practice patterns is needed.
Is vaping bad for you?
All of the medical dangers of vaping are unknown. Only a small number of people who admit to vaping marijuana are doing so for medical reasons, and there are almost no studies. A large number of people believe that vaping tobacco is a healthy way to quit, and this belief has been fostered by the tobacco industry.6,14There is no strong clinical signal in the direction of using electronic cigarettes as an effective method of quitting smoking. It is difficult to hold an informed discussion with patients about the potential risks and benefits of vaping. Potential risks come from multiple places: device specific concerns, the makeup of the liquid products being vaporized, and the potential for toxicity of both nicotine and marijuana when inhaled in concentrated forms.
Is vaping marijuana safe?
The studies on the safety or dangers of vaporizing marijuana are limited in number because the marijuana itself is difficult to acquire. There were a small number of the plants released in the early 90s for clinical research.12Most of those studies utilized the same device, manufactured under the name “Volcano”. This device is expensive and is drastically different from any of the modern handheld devices for vaporizing marijuana and tobacco. It does not serve as a good facsimile for comparison to modern day vaporization technology. Many of the clinical research studies available focus on aspects of vaping such as the amount of nicotine or marijuana delivered but there’s not a great deal of evidence on the analysis of other toxins released both from vaporizing tobacco leaf products and marijuana. With all of these limitations, most of the available studies are non-clinical or have very small numbers of study subjects. A strong and thorough assessment of the potential dangers of vaporizing tobacco and marijuana products has not been forthcoming.12,13
Where to report e-cigarettes?
CDC encourages clinicians to continue to report possible cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) to their local or state health department for further investigation.
What to ask about e-cigarettes?
If EVALI is suspected, health care providers should ask about the use of e-cigarette, or vaping, products in a confidential and nonjudgmental manner. The most critical step in assessing EVALI is to ask patients about recent use of e-cigarette, or vaping, products. If product use is confirmed, ask about the types of substances used (e.g., [tetrahydrocannabinol] THC and nicotine) and where they were obtained.
What is the best treatment for evali?
Corticosteroids might be helpful in treating EVALI.
How long should a patient be stable before discharge?
Discharge Planning. Hospitalized patients should be documented as clinically stable for 24–48 hours prior to discharge.
How long after discharge can you get CXR?
Additional follow-up testing 1–2 months after discharge might include spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), and CXR.
Is vitamin E acetate linked to the eli outbreak?
Vitamin E acetate is strongly linked to the EVALI outbreak. Vitamin E acetate has been found in product samples tested by FDA and state laboratories and in patient lung fluid samples tested by CDC from geographically diverse states. Vitamin E acetate has not been found in the lung fluid of people that do not have EVALI.
Where to report evali?
Report cases of EVALI to your state or local health department.
What is an end vape?
ENDS, also known as E-cigarettes and vaping devices, were originally developed as a replacement device for conventional tobacco cigarette smokers [1]. However, their success in the arena of smoking cessation has been very limited, and they remain unapproved as cessation tools due to a lack of data demonstrating efficacy relative to currently approved nicotine replacement therapies [2]. The aerosols produced by E-cigarettes are known to cause a variety of deleterious health effects, although more research and long-term studies are still needed [2]. E-devices have rapidly evolved since entering the international market in 2013, with vape pens, box mods, and pod-based devices being the most commonly used vaping devices in 2020 [3]. Although E-cigarettes are used in conjunction with conventional tobacco by many cigarette smokers (dual users), their sole use in young adults and adolescents has skyrocketed [4]. This is concerning as use of tobacco products had been declining worldwide for over 50 years, and now, a new generation of nicotine addicts is being created through these novel vaping devices through the use of appealing flavors and packaging [5]. Even more concerning is that children and teenagers who use E-cigarettes are more likely to smoke conventional tobacco [6].
