Vaping FAQs

what is causing the lung problems with vaping

by Dr. Conrad Rutherford I Published 1 year ago Updated 1 year ago
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Deadly vaping lung illnesses are cropping up across the US, and experts blame everything from vegetable oil to ‘Dank Vapes’

  • Vape juices often contain chemicals like formaldehyde. The flavors of vaping liquids are one of the top two reasons young people told Reuters they begin using e-cigs. REUTERS/David Becker ...
  • Most e-cigs also produce acrolein, a chemical often found in weed killer. The chemical acrolein releases when gasoline is burned. ...
  • Nicotine hurts the lungs, whether it's vaped or smoked, and could also be at fault. ...

Vaping and Popcorn Lung
Diacetyl is frequently added to flavored e-liquid to enhance the taste. Inhaling diacetyl causes inflammation and may lead to permanent scarring in the smallest branches of the airways — popcorn lung — which makes breathing difficult.

Full Answer

Is vaping still bad for Your Lungs?

Vaping, the act of vaporizing a liquid to inhale, is an increasingly popular alternative to cigarette smoking. However, it could damage health by irritating the lungs and throat and introducing toxins into the body. Some vape product manufacturers claim that vaping is a completely safe alternative to smoking.

How does vaping affect your lungs?

Vaping-related lipoid pneumonia is the result of inhaling oily substances found in e-liquid, which sparks an inflammatory response in the lungs. Symptoms of lipoid pneumonia include: Chronic cough. Shortness of breath. Coughing up blood or blood-tinged mucus.

What happens to your lungs when you vape?

These include:

  • Diacetyl: This food additive, used to deepen e-cigarette flavors, is known to damage small passageways in the lungs.
  • Formaldehyde: This toxic chemical can cause lung disease and contribute to heart disease.
  • Acrolein: Most often used as a weed killer, this chemical can also damage lungs.

Will vaping clean out your lungs?

The lungs have self-cleaning characteristics which can wash out 100% of the impurities. There is still no concrete answer to does actually vaping leave water in the lungs. All, that can be said is it might be less harmful than smoking conventional cigarettes, but definitely not 100% safe.

What is the chemical that can damage your lungs?

What is a vape pen?

What happens if you inhale diacetyl?

What to do if your lung hurts?

What is the condition called when you get sick from eating popcorn?

Does vaping affect the lungs?

Is second hand vapor safe?

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How do you tell if your lungs are damaged from vaping?

What are the symptoms of EVALI?Shortness of breath.Cough.Chest pain.Fever and chills.Diarrhea, nausea, vomiting, and abdominal pain.Rapid heartbeat.Rapid and shallow breathing.

Can your lungs heal after quitting vaping?

Enhanced Lung Capacity Within the first 1 to 9 months after quitting vaping, the lung's capacity to clear out mucus and fight off infections significantly increases. This event is even more noticeable than the early signs of increased lung capacity most people will feel shortly after they quit vaping.

Is vape worse than cigarettes?

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.

What can I do instead of vaping?

Here are some ideas:Keep your mouth and hands busy. Chew gum. ... Exercise. Go for a walk. ... Change your routine. ... Use nicotine replacement therapy. ... Tell others that you are quitting. ... Prepare to handle places where people smoke. ... Take deep breaths. ... Let your feelings out.More items...

How long after I quit vaping will I feel better?

The withdrawal timeline is also different for everyone, but according to a 2015 study, symptoms like these set in between 4 and 24 hours after the last use, peak on day 3, and typically subside during the following 3-4 weeks.

How long do you have to vape for it to cause damage?

Exposure for just three days was enough to incur sufficient damage to their lungs, setting the stage for long-term chronic lung damage.

Can't breathe after quitting vaping?

Yes it takes a few months for breathing to get better and many people feel a little worse the first month or two. This is primarily because you are starting to clear a lot of gunk from your lungs also the nicotine withdrawal is probably making you a little more sensitive to your body.

How long does vaping withdrawal last?

Nicotine withdrawal symptoms set in between 4 and 24 hours after a person last vaped. The symptoms peak around day three of abstinence and then gradually subside over the following three to four weeks.

4 Major Health Risks Linked To E-Cigarette Use - WebMD

E-cigarette use, or "vaping," has been linked to lung, heart, brain, and gum illnesses. While using e-cigarettes ("vaping") may be healthier than smoking traditional cigarettes, users still face ...

