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Petrella F. Electronic cigarettes, vaping-related lung injury and lung cancer: where do we stand? Eur J Cancer Prev 2021; 30:293-296. [PMID: 34103460 DOI: 10.1097/cej.0000000000000630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Electronic cigarettes have been considered a promising alternative to nicotine replacement products to help heavy tobacco smokers quit smoking. They work thanks to a heating coil causing evaporation of the liquid rapidly followed by cooling, thus creating an aerosol, a completely different mechanism from the combustion of tobacco in traditional cigarettes. The term 'vaping' indicates the use of electronic cigarettes or other devices to inhale heated, aerosolized nicotine, or other substances like cannabidiol, tetrahydrocannabinol, or butane hash oils together with solvents, mainly propylene glycol and vegetable glycerine or their combination. A very fast increase of vaping among adolescents has been observed since electronic cigarettes and other vaping devices first appeared. Although electronic cigarettes have been advocated as a short-term cessation aid for tobacco smokers or as a long-term alternative, there is the concrete risk that they can be perceived by young nonsmokers as a less dangerous alternative to tobacco smoking, thus stimulating nonsmokers to start smoking rather than helping heavy tobacco smokers to quit smoking. Moreover, several cases of exogenous lipoid pneumonia and diffuse alveolar hemorrhage with proven alveolar injury, as well as vaping-associated bronchiolitis obliterans, have been recently reported among electronic cigarette smokers, with severe clinical impact, thus posing the risk of the life-threatening toxic potential of vaping. At the moment, no definitive assessment can be made about the efficacy of electronic cigarettes as a smoking cessation aid, and further studies are required about vaping-related life-threatening acute lung injury.
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Mado H, Reichman-Warmusz E, Wojnicz R. The vaping product use associated lung injury: is this a new pulmonary disease entity? REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:145-157. [PMID: 34981704 DOI: 10.1515/reveh-2020-0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/24/2020] [Indexed: 06/14/2023]
Abstract
In the summer of 2019, an epidemic of e-cigarette or vaping product use associated lung injury (EVALI) broke out in the United States of America. EVALI is a lung disease that can be severe and life-threatening. It should be emphasized that EVALI is not a clinical diagnosis, but surveillance case definition. Due to the profile of users of such devices, the pathology mainly affects young adults, although cases of EVALI have been reported in almost all age groups, from teenage children to seniors. The worst prognosis is in patients over 35 years of age, with accompanying diseases. A significant number of patients declared the use of products containing tetrahydrocannabinol (THC). The most likely factor responsible for the occurrence of EVALI is vitamin E acetate, which is sometimes added to liquids necessary for the use of electronic cigarette type devices, especially those liquids that contain THC. Nevertheless, it is possible that other substances used in liquids may also be a causative factor. Typical for EVALI are respiratory, gastrointestinal and systemic symptoms, while in imaging tests, a characteristic feature of EVALI is the presence of opacities on the chest radiogram and ground-glass clouds on computed tomography scans. In the course of this disease, respiratory failure often occurs (58%). In the vast majority of cases oxygen substitution is necessary. Currently, the best treatment of EVALI is considered to be the administration of systemic glucocorticosteroids. Over 90% of patients with EVALI required hospitalization, while the mortality rate was about 2.42%. Median age of the fatalities was 51 years. The aim of this review is to summarise the available information on EVALI and to consider possible causative factors and pathomechanism.
