E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury — Utah, April–October 2019

Lewis, Nathaniel M.; McCaffrey, Keegan; Sage, Kylie; Cheng, Chia-Jung; Green, Jordan J.; Goldstein, Leah; Campbell, H. E.; Ferrell, Deanna; Malan, Nathan; LaCross, Nathan; Maldonado, Alejandra; Board, Amy; Hanchey, Arianna; Harris, Dixie; Callahan, Sean J.; Aberegg, Scott K.; Risk, Ilene; Willardson, Sarah; Carter, Amy; Nakashima, Allyn K.; Duncan, Janae; Burnett, Cindy; Atkinson-Dunn, Robyn; Dunn, Angela

doi:10.15585/mmwr.mm6842e1

Cited by 63 publications

(67 citation statements)

References 6 publications

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“…Clusters of e-cigarette or vaping product use-associated lung injury cases (Layden et al, 2019;Lewis et al, 2019;Siegel et al, 2019;Dicpinigaitis et al, 2020) have been widely reported throughout the USA, but not in Europe. This has been the subject of a number of public health reports and recommendations in the USA (Blount et al, 2019;Lewis et al, 2019;Siegel et al, 2019). A variety of other pulmonary conditions, apparently associated with e-cigarette use, has appeared, sporadically, in a small number of case reports ( Table 3).…”

Section: Lung Disease and E-cigarettesmentioning

confidence: 99%

“…The clinical features of e-cigarette or vaping product use-associated lung injury, described in three of the largest published series, are summarised in Table 1 (Layden et al, 2019;Lewis et al, 2019;Siegel et al, 2019). Typically, it is an acute illness characterised by respiratory and gastrointestinal symptoms, and systemic upset.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Bronchoscopy and bronchoalveolar lavage have yielded variable results, with variable leucocytosis, no eosinophilia, and often 'foamy' or lipid-laden macrophages (positive O red or Sudan staining), which has led to the suggestion of 'lipoid pneumonia' changes (Viswam et al, 2018;Layden et al, 2019;Lewis et al, 2019;Maddock et al, 2019;Dicpinigaitis et al, 2020). However, the significance of this is controversial.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Empirical treatment has generally, understandably, included broad spectrum antibiotics (which have often been stopped early) and high dose corticosteroids (often methylprednisolone) with the clinical impression of associated rapid benefit, as well as supplemental oxygen and supportive care (Layden et al, 2019;Lewis et al, 2019;Siegel et al, 2019;Dicpinigaitis et al, 2020).…”

Section: Clinical Managementmentioning

confidence: 99%

“…Quite rapid deterioration can occur, requiring admission to the intensive therapy unit and intubation and ventilation in a substantial number of cases. Up to 2% of patients have died despite intensive therapy unit interventions (Blount et al, 2019;Layden et al, 2019;Lewis et al, 2019;Siegel et al, 2019;Dicpinigaitis et al, 2020).…”

Section: Clinical Managementmentioning

confidence: 99%

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E-cigarette or vaping product use-associated lung injury

Ind

2020

Br J Hosp Med

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E-cigarette or vaping product use-associated lung injury is a recently recognised, acute pulmonary syndrome which has been reported (particularly from June to October 2019) throughout the USA, but not in Europe (although one probable case, in the UK, has been reported; Medicines and Healthcare products Regulatory Agency, 2020 ). It presents acutely, most often in young men, as severe pulmonary consolidation, usually with respiratory failure. The mortality is around 2%. The cause(s) are unknown, but it is associated with vaping, particularly using unlicensed cannabis-containing products with tetrahydrocannabinol. Vitamin E acetate, often present in tetrahydrocannabinol-containing vape products as a solvent, has been implicated, as it has been identified in the bronchoalveolar lavage fluid of patients with e-cigarette or vaping product use-associated lung injury. This article reviews the recent literature, including clinical features, presentation and investigations, and possible mechanisms, in the context of vaping practices in the USA and the UK.

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Section: Lung Disease and E-cigarettesmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Managementmentioning

confidence: 99%

Section: Clinical Managementmentioning

confidence: 99%

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E-cigarette or vaping product use-associated lung injury

Ind

2020

Br J Hosp Med

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Severe Lung Injury Associated With Use of e-Cigarette, or Vaping, Products—California, 2019

