Diagnosis of EVALI

Aberegg, Scott K.; Maddock, Sean D.; Blagev, Denitza; Callahan, Sean J.

doi:10.1016/j.chest.2020.02.018

Cited by 15 publications

(10 citation statements)

References 39 publications

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“…3,8 Risk factors associated with EVALI include younger age, male sex, and use of THC products. 5,6 The median age of hospitalized patients diagnosed with EVALI is 24 years, with patients ranging from 13 to 85 years old. 3 Overall, 66% of all EVALI patients were male, 82% reported use of a THCcontaining product, and 57% reported use of a nicotinecontaining product.…”

Section: Epidemiology and Demographicsmentioning

confidence: 99%

“…12 If the patient reports use, details, including the types of devices, how they were obtained and used, the ingredients in the e-cigarette solution (e-liquid), and the presence of additives or flavorings, should all be noted. 3,5,9,12 This history may not be volunteered by the patient, which could result in a delay in diagnosing EVALI. 9,12 Although the CDC uses vaping within 90 days in the criteria for diagnosis, 3 the likelihood of EVALI decreases with increased time from last use; longer than 1 month is unlikely to be related.…”

Section: Historical Featuresmentioning

confidence: 99%

“…Physical assessment of a patient with EVALI may be notable for fever, tachypnea, hypoxemia, or tachycardia; rales may be present, but the exam is often otherwise unrevealing. 5,11,12 Lab studies may show a mild leukocytosis with neutrophilic predominance and elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein. Procalcitonin may be normal or mildly increased, and, rarely, impaired renal function, hyponatremia, and mild transaminitis may also be present.…”

Section: Physical Exam and Laboratory Studiesmentioning

confidence: 99%

“…Procalcitonin may be normal or mildly increased, and, rarely, impaired renal function, hyponatremia, and mild transaminitis may also be present. 5,7 As EVALI remains a diagnosis of exclusion, an infectious workup must be completed, which should include evaluation of respira-tory viruses and influenza, as well as SARS-CoV-2 testing. 11,12…”

Section: Physical Exam and Laboratory Studiesmentioning

confidence: 99%

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

Clark

Walley

2021

Journal of Hospital Medicine

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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.

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Section: Epidemiology and Demographicsmentioning

confidence: 99%

Section: Historical Featuresmentioning

confidence: 99%

Section: Physical Exam and Laboratory Studiesmentioning

confidence: 99%

Section: Physical Exam and Laboratory Studiesmentioning

confidence: 99%

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

Clark

Walley

2021

Journal of Hospital Medicine

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“…EVALI is a diagnosis of exclusion. Initially the respiratory (bacterial, viral or fungal) infection and other alternative diagnoses must be excluded (scheme 1) [6] [12] [13]. The viral panel includes in uenza A and B virus, parain uenza virus 1, 2 and 3, respiratory syncytial virus, adenovirus, rhinovirus, enterovirus [14].…”

Section: Introductionmentioning

confidence: 99%

Respiratory Impairment Related To Vaping

Wysoczańska

Moreira

Barg

2021

Preprint

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The use of electronic cigarettes referred to as “vaping” have a detrimental impact on human health, especially on the respiratory system. Depending on the chemical composition and the frequency and quantity of inhalation exposure, the severity of the symptoms may vary among patients. Here we discuss the main potential triggers for EVALI (e-cigarette or vaping product use-associated lung injury). Some vaping-related cellular response mechanisms, including inflammatory response and oxidative stress, and a correlation between vaping and the susceptibility to respiratory infections (including SARS-CoV-2), are presented. In-depth, long-term studies, especially involving cellular responses, are necessary to fully elucidate the process leading to the onset of EVALI symptoms.

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E‐cigarette or vaping product use‐associated lung injury (EVALI) characterized by pulmonary ultrasound

Sacci

Hutchinson

2020

JACEP Open

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Pulmonary ultrasound is a useful tool in the diagnosis and resuscitation of emergency department (ED) patients with dyspnea. We present the case of a patient who was diagnosed with E‐cigarette or vaping product use‐associated lung injury (EVALI) using pulmonary ultrasound. Many of these cases are diagnosed using x‐ray, computerized tomography, or bronchoscopy and to our knowledge this is the first published case that demonstrates utility of ultrasound in diagnosing EVALI. While more investigation is needed on the use of this technique, the patient in this case was diagnosed with EVALI based on positive history, presence of normal cardiac function, non‐cardiogenic pulmonary edema on ultrasound, and absence of pulmonary infection.

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Diagnosis of EVALI

Cited by 15 publications

References 39 publications

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

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

Respiratory Impairment Related To Vaping

E‐cigarette or vaping product use‐associated lung injury (EVALI) characterized by pulmonary ultrasound

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