Can vaping damage your lungs? What we do (and don’t) know

The rising popularity of vaping has been dramatic, especially among teenagers.According to a 2019 study, about 37% of high school seniors reported vaping in 2018, up from 28% the year before.An estimated 2.1 million middle school and high school students reported using e-cigarettes in 2017; that number jumped to 3.6 million in 2018.A more recent survey found that among high school seniors ...

What are the symptoms of vapors?

Typically, symptoms have started gradually, with shortness of breath and/or chest pain before more severe breathing difficulty led to hospital admission.

How many people have lung disease from e-cigarettes?

According to the CDC: Nearly 200 e-cigarette users have developed severe lung disease in 22 states (and the numbers keep rising — a Washington Post story put the number at 354). Most cases were among teens and young adults.

What are the effects of smoking?

The recent tragic and alarming cases of severe lung disease are clearly cause for concern. A number of other health effects are also worrisome: 1 Nicotine is highly addictive and can affect the developing brain, potentially harming teens and young adults. Even some "nicotine-free" e-cigarettes have been found to contain nicotine. 2 Some substances found in e-cigarette vapor have been linked to an increased risk of cancer. 3 Teens who vape are more likely to begin smoking cigarettes. 4 Explosions and burns have been reported with e-cigarettes while recharging the devices, due to defective batteries. 5 Accidental exposure to liquid from e-cigarettes has caused acute nicotine poisoning in children and adults. 6 Vaping during pregnancy could harm a developing fetus.

What are the chemicals in e-cigarettes?

E-cigarettes produce a number of dangerous chemicals including acetaldehyde, acrolein, and formaldehyde. These aldehydes can cause lung disease, as well as cardiovascular (heart) disease. Electronic cigarettes, or e-cigarettes, put nicotine into your lungs and bloodstream.

How many puffs can you have with vaping?

With vaping, you can have one or two puffs, be satisfied, and be done whenever you want. You are not committed. You might only need one puff, then maybe five minutes later you take another one. You won’t overdo because your brain will never have to justify it as an expense if you stop now. You just stop now.

What is the e-cigarette called?

The Centers for Disease Control and Prevention has created a web page with the latest information and recommendations about what is now being called EVALI (for e-cigarette, or vaping, product use associated lung injury).

Can e-cigarettes cause nicotine poisoning?

Accidental exposure to liquid from e-cigarettes has caused acute nicotine poisoning in children and adults.

What is the e-cigarette vaping outbreak?

Lung injuries and a spate of deaths are the result of what's now called EVALI (e-cigarette, or vaping, product use-associated lung injury). (Getty Images) The outbreak has raised nationwide concern and questions about the effects of vaping on the lungs.

What are the symptoms of e-cigarettes?

If you've recently used e-cigarettes or other vaping devices, what could make you suspect that you might have EVALI? Shortness of breath and cough are primary symptoms. Some patients also have symptoms of gastric illness and even weight loss.

What are the symptoms of evali?

As CDC gleaned data from medical records, they found that patients eventually diagnosed with EVALI initially had some of the following symptoms: 1 Cough. 2 Chest pain. 3 Shortness of breath. 4 Abdominal pain. 5 Nausea. 6 Vomiting. 7 Diarrhea. 8 Fever. 9 Chills. 10 Weight loss.

How many young people use e-cigarettes?

About 1 in 5 young adults between ages 18 to 38 uses e-cigarettes either daily or recreationally, according to survey data released by the American Society of Clinical Oncology in September. Nearly 1 in 4 young adults believes that the products are harmless and not addictive, the ASCO survey found.

What is the name of the abnormally rapid breathing?

Rapid heart rate (tachycardia). Abnormally rapid breathing (tachypnea). Decreased oxygen levels in the blood (measured by a pulse-oximeter device). Stethoscope exams typically didn't reveal any remarkable respiratory changes, even among patients with severe lung injury.

Does vaping cause lung problems?

How Vaping Causes Serious Lung Disorders. More. Across the U.S., an epidemic of severe lung disease is affecting people who vape. Although vapers don't expect to end up in the intensive care unit with respiratory and gastrointestinal problems, that's been the experience for some. Lung injuries and a spate of deaths are the result ...

Can pregnant women use e-cigarettes?

