Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth

Abstract

E lectronic cigarettes (e-cigarettes) are the most commonly used nicotine products among Canadian youth; a 2017 study estimated that 272 000 Canadians aged 15 to 24 years had used e-cigarettes in the last 30 days. 1 First available in China in 2004 and in the United States in 2006, 2 e-cigarettes are battery-powered devices that aerosolize various substances for inhalation, including nicotine, tetrahydrocannabinol (THC), cannabidiol and flavouring agents that may contain diacetyl, a compound known to cause pulmonary toxicity. 3 Since its introduction to the North American market, use of e-cigarettes, or "vaping," has continued to rise. 4 Although use of this heavily marketed device is rapidly growing and becoming commonplace in Canada-particularly among youth-the impact of e-cigarettes on health is poorly understood. In recent years, several patterns of adverse reactions to vaping have been reported, including hypersensitivity pneumonitis, 5-8 diffuse alveolar hemorrhage, 9 organizing pneumonia, 10-14 acute eosinophilic pneumonia 15,16 and lipoid pneumonia. 17-21 Most recently, a cluster of 53 cases in the US was described as having hypoxemia and bilateral ground-glass opacities, consistent with a diffuse alveolar damage pattern of lung injury. 22 As of Nov.

Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury

“…Accordingly, CDC has declared an "outbreak" of the e-cigarette or vaping product use associated lung injury or EVALI throughout the United States (Blount et al, 2019a;Moritz et al, 2019;Navon et al, 2019). Nevertheless, the recent EVALI cases from Canada and Barcelona highlight the importance of understanding the pathogenesis of EVALI and the treatment options available outside the United States (Casanova et al, 2019;Landman et al, 2019). This article provides perspectives of e-cig vaping on chemistry, toxicity, and pathological mechanisms on current episodes of EVALI.…”

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

“…In the majority of cases, the injury involved distal airway and parenchymal areas and the histologic findings of acute lung injury patterns, mainly DAD and organizing pneumonia, were consistent with an underlying inflammatory pathophysiology [39]. The inflammatory pathway response, possibly triggered by the inhalational exposure to e-cigarette aerosols, was expressed as various types of pneumonitis (lipoid, organizing, eosinophilic, hypersensitivity, interstitial) often complicated by ARDS [196].…”

“…Most common diagnosis was EVALI (n = 15) [26][27][28][29][30][31][32][33][34][35][36] or EVALI with an additional finding (n = 1) [37]. Second most common diagnosis included either organizing pneumonia/ Bronchiolitis obliterans with organizing pneumonia (BOOP)/ respiratory bronchiolitis (n = 12) [38][39][40][41][42][43][44][45][46] or lipoid pneumonia (n = 9) [11,[47][48][49][50][51]. In 4 cases vaping precipitated a pneumothorax [52][53][54] and in 2 exacerbated pre-existing asthma [55].…”

Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness

“…This new vape-related case calls for further exploration into the toxicity of vape liquid, as the patient's condition could have been caused by the THC added to the vaping devices, or the chemical that affected factory workers in the past -diacetyl. Diacetyl is present in many e-cigarette flavors [14]. The American Lung Association has called for the FDA to require that diacetyl and other hazardous chemicals be removed from e-cigarette cartridges.…”