Considering*COVID/19:* E/cigarettes*&*Vaping*with*Asthma - PDF document

10/7/20 Allergy'&'Asthma'Network'– Upcoming'Webinars We'record'all'of'our'webinars!'' Access'the'recordings'and' register'for'upcoming'webinars' at: www.allergyasthmanetwork.org Inhaler(Confusion:(The(Right( Experts(Answer(YOUR( News Medication,(Right(Technique( Questions(about(COVIDF19,( at(the(Right(Time Asthma,(Allergies(&(the(Flu Webinars Dr.$Mark$Corbett Dr.$Jackie$Eghrari3Sabet,$Dr.$Purvi Parikh$&$Tonya$Winders October'22'– 4:00'PM'ET October'27'– 4:00'PM'ET https://allergyasthmanetwork.org/allergyJasthmaJwebinars/ Considering*COVID/19:* E/cigarettes*&*Vaping*with*Asthma Mary%Cataletto,%M.D.,%M.M.M. Tonya%Winders 1

10/7/20 Our$Speakers Dr.&Mary&Cataletto Tonya&Winders President$&$CEO,$Allergy$&$ Professor$of$Clinical$ Asthma$Network Pediatrics President,$Global$Allergy$&$ NYUCLong$Island$School$of$ Airways$Patient$Platform Medicine Mineola,$New$York Outline ! Current*State*of*COVID*– 19 ! E6cigarettes*&*Vaping ! COVID619*Resources 2

10/7/20 Poll$Question • We’d%like%to%know%who%is%here%today. • What%“title”%best%describes%you? Current'State'of'COVID019 Tonya&Winders 3

10/7/20 Cases#in#the#last#7#days US#Data#Report#– CDC# 4

10/7/20 In#the#News • “We’re#not#in#a#good#place,”#Dr.#Anthony# Fauci,#the#nation’s#leading#expert#on# infectious#diseases,#warned. • CovidB19#cases#are#on#the#rise#again#across# the#United#States#as#more#and#more#states# have#loosened#restrictions#put#into#place# to#slow#the#spread#of#the#virus. • President#Trump#is#back#at#the#White# House#after#being#treated#at#Walter#Reed# Army#Hospital#for#COVIDB19 • Many#of#the#White#House#staff#have#also# tested#positive • Only#10#states#are#seeing#downward# trends#in#new#CovidB19#cases,#and#NYC# now#has#a#surge In#the#News • Vaccine#Tracker#– NY#Times • Researchers#are#testing 44 vaccines in#clinical#trials#on#humans,#and#at# least#91#preclinical#vaccines#are under#active#investigation in#animals. 5

10/7/20 COVID&19)Cases)in)US)by)Date)Reported New)Cases)by)Day 70000 60000 50000 40000 30000 20000 10000 0 3 0 7 3 0 7 4 1 8 5 2 9 3 0 7 8 6 1 8 5 2 9 6 3 0 7 4 1 7 4 1 8 5 1 2 2 ) 2 h ) 1 2 2 ) 1 1 2 ) ) 1 2 2 ) ) ) 1 2 2 ) 1 1 2 3 r 1 2 2 ) i l y y e e y t r ) h ) h ) h ) r ) ) ) ) ) ) ) ) ) ) ) ) s ) ) ) ) e ) ) ) e y c l l l a a y y y n n e e e u l y y y t t t t r r r p r i r i r i u s s s s b e e e b r r c c c M M a a a u u n n n l l l a a A J u u u g u u u u m b b b r r r p p p M M M J J u u u o u M a a a A A A J J J u g g g g m m m J J J t r M M M A u u u u e c b A A A A t e e e O p e t t p e p p F e e e S S S S Cases Poll$Question • What%is%the%trend%of%the%rate%of%new%COVID4 19%cases%in%your%area? 6

10/7/20 COVID&19)Information)– Allergy)&)Asthma)Network) • COVID&19)Information)Center • FAQ’s • Mental)Health)Tools • Infographics • Much)more).).).) • COVID&19))School)Resources)) • National)recommendations • Network)Notes)for)Parents • Planning)Tools • Asthma)Care)Resources • Posters)for)School E"cigarettes+&+Vaping Dr.$Mary$Cataletto 7

10/7/20 Impact'of'COVID'.19'on'Smoking'&'Vaping The Social'Isolation Perfect'Storm Anxiety COVID.19:''RISK'OF'INCREASE'IN'SMOKING'RATES'AMONG'ENGLAND’S'6'MILLION'SMOKERS' AND'RELAPSE'AMONG'ENGLAND’S'11'MILLION'EX.SMOKERS,'PATWARDAN','BJGP'2020 Percentage)of)adults)aged)18)years)or)older)who) reported)any)tobacco)product)use)“every)day”)or)“some)days” NORTHEAST:*17.5% Overall) WEST:**15.3% MIDWEST:**23.6% use:) 19.7%. SOUTH:)21.4% https://www.cdc.gov/tobacco/data_statistics/mmwrs/byyear/2019/mm6845a2/index.html 8