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MacMurdo M, Lin C, Saeedan MB, Doxtader EE, Mukhopadhyay S, Arrossi V, Reynolds J, Ghosh S, Choi H. e-Cigarette or Vaping Product Use-Associated Lung Injury: Clinical, Radiologic, and Pathologic Findings of 15 Cases. Chest 2021; 157:e181-e187. [PMID: 32505323 DOI: 10.1016/j.chest.2020.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Since mid-2019, > 2,000 cases of e-cigarette or vaping product use-associated lung injury (EVALI) have been reported. Although initial reports suggested that this entity may be a form of inhalation-related lipoid pneumonia, subsequent studies indicate that EVALI represents various patterns of acute lung injury. Cases of EVALI continue to be reported, and public awareness of the epidemic is increasingly high. However, evidence surrounding optimal management of EVALI remains limited. In this case series, we report 15 cases of EVALI across a spectrum of severity, highlighting key radiologic, pathologic, and cytologic findings, and discuss management implications. In line with national findings, most patients with EVALI in the series vaped liquids containing tetrahydrocannabinol. Our imaging and pathologic findings support the notion that EVALI is a form of acute lung injury.
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Pacula RL. The need to more effectively regulate END markets: A primary public health lesson of the U.S. vaping associated lung injury outbreak. Addiction 2021; 116:994-995. [PMID: 32754924 PMCID: PMC9273308 DOI: 10.1111/add.15179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 01/28/2023]
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Cox S, Notley C. Cleaning up the science: the need for an ontology of consensus scientific terms in e-cigarette research. Addiction 2021; 116:997-998. [PMID: 33449389 DOI: 10.1111/add.15374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
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Morgan JC, Silver N, Cappella JN. How did beliefs and perceptions about e-cigarettes change after national news coverage of the EVALI outbreak? PLoS One 2021; 16:e0250908. [PMID: 33930093 PMCID: PMC8087005 DOI: 10.1371/journal.pone.0250908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Exposure to media content can shape public opinions about tobacco. In early September 2019, the outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) became headline news in the United States. Methods In August and September 2019, we conducted two cross-sectional online surveys with current and former smokers assessing attitudes and beliefs about e-cigarettes. Study one (n = 865) was collected before the EVALI outbreak was widely covered and study two (n = 344) was collected after the outbreak had become nation-wide news. We examined differences in perceptions and beliefs between time points. Results E-cigarette harm perceptions increased between study one (mean = 2.67) and study two (mean = 2.90, p < .05). Ever-users of e-cigarettes largely account for this change. Endorsement of the belief that e-cigarettes were risky and more likely to cause lung damage compared to cigarettes increased between studies (p < .05). Seventy eight percent of participants at study two were aware of the vaping illness story. Being aware of the story was associated with more endorsement of the belief that e-cigarettes were risky to use, but not that using e-cigarettes would make the participant more likely to get damaged lungs. Discussion When the stories about the health and safety of tobacco products dominate the public information environment, it presents an opportunity to change beliefs that are frequently targeted by paid health campaigns. Changes in participant’s perceptions of e-cigarettes were associated with coverage of this large news story, underscoring the importance of working to ensure that coverage is a scientifically accurate as possible.
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Abstract
PURPOSE OF REVIEW Over the last decade, vaping has emerged into an epidemic of alarming proportions among US teens. This review evaluates the factors leading to the rise of vaping, reasons for its striking popularity among US teens, health consequences of vaping, and measures to mitigate the vaping epidemic. RECENT FINDINGS Contemporary research highlights the continued rise of vaping amongst US teens and explains the reasons for its popularity, such as the variety of devices, a wide range of available flavors, youth-targeted advertisements, and lack of awareness of adverse consequences from vaping. This publication highlights current research findings of health consequences of vaping, including a discussion of EVALI (e-cigarette or vaping product use-associated lung injury) and provides an update on strategies to curtail the vaping epidemic. SUMMARY Vaping has risen to epidemic proportions amongst US teens. This poses a clear and present danger to teens' health with adverse effects ranging from acute lung injury to long-term addiction. This article summarizes key research findings that explain the reasons for the epidemic, health consequences of vaping, and provides an overview of efforts to mitigate the vaping threat to US teens.