et al. 2020

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more than 2700 patients have been hospitalized with e-cigarette, or vaping, product use-associated lung injury (EVALI) across the United States. This report describes the outbreak in California, a state with one of the highest case counts and with a legal adult-use (recreational) cannabis market. OBJECTIVE To present clinical characteristics and vaping product exposures of patients with EVALI in California. DESIGN, SETTING, AND PARTICIPANTS Case series describing epidemiologic and laboratory data from 160 hospitalized patients with EVALI reported to the California Department of Public Health by local health departments, who received reports from treating clinicians, from August 7 through November 8, 2019.EXPOSURES Standardized patient interviews were conducted to assess vaping products used, frequency of use, and method of product acquisition. Vaping products provided by a subset of patients were tested for active ingredients and other substances.MAIN OUTCOMES AND MEASURES Demographic and clinical characteristics, level of care, and outcomes of hospitalization were obtained from medical record review.RESULTS Among 160 patients with EVALI, 99 (62%) were male, and the median age was 27 years (range, 14-70 years). Of 156 patients with data available, 71 (46%) were admitted to an intensive care unit, and 46 (29%) required mechanical ventilation. Four in-hospital deaths occurred. Of 86 patients interviewed, 71 (83%) reported vaping tetrahydrocannabinol (THC)-containing products, 36 (43%) cannabidiol (CBD)-containing products, and 39 (47%) nicotine-containing products. Sixty-five of 87 (75%) THC-containing products were reported as obtained from informal sources, such as friends, acquaintances, or unlicensed retailers. Of 87 vaping products tested from 24 patients, 49 (56%) contained THC. Vitamin E or vitamin E acetate was found in 41 (84%) of the THC-containing products and no nicotine products.CONCLUSIONS AND RELEVANCE Patients' clinical outcomes and vaping behaviors, including predominant use of THC-containing products from informal sources, are similar to those reported by other states, despite California's legal recreational cannabis market. While most THC products tested contained vitamin E or vitamin E acetate, other underlying cause(s) of injury remain possible. The California Department of Public Health recommends that individuals refrain from using any vaping or e-cigarette products, particularly THC-containing products from informal sources, while this investigation is ongoing.

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Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use–Associated Lung Injury Among Patients Treated at an Academic Medical Center

et al. 2020

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IMPORTANCE e-Cigarette, or vaping, product use-associated lung injury (EVALI) has caused more than 2800 illnesses and 68 deaths in the United States. Better characterization of this novel illness is needed to inform diagnosis and management. OBJECTIVE To describe the clinical features, bronchoscopic findings, imaging patterns, and outcomes of EVALI. DESIGN, SETTING, AND PARTICIPANTS This case series of 31 adult patients diagnosed with EVALI between June 24 and December 10, 2019, took place at an academic medical center in Salt Lake City, Utah. EXPOSURES e-Cigarette use, also known as vaping. MAIN OUTCOMES AND MEASURES Symptoms, laboratory findings, bronchoscopic results, imaging patterns, and clinical outcomes. RESULTS Data from 31 patients (median [interquartile range] age, 24 [21-31] years) were included in the study. Patients were primarily men (24 [77%]) and White individuals (27 [87%]) who used e-cigarette products containing tetrahydrocannabinol (THC) (29 [94%]). Patients presented with respiratory (30 [97%]), constitutional (28 [90%]), and gastrointestinal (28 [90%]) symptoms. Serum inflammatory markers were elevated in all patients. Bronchoscopy was performed in 23 of 28 inpatients (82%) and bronchoalveolar lavage (BAL) revealed the presence of lipid-laden macrophages (LLMs) in 22 of 24 cases (91%). BAL samples tested positive for Pneumocystis jirovecii (3 patients [13%]), rhinovirus (2 patients [8%]), human metapneumovirus and Aspergillus (1 patient each [4%]); all except human metapneumovirus were determined to be false-positives or clinically inconsequential. The exclusive or dominant computed tomography (CT) pattern was organizing pneumonia in 23 of 26 cases (89%). Patients received antibiotics (26 [84%]) and corticosteroids (24 [77%]), and all survived; 20 patients (65%) seen in follow-up showed marked improvement, but residual symptoms (13 [65%]), radiographic opacities (8 [40%]), and abnormal pulmonary function tests (8 of 18 [44%]) were common. CONCLUSIONS AND RELEVANCE In this case series, patients with EVALI characteristically presented with a flu-like illness with elevated inflammatory markers, LLMs on BAL samples, and an organizing pneumonia pattern on CT imaging. Bronchoscopic testing for infection had a high incidence of false-positive results. Patients had substantial residual abnormal results at early (continued) Key Points Question What are the typical clinical, radiographic, and bronchoscopic findings and clinical outcomes of e-cigarette, or vaping, product use-associated lung injury (EVALI)? Findings This case series of 31 patients found that EVALI typically presented as a flu-like illness with elevated inflammatory markers and an organizing pneumonia pattern on computed tomography imaging. Bronchoscopy showed lipid-laden macrophages and had a high rate of false-positive results for infection. Meaning The findings of this study suggest that EVALI has a characteristic clinical and radiographic presentation and that bronchoscopy has limited utility in its evaluation.

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E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury — Utah, April–October 2019

Cited by 63 publications

References 6 publications

E-cigarette or vaping product use-associated lung injury

E-cigarette or vaping product use-associated lung injury

Severe Lung Injury Associated With Use of e-Cigarette, or Vaping, Products—California, 2019

Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use–Associated Lung Injury Among Patients Treated at an Academic Medical Center

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