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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2014&#44; the Oxford English Dictionary named &#8220;vape&#8221; word of the year&#44; a verb meaning &#8220;to inhale and exhale the vapour produced by an electronic cigarette or similar device&#46; In Spain&#44; the first devices used for vaping&#44; known as e-cigarettes&#44; entered the market in 2007&#44; and their use has grown considerably since&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Vaping originally emerged as a strategy to quit smoking&#44; a tool for everyday smokers to overcome nicotine dependence&#44; but turned out to be a double-edged sword&#46; The data regarding the efficacy of e-cigarettes as an aid to quit smoking are contradictory&#44; while their use is expanding among nonsmokers&#44; especially in the young population&#44; and not only to deliver nicotine but also other substances&#44; such as cannabinoids&#44; tetrahydrocannabinol&#44; marihuana or a variety of oils&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Multiple studies have warned that vaping has had the opposite effect in youth&#44; with its use associated with progression to conventional smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> In the United States&#44; vaping has become a public health problem in the adolescent population&#44; as use of e-cigarettes has become widespread and 1 out of every 11 middle school students reports consuming them&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Vaping in the young population is also growing in Spain&#44; where 1 out of every 4 users of e-cigarettes does not have a previous history of tobacco use&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At present&#44; a variety of battery-operated devices are available to inhale aerosolised substances&#46; Although social acceptance of these devices is greater&#44; the legislation on their use is underdeveloped&#44; and they have been marketed as a preferable alternative to conventional smoking&#46; However&#44; significant conflicts of interest have been reported in studies on the subject&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> and the development of cases of severe pulmonary disease associated with their use has caused widespread concern in recent months&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Research on the effects of vaping is currently insufficient&#46; Side effects have not been associated solely to classic vaping products &#40;nicotine and cannabinoids&#41;&#44; but oils and chemicals used in the different flavours may also be harmful to health&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a> The potential of inhaling chemicals with unknown effects is high&#44; and it is difficult to determine the amounts that are being inhaled &#40;which depend on the product consumed&#44; its concentration and the device used for delivery&#41; or the source of the product&#46; Recently&#44; evidence has emerged warning of potential&#44; hereto unknown side of vaping&#46; The Centers for Disease Control and Prevention &#40;CDC&#41; and the health authorities of the United States are collaborating to investigate the growing number of cases of severe lung disease associated with e-cigarette use&#44; urging doctors to actively collect data on this potential association&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> There have been reports in previously healthy youth of cases of acute lung disease presenting with cough and chest pain with quick progression to dyspnoea and severe respiratory failure&#44; sudden onset sometimes associated with fever&#44; gastrointestinal manifestations &#40;such as vomiting or diarrhoea&#41; and systemic manifestations&#46; According to different publications of the CDC&#44; the first case of severe pulmonary disease associated with vaping was diagnosed in July 2019&#44; in August 110 cases had been reported in 15 states&#44; and in September the case count had already risen to 500&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The definition of the CDC of a confirmed case of pulmonary disease associated with vaping is a patient reported use of an e-cigarette &#40;vaping&#41; or dabbing in the 90 days before onset with evidence of pulmonary infiltration on chest plain radiograph and in the absence of an alternative plausible cause&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> and&#44; along with the Food and Drug Administration &#40;FDA&#41; of the United States&#44; it has been investigating its relationship with cases of convulsive seizures since its initial statement warning of this potential side effect&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; e-cigarette use is increasing among our youth and vaping is associated with an increased risk of starting to smoke conventional cigarettes&#44; their long-term effects have not been investigated adequately&#44; and at present both the CDC and the FDA are researching potential severe adverse effects&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">As paediatricians in Spain&#44; whether in primary care or at the hospital level&#44; we must be prepared to face this new epidemic&#46; Recommendations against tobacco given in primary care must now be accompanied by recommendations against vaping&#44; and we must also warn of the risks involved in passive exposure to vaping products&#46; Educational materials must be developed to provide to our patients and their families&#46; We must directly ask adolescents about their use of e-cigarettes and warn parents about them&#44; as use is difficult to detect due to their near non-existent smell&#46; Furthermore&#44; in case of acute respiratory diseases or convulsive seizures of unclear aetiology in adolescents&#44; we must rule out a potential association with vaping&#44; and start a national register of potential cases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In light of all of the above&#44; I consider that working groups should be created in the <span class="elsevierStyleItalic">Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a</span> to detect and study potential side effects of vaping&#44; and urgent strategies developed to prevent e-cigarette use in our patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study was made possible by the aid received from the <span class="elsevierStyleGrantSponsor" id="gs1">Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a</span> &#40;Spanish Association of Pediatrics&#44; AEP&#41;&#58; 2018 InvestAEP research grant&#46;</p></span></span>"
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Scientific Letter
Vaping: The new problems of a new epidemic and the importance of paediatricians in their prevention
Vaping: los nuevos problemas de una nueva epidemia y la importancia de los pediatras en su prevención