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Kalkhoran S, Chang Y, Rigotti NA. Online Searches for Quitting Vaping During the 2019 Outbreak of E-cigarette or Vaping Product Use-Associated Lung Injury. J Gen Intern Med 2021; 36:559-560. [PMID: 32052253 PMCID: PMC7878629 DOI: 10.1007/s11606-020-05686-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
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Koslow M, Petrache I. A Finale on EVALI?: The Abated but Not Forgotten Outbreak of Acute Respiratory Illness in Individuals Who Vape. JAMA Netw Open 2020; 3:e2019366. [PMID: 33156344 DOI: 10.1001/jamanetworkopen.2020.19366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Wang F, Kream RM, Stefano GB. Long-Term Respiratory and Neurological Sequelae of COVID-19. Med Sci Monit 2020; 26:e928996. [PMID: 33177481 PMCID: PMC7643287 DOI: 10.12659/msm.928996] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 12/15/2022] Open
Abstract
Since the initial reports of coronavirus disease 2019 (COVID-19) in China in late 2019, infections from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have spread rapidly, resulting in a global pandemic that has caused millions of deaths. Initially, the large number of infected people required the direction of global healthcare resources to provide supportive care for the acutely ill population in an attempt to reduce mortality. While clinical trials for safe and effective antiviral agents are ongoing, and vaccine development programs are being accelerated, long-term sequelae of SARS-CoV-2 infection have become increasingly recognized and concerning. Although the upper and lower respiratory tracts are the main sites of entry of SARS-CoV-2 into the body, resulting in COVID-19 pneumonia as the most common presentation, acute lung damage may be followed by pulmonary fibrosis and chronic impairment of lung function, with impaired quality of life. Also, increasing reports have shown that SARS-CoV-2 infection involves the central nervous system (CNS) and the peripheral nervous system (PNS) and directly or indirectly damages neurons, leading to long-term neurological sequelae. This review aims to provide an update on the mechanisms involved in the development of the long-term sequelae of SARS-CoV-2 infection in the 3 main areas of lung injury, neuronal injury, and neurodegenerative diseases, including Alzheimer disease, Parkinson disease, and multiple sclerosis, and highlights the need for patient monitoring following the acute stage of infection with SARS-CoV-2 to provide a rationale for the prevention, diagnosis, and management of these potential long-term sequelae.
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Casey AM, Muise ED, Crotty Alexander LE. Vaping and e-cigarette use. Mysterious lung manifestations and an epidemic. Curr Opin Immunol 2020; 66:143-150. [PMID: 33186869 PMCID: PMC7755270 DOI: 10.1016/j.coi.2020.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022]
Abstract
Electronic (e)-cigarette use and the practice of vaping has rapidly expanded both in adult smokers and previously nicotine naïve youths. Research has focused on harm reduction in adults using e-cigarettes to stop or reduce traditional cigarette use, but the short and long-term safety of these products has not been established. Vaping has more recently been associated with a growing list of pulmonary complications with the most urgent being the e-cigarette or vaping product use-associated lung injury (EVALI) epidemic. This review details the inhalant toxicology of vaping products, the described lung diseases associated with vaping with a focus on EVALI, and the predicted long-term consequences of e-cigarette use, including increased asthma severity.
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Smith E, Cherian R, McGillen B. A Case of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in a Previously Healthy Patient: Case Report and Literature Review. J Gen Intern Med 2020; 35:2767-2770. [PMID: 32440996 PMCID: PMC7459041 DOI: 10.1007/s11606-020-05909-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
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Huey S, Tierney C, Granitto M, Brien L. The vaping epidemic: Calling nurses to action. Nursing 2020; 50:55-59. [PMID: 32826679 DOI: 10.1097/01.nurse.0000694780.89896.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Youth e-cigarette use was declared a national epidemic in 2018. This article discusses e-cigarette- or vaping-associated lung injury (EVALI) and highlights the unique role nurses can have as advocates, patient educators, and champions of health promotion and disease prevention for their patients and families.
