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CDC, FDA escalate inquiry into link between e-cigarette use, respiratory disease

U.S. federal authorities are ramping up their investigations into the potential health risks of e-cigarettes.

The U.S. Food and Drug Administration and Centers for Disease Control and Prevention are working with local health officials to investigate incidents of severe respiratory disease associated with the use of e-cigarette products, the agencies said Aug. 30.

As of Aug. 27, there were 215 incidents from 25 states of potential cases of respiratory illnesses reported after the use of e-cigarettes, the agencies said. An adult in Illinois with a history of recent e-cigarette use died Aug. 20 after being hospitalized on July 29 with severe pulmonary disease.

"We are working closely with state and local health officials to investigate these incidents as quickly as possible, and we are committed to taking appropriate actions as a clearer picture of the facts emerges," FDA acting Commissioner Ned Sharpless said in a statement Aug. 30.

While some cases in each of the states are similar and appear to be linked to e-cigarette product use, more information is needed to determine the cause of the respiratory illnesses, Sharpless said.

No single substance or e-cigarette product has been consistently tied with illness, the CDC said. Many patients have reported using e-cigarettes containing cannabis products like THC and cannabidiol.

"We will continue using every regulatory and enforcement power we have to stop the epidemic of youth e-cigarette use," U.S. Department of Health and Human Services Secretary Alex Azar said in a statement Aug. 30.

Adult smokers looking to quit should use evidence-based treatments, the CDC said. The agency said e-cigarettes should not be used by youth, young adults, those who are pregnant or adults not currently using tobacco products.

The CDC recommended that anyone concerned by certain health risks should consider refraining from using e-cigarette products. It said consumers should not buy e-cigarettes off the street and not modify them in ways not intended by the manufacturer.

People who do use e-cigarettes should monitor themselves for symptoms like coughing, shortness of breath and chest pain and should promptly seek medical attention if they have health concerns, the CDC said.

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Juul is facing mounting scrutiny of its role in youth vaping.

Source: Juul Labs Inc.

E-cigarette companies are currently facing increased scrutiny on multiple fronts.

On Aug. 7, the FDA said it was investigating 127 reports of people having seizures following the use of e-cigarettes. A number of people who reported having seizures after using devices made by Juul Labs Inc. prompted the investigation, though the FDA did not find any proof of causality. The U.S. Federal Trade Commission is also investigating whether Juul targeted minors or used influencers for marketing its product.

Juul did not immediately respond to an S&P Global Market Intelligence request for comment Aug. 30. However, the e-cigarette maker is working with retailers across the U.S. to implement a stricter form of age verification for customers as part of its efforts to curb youth vaping.

The company has also voluntarily pulled flavored versions of its devices from store shelves, though they are still sold online. Juul has also discontinued its U.S.-based Instagram and Facebook accounts.

Nevertheless, the attorneys general in Illinois and Washington, D.C., are investigating how Juul's vaping device has become so popular with underage users, according to an Associated Press report. The U.S. House of Representatives also launched an investigation into four major e-cigarette makers about the health effects of their products. Juul and Philip Morris USA Inc., an Altria Group Inc. subsidiary, have been sued by a man accusing the companies of marketing their products to minors.

As the investigations mount, the future of the e-cigarette business in the U.S. is still being decided. On July 12, a federal judge ordered the FDA to implement a 10-month deadline for the submission of applications to sell e-cigarettes.

A new alternative to smoking is also slated to hit the U.S. market in September in the form of Philip Morris International Inc.'s heat-not-burn tobacco device called IQOS, which is already sold outside the U.S. Philip Morris has an agreement with Altria in which Altria will market and sell IQOS in the U.S. and pay royalties to Philip Morris, which operates mostly outside the U.S. Altria also owns a 35% stake in Juul.

Philip Morris and Altria are currently discussing a potential merger after the two companies separated in 2008. Both are facing a drop in cigarette sales as they look to alternative products like e-cigarettes and IQOS to sustain them in the longer term.

The new products are also being positioned as alternatives to cigarettes. Juul advertisements feature adults who have quit smoking in favor of its e-cigarettes, and Philip Morris is seeking permission from the FDA to be marketed as a safer alternative to combustible tobacco.