Youth, young adults and pregnant women should never use e-cigarettes or vaping products. "We know that nicotine levels in e-cigarettes are quite harmful for the developing brain, which continues to develop through age 25," Schuchat said.

When will vaping peak?

Emergency department (ED) visits related to e-cigarette, or vaping, products continue to decline, after sharply increasing in August 2019 and peaking in September.

When is the next vaping hospital admission?

Dates of symptom onset and hospital admission for patients with lung injury associated with e-cigarette use, or vaping — United States, March 31, 2019–February 15, 2020. Numbers do not sum to 2,807 due to missing admission dates.

What is an e-cigarette?

Using an e-cigarette is commonly called vaping. E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.

How to contact CDC about e-cigarettes?

If you have questions about CDC’s investigation into the lung injuries associated with use of e-cigarette, or vaping, products, contact CDC-INFO or call 1-800-232-4636.

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.

Who monitors e-cigarettes?

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are continuing to monitor e-cigarette, or vaping, product use-associated lung injury (EVALI).

Is vitamin E acetate in bronchoalveolar fluid?

Vitamin E acetate was identified in bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 48 of the 51 EVALI patients, but not in the BAL fluid from the healthy comparison group.

What happens when you lose elasticity in your lungs?

COPD occurs when the tubes in the lungs lose their elasticity. This loss causes some air to remain in the lungs after exhaling.

How many participants were in the study of e-cigarette smokers?

The study included 44 participants, a mixture of conventional cigarette smokers, e-cigarette users, and non-smokers. Researchers discovered proteins in the airways of e-cigarette smokers that are known to contribute to COPD. All smokers in the study showed markers of oxidative stress associated with lung disease.

What is a pulmonary function test?

Also known as a pulmonary function test, spirometry detects even early cases of COPD. It involves exhaling forcefully into a tube connected to a spirometer. The device measures how much and how quickly air is exhaled.

How to help someone with smoking cessation?

Build a support network: Ask family and friends for help and support. Join a smoking cessation support group or online forum.

Why are older adults more likely to have COPD?

Older adults are more likely to have COPD because symptoms typically develop over several years.

Is vaping good for COPD?

Vaping is often seen as an alternative to traditional cigarettes, especially for those with lung conditions such as COPD, as it is thought to be less harmful. There is, however, insufficient research available on the effects of vaping for people with COPD. COPD, or chronic obstructive pulmonary disease, is caused primarily by exposure ...

Is it safe to quit vaping?

Quitting. Takeaway. The safety and long-term health effects of using e-cigarettes or other vaping products still aren’t well known. In September 2019, federal and state health authorities began investigating an outbreak of a severe lung disease associated with e-cigarettes and other vaping products. Trusted Source.

Why are e-cigarettes linked to lung disease?

A culprit thickener, or other additive, might explain why both e-cigarettes, which have legal cartridges that typically carry nicotine, and vaporizers are linked to the 450 people with lung illness, said Kovacevich. “With black market cartridges, or counterfeit cartridges — we see a lot of those — the ingredients are not known.”

What is vaporizer in e-cigarettes?

Advertisement. “Vaping” is shorthand for inhaling vaporized liquid, usually a mixture of nicotine and oil heated by a battery-powered atomizer in an e-cigarette or larger vaporizer. E-cigarettes have been sold in the US since 2007, with more than 9 million people using them on a regular basis, according to the CDC.

What are the thickeners in vaping liquids?

There is some suspicion about the “thickeners” added to vaping liquids, Nick Kovacevich, CEO of KushCo Holdings, the largest US seller of vaping products and accessories (but not vaping liquids), told BuzzFeed News. Thickeners make vaping liquids more viscous, preventing oversaturation of a vaporizer’s combustion chamber. Typically in THC vaping liquids, they are loaded with the terpenes that give marijuana its taste.

What devices did people with lung injuries use?

Patients with lung injuries used a wide variety of devices, including both vaporizers, large-ish gadgets with a refillable liquid reservoir, smaller e-cigarettes that vaporize nicotine liquid from cartridges, and a wide variety of brands of liquids and cartridges. Around 80% reported they used vaping liquids that contained THC, the central clue in the case, with investigators hinting that the chemical was likely involved in all of the cases.

Is vaping legal in Michigan?

