Confirmed E-cigarette or vaping product use associated lung injury (EVALI) with lung biopsy; A case report and literature review

Cedano, Jorge; Sah, Anuraag; Cedeno-Mendoza, Ricardo; Fish, H. D.; Remolina, Carlos

doi:10.1016/j.rmcr.2020.101122

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Bronchoalveolar lavage (BAL) fluid analysis revealed alveolar macrophages and ciliated respiratory epithelial cells but no organisms on gram stain with negative bacterial and fungal cultures. Transbronchial biopsy was benign and suggestive of organizing pneumonia with a nonspecific differential, which is consistent with previously reported pathological findings of EVALI [ 8 , 9 ]. Despite empiric antibiotic coverage, the patient continued to clinically decline on day 3 of admission with worsening subjective dyspnea, increased work of breathing, and an increasing oxygen requirement.…”

Section: Case Presentationsupporting

confidence: 91%

E-cigarette, or vaping, product use associated lung injury and the risks and benefits of a thorough infectious work-up

Lilley

Kravitz

Haynes

et al. 2021

Respiratory Medicine Case Reports

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As of February 2020, over 2800 cases of lung injury associated with vapes have been reported in all 50 states (Cullen et al., 2019) [1]. This case is about a 29-year-old female with a five-year history of vaping tetrahydrocannabinol (THC) who presented with symptoms consistent with e-cigarette, or vaping, product-use associated lung injury (EVALI). This case report is unique because this patient clinically improved on a lower dose of corticosteroids compared to other reported cases of EVALI. Additionally, this case report highlights the importance and difficulty of excluding other disease processes prior to treating patients for EVALI, particularly during the coronavirus disease 2019 (COVID-19) global pandemic.

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Section: Case Presentationsupporting

confidence: 91%

E-cigarette, or vaping, product use associated lung injury and the risks and benefits of a thorough infectious work-up

Lilley

Kravitz

Haynes

et al. 2021

Respiratory Medicine Case Reports

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“…Thirteen reviews were included in this category. Six reviews related to ‘e-cigarette or vaping-associated lung injury’ (EVALI) indicated that vitamin E acetate (an additive in some tetrahydrocannabinol-containing ENDS) is the primary, but not only, cause of EVALI 54–59. Four reviews demonstrated a consistent and strong association between ENDS use and respiratory disorders (eg, asthma exacerbation) among adolescents and adults 36 60–62.…”

Section: Resultsmentioning

confidence: 99%

Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies

Asfar

Jebai

et al. 2022

Tob Control

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ObjectivesThis umbrella review aims to summarise the evidence about electronic nicotine delivery systems’ (ENDS) risk and safety health profile to inform ENDS health communication strategies.Data sources and study selectionSix databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4.Data extractionFindings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine’s Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive.Data synthesisWe found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes.ConclusionsAs evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided.PROSPERO registration numberCRD42021241630.

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“…Multiple case reports have described pneumonia, alveolar damage, alveolar hemorrhage, and respiratory distress in patients presenting with EVALI. [8][9][10][11][12][13][14][15] It was later identified that these cases were related to vitamin E acetate as additive of some e-cigarettes; however, this EVALI outbreak highlighted the need for additional research on the potential risks associated with ENDS use. Fatal cases of EVALI were more likely to have a history of asthma, cardiac disease, mental health conditions, or obesity compared to non-fatal cases.…”

Section: Introductionmentioning

confidence: 99%

Demographic, Clinical, and Behavioral Factors Associated With Electronic Nicotine Delivery Systems Use in a Large Cohort in the United States

et al. 2023

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Introduction Our primary purpose is to understand comorbidities and health outcomes associated with electronic nicotine delivery systems (ENDS) use. Methods Study participants were Kaiser Permanente (KP) members from eight US regions who joined the Kaiser Permanente Research Bank (KPRB) from September 2015 through December 2019 and completed a questionnaire assessing demographic and behavioral factors, including ENDS and traditional cigarette use. Medical history and health outcomes were obtained from electronic health records. We used multinomial logistic regression to estimate odd ratios (ORs) and 95% confidence intervals (CIs) of current and former ENDS use according to member characteristics, behavioral factors, and clinical history. We used Cox regression to estimate hazard ratios (HRs) and 95% CIs comparing risk of health outcomes according to ENDS use. Results Of 119 593 participants, 1594 (1%) reported current ENDS use and 5603 (5%) reported past ENDS use. ENDS users were more likely to be younger, male, gay or lesbian, and American Indian / Alaskan Native or Asian. After adjustment for confounding, current ENDS use was associated with current traditional cigarette use (OR = 39.55; CI:33.44-46.77), current marijuana use (OR = 6.72; CI:5.61-8.05), history of lung cancer (OR = 2.64; CI:1.42-4.92), non-stroke cerebral vascular disease (OR = 1.55; CI:1.21-1.99), and chronic obstructive pulmonary disease (OR = 2.16; CI:1.77-2.63). Current ENDS use was also associated with increased risk of emergency room (ER) visits (HR = 1.17; CI: 1.05-1.30) and death (HR = 1.84; CI:1.02-3.32). Conclusions Concurrent traditional cigarette use, marijuana use, and comorbidities were prevalent among those who used ENDS, and current ENDS use was associated with an increased risk of ER visits and death. Additional research focused on health risks associated with concurrent ENDS and traditional cigarette use in those with underlying comorbidities is needed.

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Confirmed E-cigarette or vaping product use associated lung injury (EVALI) with lung biopsy; A case report and literature review

Cited by 4 publications

References 10 publications

E-cigarette, or vaping, product use associated lung injury and the risks and benefits of a thorough infectious work-up

E-cigarette, or vaping, product use associated lung injury and the risks and benefits of a thorough infectious work-up

Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies

Demographic, Clinical, and Behavioral Factors Associated With Electronic Nicotine Delivery Systems Use in a Large Cohort in the United States

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