What is the difference between evali and lipoid pneumonia?
a, bThe histologic distinction between exogenous lipoid pneumonia and electronic cigarette or vaping-associated lung injury (EVALI) is dramatic and distinctive. Exogenous lipoid pneumonia shows numerous lipid vacuoles a, most of which are much larger than individual cells. There is associated fibrosis in which many of the droplets are embedded. Occasional macrophages contain lipid droplets within their cytoplasm. However, the droplets are much larger and more variable (arrow) compared to EVALI, H&E, × 100. Larger lipid vacuoles are surrounded by several multinucleated giant cells and a foreign body giant cell reaction (arrowhead) b, a feature not seen in EVALI, H&E, × 200
How long does it take for eli to show up?
Symptoms occur anywhere from hours to weeks prior to presentation. Laboratory tests commonly reveal an elevated erythrocyte sedimentation rate and c-reactive protein level, transaminitis, and leukocytosis [13]. To meet the CDC criteria for a “confirmed” EVALI case, patients must have vaped within 90 days before symptom onset, have bilateral infiltrates on chest imaging, have a negative evaluation for infection, and have no other plausible alternative diagnoses. Cases of “Probable” EVALI share similar criteria, except that infection may be present, but the clinical team caring for the patient has high confidence that infection is not the primary cause for the patient’s respiratory condition.
What is a Bairspace macrophage?
a, bAirspace macrophages seen in biopsy specimens from patients with electronic cigarette or vaping-associated lung injury. Marked accumulation of macrophage with distended and foamy cytoplasm is frequently encountered (arrow) a, H&E, × 400. Some of the macrophages may have pigment or pigmented material in the cytoplasm b, H&E, × 200
Is vaping a respiratory disease?
In the summer of 2019, an acute, mysterious, and deadly respiratory illness related to vaping emerged, primarily in young patients, in the USA. Cases increased dramatically and peaked in late September 2019. The Center for Disease Control and Prevention (CDC) termed the disease causing this epidemic E-cigarette or vaping product use-associated lung injury (EVALI). Prior to EVALI, vaping had been associated with a variety of different pulmonary presentations ranging from lipoid pneumonia to diffuse alveolar hemorrhage, but at low numbers. In this review, we discuss electronic nicotine delivery systems (ENDS) as well as the etiology, clinical presentation, imaging findings, pathologic features, treatment, and long-term consequences of EVALI. We conclude with a discussion on the practical impact EVALI has had on the practice of pathology.
Is vaping a lung disease?
Although lung diseases caused by vaping have been reported since the modern invention of the electronic cigarette , in the summer of 2019, patients began to present to health care centers at epidemic levels with an acute respiratory illness relating to vaping, which the Center for Disease Control termed E-cigarette or vaping product use-associated lung injury (EVALI). This review discusses electronic nicotine delivery systems as well as the etiology, clinical presentation, imaging findings, pathologic features, treatment, and long-term consequences of EVALI. We conclude with the practical impact EVALI has had on the practice of pathology.
Does lung biopsy show tungsten?
Interestingly, energy-dispersive X-ray spectroscopy on the actual tissue samples failed to reveal evidence of tungsten or cobalt.
Why is vaping so successful?
Vaping is more success full than other methods because it also mimics (mimics, not reality) other parts of the smoking "experience.". You're inhaling. It has a flavor. It produces what looks like, but isn't, smoke.
Is Vitamin E acetate a condensing agent?
Vitamin E acetate is sometimes added as a condensing agent in e-liquid, particularly in those containing THC, and this has been associated with EVALI. As such, the CDC discourages use of THC-containing [vape products], particularly those sourced informally from family or friends.
Is vaping safe for 2021?
By Cameron English — May 25, 2021. Despite increasing evidence that vaping is safer than smoking, uncertainty surrounds the long-term effects of electronic cigarette use. Many in the tobacco control field have used the lack of data to speculate about these unknown risks.
Is vaping bad for you?
After contrasting the overall risk of vaping with smoking, Barton added that some preliminary studies have indeed associated e-cigarette use with various negative outcomes. For example, an onslaught of headlines in mid-2019 warned the public about an outbreak of “e-cigarette or vaping product use-associated lung injury” (EVALI). Under-reported at the time was the fact that the injury-causing devices were typically purchased illegally and contained THC or certain dangerous additives, which made them far more harmful than the nicotine-containing devices adult customers can legally purchase in licensed vape shops in the US and UK. Surveying the literature nearly two years later, we get a better sense of the problem:
Is nicotine replacement a tobacco product?
