Clinical Progress Note: E‐cigarette, or Vaping, Product Use‐Associated Lung Injury

Abstract

E-cigarettes are handheld devices that are used to aerosolize a liquid that commonly contains nicotine, flavorings, and polyethylene glycol and/or vegetable glycerin. These products vary widely in design and style (Figure 1); from the disposable "cigalikes" to vape pens, mods, tanks, and pod systems such as JUUL, there has been a dramatic increase in the recognition, use, sale, and variety of products. 1 In addition to the known risks of e-cigarette use, with youth nicotine addiction and progression to cigarette smoking, there is evidence of a wide range of health concerns, including pulmonary and cardiovascular effects, immune dysfunction, and carcinogenesis. 1 The emergence of patients with severe lung injury in the summer of 2019 highlighted the harmful health effects specific to these tobacco products. 2 Ultimately named EVALI (e-cigarette, or vaping, product use-associated lung injury), there have been 2,807 hospitalized patients with 68 deaths reported to the Centers for Disease Control and Prevention (CDC). 2,3 This clinical progress note reviews the epidemiology and clinical course of EVALI and strategies to distinguish the disease from other illnesses. This is particularly timely with the emergence of and surges in COVID-19 cases. 4 SEARCH STRATEGYAs the first reports of patients with e-cigarette-associated lung injury were made in the summer of 2019, and the CDC defined EVALI in the fall of 2019, a PubMed search was performed for studies published from June 2019 to June 2020, using the search terms "EVALI" or "e-cigarette-associated lung injury." In addition, the authors reviewed the CDC and US Food and Drug Administration (FDA) website and presentations on EVALI available in the public domain. Articles discussing COVID-19 and EVALI that the authors became aware of were also included. This update is intended for hospitalists as well as researchers and public health advocates.