10/7/20 Active,(Second(&(Third(Hand(Smoke(Exposure There(is(no(safe(level(of(tobacco(exposure Active(Smoking Second(Hand Third(Hand • Lung(cancer • More(ear( • Sudden(Infant(death infections • COPD • Respiratory( • More(asthma infections,(including( • More(URTIs Bronchiolitis • More(asthma( • More(LRTIs • More(ear(infections exacerbations • CV(Disease • More(severe(asthma • Stroke • Slowed(lung(growth https://www.cdc.gov/tobacco/basic_information/secondhand_smoke/ Disparities)in)Second)Hand)Smoke)Exposure 9

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10/7/20 E"cigarette*Use*Among*Middle*&*HS*Students*in*U.S.* 2020* Study&Shows&Teen&Vapers&Up&to7X& More&Likely&to&Get&COVID?19&Than&Non?users 11

10/7/20 Nicotine Stimulant- Highly-Addictive Causes-changes-in-brain- chemistry Nicotine(in(the(Brain 12

10/7/20 Additional?Chemicals https://www.cdc.gov/tobacco/basic_information/e7cigarettes/pdfs/ecigarette7or7vaping7 products7visual7dictionary7508.pdf Behavior)Risks E.cigarette)use)among)youth)and)young) adults)is)strongly)linked)to)the)use)of) other)tobacco)products,)such)as)regular) cigarettes,)cigars,)hookah,)and)smokeless) tobacco. Some)evidence)suggests)that)e.cigarette) use)is)linked)to)alcohol)use)and)other) substance)use,)such)as)marijuana.)And) certain)e.cigarette)products)can)be)used) to)deliver)other)drugs)like)marijuana. Know%The%Risks:%E/Cigarettes%&%Young%People%– Behavior%Risks".%Surgeon%General%of%the%United%States.%2019. 13

10/7/20 Acute&Exposure&to&Vaping& Damages&airway& Decreases& cells macrophage Decreases& neutrophil& antimicrobial& function& Impaired)Microbial)Defenses IMPAIRED MUCOCILIARY)CLEARANCE MUCOCILIARY)CLEARANCE • Increased)mucus)production)and) NICOTINE A altered)mucus)clearance)are) S L hallmarks)of)airway)inflammation 1 TRPA)A)1 NICOTINE MUCIN)SECTRETION • EC)vapor)appears)to)have)potential)to) APICAL)ION)TRANSPORT REGULATES)NET)FLOW)OF)WATER INSUFFICIENT)HYDRATIONS impair)mucociliary clearance 2 TRPA1 CFTR BK CHANNEL MUCUS)CONTAINING) VESIvLES CHUNG,)S,)2020 1. Vaping)appears)to)have)potential)to)impair)mucociliary clearance Aufderheide M,)Emura M.)Phenotypical)changes)in)a)differentiating)immortalized)bronchial)epithelial)cell)line)after) exposure)to)mainstream)cigarette)smoke)and)eEcigarette)vapor.)Exp)Toxicol Pathol 2017;69:393E401.) 2. GarciaEArcos I,)Geraghty)P,)Baumlin N,)et)al.)Chronic)electronic)cigarette)exposure)in)mice)induces)features)of)COPD)in)a)nicotineEdependent)manner.)Thorax)2016;71:1119E29 14

10/7/20 Vaping'&'Asthma Numerous'studies'have'implicated'exposure'to'reactive'carbonyls,' including'formaldehyde,'acetaldehyde,'&'acrolein,'in'the' pathogenesis'&'exacerbation'of'asthma Aerosolization'of'propylene'glycol'and'glycerin'results'in'the' formation''&'inhalation'of'reactive'compounds'known'to'exacerbate' asthma' Many'users'prefer'to'vape'at'high'temperatures'as'more'aerosol'is' generated SARS$CoV$2)Under)the)Microscope www.cdc.gov https://www.globalhealthnow.org 15

10/7/20 Pathogenesis+of+COVID219 Inhaled+virus+SARS2CoV22+likely+binds+to+epithelial+ cells+in+the+nasal+cavity+and+starts+replicating+in+the+ nose,+pharynx,+larynx,+trachea,+bronchi,+and+ bronchioles+ American+chemical+society.org • RNA+virus+enters+human+cells+when+their+glycoproteins+bind+ proteins+on+the+cell+surface • Undergo+a+structural+change+that+allows+the+viral+membrane+ to+fuse+with+the+cell+membrane • Viral+genes+can+then+enter+the+host+cell+to+be+copied • Virus+copies+are+released+from+the+host+cell+where+they+can+ infect+more+cells https://www.nih.gov Potential)Impact)of)Smoking)&)Vaping)on) Vulnerability)&)Severity)Risk)From)COVID?19 Vulnerability:-- • Existing)lung)disease)or)reduced)lung)capacity • Behaviors)facilitating)transmission:)Shared)vape)devices,)hand)to)mouth)transmission) Severity(Risk: Reduced)cough)sensitivity Risk(of(Pneumonia Impaired)mucociliary function Immune)suppression https://www.who.int/emergencies/diseases/novel6coronavirus62019/question6and6answers6hub/q6a6detail/q6a6on6smoking6and6covid619# Glantz,)S,)UCSF)Center)for)Tobacco)Control)Research)&)Education,)https://tobacco.ucsf.edu/reduce?your?risk?serious?lung?disease?caused?corona?virus?quitting?smoking?and?vaping accessed)5/6/2020 16