According to Nicotine and Tobacco Research, "If all products containing nicotine derived from tobacco were labeled as 'tobacco products' internationally, then nicotine-replacement therapies would be classified as tobacco products, which they are clearly not.".
Can you buy THC in vape shops?
Under-reported at the time was the fact that the injury-causing devices were typically purchased illegally and contained THC or certain dangerous additives, which made them far more harmful than the nicotine-containing devices adult customers can legally purchase in licensed vape shops in the US and UK.
Is vaping better than smoking?
Compared to the typical news report about vaping —"Vaping is not better than smoking, and it still causes long-term lung damage"—Barton's article illustrated how we should talk about scientific issues when the evidence surrounding them is evolving. Let's consider a few examples.
How old are you when you vape?
Younger adults are more likely to vape than older adults. In fact, adults between 18 and 24 years old are three times more likely than average to use e-cigarettes or a similar vaping product, and adults between 25 and 34 years old are twice as likely.
How many people use e-cigarettes in 2017?
Survey data shows 4.6% of adults currently used e-cigarettes or a similar device in 2017, compared with 4.7% in 2016.
Which state has the lowest vaping rate?
Kentucky, for example, had the second-highest rate of both adults who vape (6.1%) and tobacco smokers (24.6%) in 2017. California, meanwhile, had the lowest rate of vaping (3%) and the second-lowest rate of tobacco smokers (11.3%).
Is e-cigarette use an epidemic?
surgeon general – have deemed e-cigarette use among youth an "epidemic. " Questions also have swirled over whether e-cigarettes are effective as a smoking-cessation tool, or whether they merely offer another path to nicotine addiction. ...
What does medical records reflect?
Medical records often reflect differing diagnoses and treatment recommendations among multiple caregivers. However, oral or written criticism of previous health care contributes nothing to the patient's needs. Patients may take casual remarks critical of prior care quite seriously, possibly destroying their relationships with previous caregivers and/or you.
Why is it important to keep your medical records up to date?
Keep your records up-to-date in order to provide the best resource for patient care and evidence that appropriate and timely care was provided. Clinically pertinent information. The medical record is a primary mechanism for providing continuity and communication among all practitioners involved in a patient's care.
What is the importance of complete medical records?
Current, complete records which assist diagnosis and treatment, and which communicate pertinent information to other caregivers also provide excellent records for risk management purposes. The use of encounter forms, checklists, flowsheets, and computer-assisted documentation for high volume activities can save time and may also reduce the communication problems and errors caused by illegible handwriting. Missing, incomplete, or illegible documentation can seriously impede patient care and the defense of a malpractice claim, even when the care was appropriate. The following advice on documentation includes issues identified through analysis of malpractice claims.
What is clinically pertinent information?
The medical record is a primary mechanism for providing continuity and communication among all practitioners involved in a patient's care. To gauge adequacy of your patient's medical records, consider what you would want documented if you were assuming management of the care of a patient you did not know.
What is current complete records?
Current, complete records which assist diagnosis and treatment, and which communicate pertinent information to other caregivers also provide excellent records for risk management purposes.
What should not be documented in Massachusetts?
What should not be documented. Derogatory or discriminatory remarks. In Massachusetts, patients have the right to access both office and institutional medical records and may be sensitive to notes they view as disrespectful or prejudicial. Include socio-economic information only if relevant to patient care.
Can a patient's perceptions be inaccurately reported?
In addition, the patient's perceptions and recollections may be inaccurately reported. If, after complete information is considered, you do judge your patient's prior care to have been flawed, a factual summary of clinical events and honest answering of patient inquiries is advised.
Marijuana
Hearing on Cannabis Policies for the New Decade – Read Dr. Volkow’s congressional testimony on the adverse health effects of cannabis, current NIH efforts to research the risks and benefits of cannabis use, and its potential for therapeutic purposes.
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