In the meantime, Michigan’s governor only last week banned the sale of flavored e-cigarettes in her state in response to teen vaping, and after its health department announced six cases of lung illness. The legal US age for e-cigarette use is 18, and Walley and others complain that with 1 in 5 teens now vaping, those rules are being flouted, with kids ending up hooked on nicotine, which changes adolescent brain development.

Is Vitamin E bad for vaping?

While health officials hunt for answers, one leading theory points to a bad ingredient in vaping liquids, perhaps Vitamin E, sold on the street. But some physicians suspect the epidemic has always been there, unnoticed until now. And for others, the culprit might be the online world of dubious home-brew recipes for getting a better high while vaping.

Is the FDA regulating e-cigarettes?

The FDA is entitled to regulate e-cigarettes but to much criticism has pushed back its review of rules until 2022. In the meantime, hundreds of flavored and THC-infused vapors have gone on sale in wild west conditions, unregulated, as teen vaping has mushroomed.

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

What is giant cell interstitial pneumonia?

Rare descriptions of additional patterns of lung injury have been described, including giant cell interstitial pneumonia that is a form of pneumoconiosis related to hard metal exposure and shows the accumulation of numerous multinucleated giant cells within the air spaces.

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.

Is lipoid pneumonia a pathologic disease?

Despite the published reports of lipoid pneumonia as a mechanism of injury in EVALI, no well-characterized radiologic and pathologic cases have been published. Most of the clinicopathologic diagnoses of lipoid pneumonia have been based on the finding of lipid-laden macrophages in BAL cytology specimens (discussed in detail below). To date, there have been no HRCT features of classic exogenous lipoid pneumonia, specifically the demonstration of macroscopic fat on HRCT, described in the literature.

What are the long term effects of inhaled vapors?

But there are other causes for concern about the long-term health effects of inhaled vapors, including humectants, flavorings, the heating process, and metallic coil corrosion. Humectants are additives used to produce vapor, such as propylene glycol or glycerol.

How many deaths from vaping in 2020?

By mid-February 2020, the CDC reported more than 2,800 cases of lung injuries requiring hospitalization across all 50 states, and 68 deaths. EVALI, as this illness is now called, continues to generate questions, ...

What is an e-cigarette?

EVALI (e-cigarette or vaping product use associated lung injury) is an inflammatory response in the lungs triggered by inhaled substances. Given a huge range of products — many illicit or counterfeit — and many different ingredients, it’s not surprising that EVALI varies, too.

How many people use vaping in high school?

Among high school seniors, for example, use rates rose from nearly zero in 2011 to almost 29% in 2019, according to the Centers for Disease Control and Prevention (CDC). An estimated 9% of adults 18 and over use vaping products, according to a 2018 Gallup poll.

Why is EVALI hard to diagnose?

Confirming a diagnosis of EVALI has been difficult because no simple lab test for it is available. Right now, doctors diagnose EVALI based on symptoms, recent use of vaping products, abnormalities found on lung scans, and no evidence of infection. Unfortunately, direct lung examination requires a bronchoscopy, which most patients are too sick to tolerate safely. Data from patients who did undergo bronchoscopy has so far failed to identify the mechanism causing lung injuries.

How many people die from vaping?

There have been 1,299 reported cases of people suffering lung injuries after using electronic cigarettes or vaping products in the U.S., along with 26 official deaths, according to a new Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC). The numbers are expected to rise along with awareness ...

What is the CDC's name for vaping?

While the concept of vaping-related illness is fairly new, the CDC just revealed there’s now a name for it: e-cigarette or vaping product use associated lung injury, aka EVALI. There’s a lot health officials still haven’t figured out about EVALI, but here’s what they do know about its potential causes, symptoms, and treatment.

What are the symptoms of EVALI specifically?

EVALI can cause symptoms that resemble those of pneumonia or the flu , the CDC warns, including the following:

What is the respiratory virus panel?

A respiratory virus panel is also recommended to rule out other illnesses and a chest CT scan. “A patient can have pneumonia or the flu,” Dr. Onugha says.

Is e-cigarettes a cause of lung cancer?

While experts know that e-cigarettes and va ping products are involved , they’re not exactly sure what it is about those products that’s causing the lung illness. The CDC did note that more than 80 percent of cases of EVALI involved products with THC (the chemical responsible for most of marijuana’s psychological effects). As a result, officials are looking into thickeners and additives that are found in black market THC cartridges.

