E-cigarette, or vaping, product use-associated lung injury: a review

Abstract

Background E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) is a disease entity related to the use of battery-operated or superheating devices that create an aerosolized form of nicotine and tetrahydrocannabinol (THC) and/or other substances for inhalation. Methods We performed a literature review to document epidemiology, pathogenesis and risk factors, diagnosis, clinical presentation, evaluation and management of EVALI. Results In the summer of 2019, an outbreak of EVALI cases brought this disease entity into the national spotlight. Since being recognized as a serious pulmonary disease with public health implications, more than 2600 cases have been reported to CDC with 68 deaths as of February 2020. The pathophysiology of EVALI remains unknown. Substances such as Vitamin E acetate have been implicated as a possible causes of lung injury. The CDC has established case definitions of “confirmed EVALI” cases to help guide identification of the disease and assist in surveillance. While clinical judgement by healthcare providers is imperative in the identification of EVALI cases, the heterogeneous presentations of EVALI make this difficult as well. Ultimately most investigative studies should be aimed at ruling out other disease processes that can present similarly. Treatment is centered around removing the offending substance and providing supportive care. Conclusions EVALI is a serious pulmonary disease with public health implications. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. It may be beneficial to involve a pulmonary specialist early in the management of this disease which is generally supportive care.

JUUL the heartbreaker: Twitter analysis of cardiovascular health perceptions of vaping

“…We collected all publicly available Twitter posts (about 1.9 million) that contained the term ‘JUUL’ from 1 January 2015 to 29 November 2019, using Crimson Hexagon, which utilizes the Twitter firehose API. The time period encompasses the introduction of JUUL to the US market (2015) and the 2019 E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) cases 7 . As a point of comparison, we also collected publicly available Twitter posts (about 6.2 million) that contained at least one vaping term (vaping, vape, vaper, vapers, vapin, vaped evape, vaporing, e-cig, ecig, e-pen, epen, e-juice, ejuice, e-liquid, eliquid, cloud chasing, cloudchasing, vapepen, vape pen).…”

“…allowing circulating nicotine levels to reach similar levels achieved using combustible cigarettes 3,4 . E-cigarettes are often marketed as reduced-risk tobacco products 5 ; although emerging evidence suggests that e-cigarette use is associated with alterations in cardiovascular function and pulmonary symptoms 6,7 . Products that are marketed as reducedrisk can have a direct impact on consumer perceptions and behaviors, which may lead to use among vulnerable populations.…”

Supplements for Smoking-Related Lung Diseases

“…Nicotine-containing e-cigarette aerosols have been reported to impair lung function [96]. Vaping e-liquids cause centrilobular nodules and ground-glass opacities in lung imaging, and have the potential to cause death [97]. There is concern as prior studies suggest that e-cigarettes are most often used by adolescents with asthma [98][99][100].…”

Overlapping public health crises during the coronavirus disease pandemic

“…[5,9] Precise data concerning the epidemiology of EVALI are difficult to confirm, but the majority of EVALI patients are otherwise healthy adolescents and young adults. [10] Since being recognized in the summer of 2019 as a serious pulmonary disease with public health implications, more than 2,800 cases have been reported to the CDC with 68 deaths as of February 2020. Among these cases, 66% were male and approximately 76% were under the age of 35 years.…”

“…Among these cases, 66% were male and approximately 76% were under the age of 35 years. [10,11] Among 2,016 EVALI patients with available data on hospitalization status, 1,906 (95%) were hospitalized, and 110 (5%) were not hospitalized. [11] This evidence shows that we are witnessing more than one serious respiratory disease with significant symptom overlap.…”