Laura Moreno-Galarraga
Unidad de Neumología Infantil, Servicio de Pediatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2014&#44; the Oxford English Dictionary named &#8220;vape&#8221; word of the year&#44; a verb meaning &#8220;to inhale and exhale the vapour produced by an electronic cigarette or similar device&#46; In Spain&#44; the first devices used for vaping&#44; known as e-cigarettes&#44; entered the market in 2007&#44; and their use has grown considerably since&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Vaping originally emerged as a strategy to quit smoking&#44; a tool for everyday smokers to overcome nicotine dependence&#44; but turned out to be a double-edged sword&#46; The data regarding the efficacy of e-cigarettes as an aid to quit smoking are contradictory&#44; while their use is expanding among nonsmokers&#44; especially in the young population&#44; and not only to deliver nicotine but also other substances&#44; such as cannabinoids&#44; tetrahydrocannabinol&#44; marihuana or a variety of oils&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Multiple studies have warned that vaping has had the opposite effect in youth&#44; with its use associated with progression to conventional smoking&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> In the United States&#44; vaping has become a public health problem in the adolescent population&#44; as use of e-cigarettes has become widespread and 1 out of every 11 middle school students reports consuming them&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Vaping in the young population is also growing in Spain&#44; where 1 out of every 4 users of e-cigarettes does not have a previous history of tobacco use&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At present&#44; a variety of battery-operated devices are available to inhale aerosolised substances&#46; Although social acceptance of these devices is greater&#44; the legislation on their use is underdeveloped&#44; and they have been marketed as a preferable alternative to conventional smoking&#46; However&#44; significant conflicts of interest have been reported in studies on the subject&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> and the development of cases of severe pulmonary disease associated with their use has caused widespread concern in recent months&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Research on the effects of vaping is currently insufficient&#46; Side effects have not been associated solely to classic vaping products &#40;nicotine and cannabinoids&#41;&#44; but oils and chemicals used in the different flavours may also be harmful to health&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a> The potential of inhaling chemicals with unknown effects is high&#44; and it is difficult to determine the amounts that are being inhaled &#40;which depend on the product consumed&#44; its concentration and the device used for delivery&#41; or the source of the product&#46; Recently&#44; evidence has emerged warning of potential&#44; hereto unknown side of vaping&#46; The Centers for Disease Control and Prevention &#40;CDC&#41; and the health authorities of the United States are collaborating to investigate the growing number of cases of severe lung disease associated with e-cigarette use&#44; urging doctors to actively collect data on this potential association&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> There have been reports in previously healthy youth of cases of acute lung disease presenting with cough and chest pain with quick progression to dyspnoea and severe respiratory failure&#44; sudden onset sometimes associated with fever&#44; gastrointestinal manifestations &#40;such as vomiting or diarrhoea&#41; and systemic manifestations&#46; According to different publications of the CDC&#44; the first case of severe pulmonary disease associated with vaping was diagnosed in July 2019&#44; in August 110 cases had been reported in 15 states&#44; and in September the case count had already risen to 500&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The definition of the CDC of a confirmed case of pulmonary disease associated with vaping is a patient reported use of an e-cigarette &#40;vaping&#41; or dabbing in the 90 days before onset with evidence of pulmonary infiltration on chest plain radiograph and in the absence of an alternative plausible cause&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> and&#44; along with the Food and Drug Administration &#40;FDA&#41; of the United States&#44; it has been investigating its relationship with cases of convulsive seizures since its initial statement warning of this potential side effect&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; e-cigarette use is increasing among our youth and vaping is associated with an increased risk of starting to smoke conventional cigarettes&#44; their long-term effects have not been investigated adequately&#44; and at present both the CDC and the FDA are researching potential severe adverse effects&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">As paediatricians in Spain&#44; whether in primary care or at the hospital level&#44; we must be prepared to face this new epidemic&#46; Recommendations against tobacco given in primary care must now be accompanied by recommendations against vaping&#44; and we must also warn of the risks involved in passive exposure to vaping products&#46; Educational materials must be developed to provide to our patients and their families&#46; We must directly ask adolescents about their use of e-cigarettes and warn parents about them&#44; as use is difficult to detect due to their near non-existent smell&#46; Furthermore&#44; in case of acute respiratory diseases or convulsive seizures of unclear aetiology in adolescents&#44; we must rule out a potential association with vaping&#44; and start a national register of potential cases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In light of all of the above&#44; I consider that working groups should be created in the <span class="elsevierStyleItalic">Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a</span> to detect and study potential side effects of vaping&#44; and urgent strategies developed to prevent e-cigarette use in our patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study was made possible by the aid received from the <span class="elsevierStyleGrantSponsor" id="gs1">Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a</span> &#40;Spanish Association of Pediatrics&#44; AEP&#41;&#58; 2018 InvestAEP research grant&#46;</p></span></span>"
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Article information
ISSN: 23412879
Original language: English
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