Can vaping help you quit smoking?

If you’re using vaping to help you quit smoking, Dr. Tsai recommends having a conversation with your doctor. They’ll likely steer you toward an evidence-based way of quitting and using FDA-approved medications, she says.

Does vaping make you feel fat?

Some pathology reports have also shown that vaping causes fat to accumulate in the lungs, and that triggers an inflammatory response that makes it hard to breathe, says Osita Onugha, MD, a thoracic surgeon and director of thoracic surgery research and surgical innovation lab at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif.

How do vape pens collapse a lung?

Vitamin E acetate is not water-soluble but also replaces the natural surfactant that lines the inside of your lungs.

What are the surfactants in the Warburg Effect?

The surfactants, Vitamin E acetate and Polysorbate 80 , block this messenger and potentially slow down cell division. This might ramp lung damage if the surrounding tissues are not fed enough oxygen (Warburg Effect). New tissue will still need to form via cell division if lung tissue is attacked by a toxin and killed in any condition.

Does cannabis cause cancer?

Cannabis ‘s natural polypharmacy works on a highly balanced rhythm that does not cause the same risk of cancer or lung damage as THC vapes. So, it is typically ill-advised to alter this balance unnaturally.

Can tocopherols replace alveoli?

There is a fluid in your lungs that allows the little sacs known as alveoli to expand with air. A lung will collapse if it loses this fluid. Therefore, it is highly problematic that tocopherols can replace this fluid since this will potentially collapse the lung.

Does heat affect THC?

Heat influences THC to turn into Delta-8, CBN, or degrade. So, heat is an issue in the identity of the molecule. When you put THC in a vape cartridge, it is Delta-9 THC in the beginning. But, does anything happen to the THC when you heat it for vaporization? That question hasn’t really been answered, yet.

Can lung tissue be destroyed by a toxin?

New tissue will still need to form via cell division if lung tissue is attacked by a toxin and killed in any condition. Otherwise, the result might be catastrophic lung damage.

Is it safe to test the vapour that comes out of a cartridge?

You missed a step. Therefore, it would be good to test the vapour that comes out of a cartridge to know if there is any risk factor.

What is the chemical that can damage your lungs?

Acrolein: Most often used as a weed killer, this chemical can also damage lungs.

What is a vape pen?

With vaping, a device (typically a vape pen or a mod — an enhanced vape pen — that may look like a flash drive) heats up a liquid ( called vape juice or e -liquid) until it turns into a vapor that you inhale. “Vaping is a delivery system similar to a nebulizer, which people with asthma or other lung conditions may be familiar with,” says Broderick. ...

What happens if you inhale diacetyl?

Diacetyl is frequently added to flavored e-liquid to enhance the taste. Inhaling diacetyl causes inflammation and may lead to permanent scarring in the smallest branches of the airways — popcorn lung — which makes breathing difficult. Popcorn lung has no lasting treatment. There are, however, treatments that manage BO symptoms, such as: 1 Coughing 2 Wheezing 3 Chest pain 4 Shortness of breath

What to do if your lung hurts?

What to Do If Your Lungs Hurt. If you smoke or vape, don’t brush off chest or lung pain as something that’s normal. If you have pain or other symptoms associated with breathing difficulties, such as shortness of breath and chronic cough, it’s important to see a doctor.

What is the condition called when you get sick from eating popcorn?

“Popcorn lung” is another name for bronchiolitis obliterans (BO), a rare condition that results from damage of the lungs’ small airways. BO was originally discovered when popcorn factory workers started getting sick. The culprit was diacetyl, a food additive used to simulate butter flavor in microwave popcorn.

Does vaping affect the lungs?

Instead of bathing lung tissue with a therapeutic mist, just as a nebulizer does, vaping coats lungs with potentially harmful chemicals. E-liquid concoctions usually include some mix of flavorings, aromatic additives and nicotine or THC (the chemical in marijuana that causes psychological effects), dissolved in an oily liquid base.

Is second hand vapor safe?

Secondhand Vapor Isn’t Safe Either. It’s a myth that secondhand emissions from e-cigarettes are harmless. Many people think the secondhand vapor is just water, but this couldn’t be farther from the truth. The vapor emitted when someone exhales contains a variety of dangerous substances, which may include: Nicotine.

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