Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report.

Adolescent Adult Disease Outbreaks Dronabinol / adverse effects Electronic Nicotine Delivery Systems Female Hospitalization Humans Illinois / epidemiology Leukocytosis / etiology Lung / diagnostic imaging Lung Injury / epidemiology Male Middle Aged Population Surveillance Radiography, Thoracic Vaping / adverse effects Wisconsin / epidemiology Young Adult

Journal

The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562

Informations de publication

Date de publication:
05 03 2020
Historique:
pubmed: 7 9 2019
medline: 17 3 2020
entrez: 7 9 2019
Statut: ppublish

Résumé

E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

Sections du résumé

BACKGROUND
E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation.
METHODS
We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools.
RESULTS
There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.
CONCLUSIONS
Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

Identifiants

DOI: 10.1056/NEJMoa1911614 PMID: 31491072
pubmed: 31491072
doi: 10.1056/NEJMoa1911614
doi:

Substances chimiques

Dronabinol 7J8897W37S

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

903-916

Commentaires et corrections

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Informations de copyright

Copyright © 2019 Massachusetts Medical Society.

Auteurs

Jennifer E Layden (JE)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Isaac Ghinai (I)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Ian Pray (I)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Anne Kimball (A)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Mark Layer (M)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Mark W Tenforde (MW)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Livia Navon (L)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Brooke Hoots (B)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Phillip P Salvatore (PP)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Megan Elderbrook (M)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Thomas Haupt (T)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Jeffrey Kanne (J)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Megan T Patel (MT)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Lori Saathoff-Huber (L)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Brian A King (BA)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Josh G Schier (JG)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Christina A Mikosz (CA)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

Jonathan Meiman (J)

From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Composés chimiques organiques › Hydrocarbures › Terpènes › Cannabinoïdes › Dronabinol › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Technologie, industrie et agriculture › Produits manufacturés › Dispositifs pour fumer › Dispositifs électroniques d'administration de nicotine › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › États-Unis › États du Centre-Ouest des États-Unis › Illinois › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hyperleucocytose › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Appareil respiratoire › Poumon › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Lésion pulmonaire › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Surveillance de la population › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Radiographie › Radiographie thoracique › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Comportement › Fumer › Vapotage › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › États-Unis › États du Centre-Ouest des États-Unis › Wisconsin › Pulmonary Illness Related to E-Cigarette Use...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Jeune adulte › Pulmonary Illness Related to E-Cigarette Use...