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Kiernan E, Click ES, Melstrom P, Evans ME, Layer MR, Weissman DN, Reagan-Steiner S, Wiltz JL, Hocevar S, Goodman AB, Twentyman E. A Brief Overview of the National Outbreak of e-Cigarette, or Vaping, Product Use-Associated Lung Injury and the Primary Causes. Chest 2020; 159:426-431. [PMID: 32758560 DOI: 10.1016/j.chest.2020.07.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
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Choi J, Tennakoon L, You JG, Kaghazchi A, Forrester JD, Spain DA. Pulmonary contusions in patients with rib fractures: The need to better classify a common injury. Am J Surg 2020; 221:211-215. [PMID: 32854902 DOI: 10.1016/j.amjsurg.2020.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion. METHODS We identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality. RESULTS Among 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16-33%], respiratory failure 40% [95%CI: 31-50%], and intubation 46% [95%CI: 33-61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications. CONCLUSIONS There is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.
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Navon L, Ghinai I, Layden J. Notes from the Field: Characteristics of Tetrahydrocannabinol-Containing E-cigarette, or Vaping, Products Used by Adults - Illinois, September-October 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:973-975. [PMID: 32701939 PMCID: PMC7377819 DOI: 10.15585/mmwr.mm6929a5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cao DJ, Aldy K, Hsu S, McGetrick M, Verbeck G, De Silva I, Feng SY. Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury. J Med Toxicol 2020; 16:295-310. [PMID: 32301069 PMCID: PMC7320089 DOI: 10.1007/s13181-020-00772-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/11/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) are battery-operated devices to insufflate nicotine or other psychoactive e-liquid aerosols. Despite initial claims of e-cigarettes as a nicotine-cessation device, aggressive marketing of e-cigarettes has led to an explosion in adolescents' and young adults' use over the last few years. Coupled with a lack of adequate investigation and regulation of e-cigarettes, the USA is facing an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) starting in mid-2019. While little long-term health hazard data are available, the components and constituents of e-cigarettes may adversely impact health. Propylene glycol and glycerin are humectants (water-retaining excipients) that generate pulmonary irritants and carcinogenic carbonyl compounds (e.g., formaldehyde, acetaldehyde, and acrolein) when heated in e-cigarettes. Metals contained in heating coils and cartridge casings may leach metals such as aluminum, chromium, iron, lead, manganese, nickel, and tin. Flavoring agents are considered safe for ingestion but lack safety data for inhalational exposures. Diacetyl, a common buttery flavoring agent, has known pulmonary toxicity with inhalational exposures leading to bronchiolitis obliterans. In 2019, clusters of lung injury associated with e-cigarette use were identified in Wisconsin and Illinois. Patients with EVALI present with a constellation of respiratory, gastrointestinal, and constitutional symptoms. Radiographically, patients have bilateral ground glass opacifications. As of February 18, 2020, the Centers for Disease Control has identified 2807 hospitalized patients diagnosed with either "confirmed" or "probable" EVALI in the US. Currently, vitamin E acetate (VEA) used as a diluent in tetrahydrocannabinol vape cartridges is implicated in EVALI. VEA cuts tetrahydrocannabinol oil without changing the appearance or viscosity. When inhaled, pulmonary tissue lacks the mechanism to metabolize and absorb VEA, which may lead to its accumulation. While most EVALI patients were hospitalized, treatment remains largely supportive, and use of corticosteroids has been associated with clinical improvement. The outbreak of EVALI highlights the need for regulation of e-cigarette devices and e-liquids. Clinicians need to be aware of the health hazards of e-cigarettes and be vigilant in asking about vaping.
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Armatas C, Heinzerling A, Wilken JA. Notes from the Field: E-cigarette, or Vaping, Product Use-Associated Lung Injury Cases During the COVID-19 Response - California, 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:801-802. [PMID: 32584801 PMCID: PMC7316321 DOI: 10.15585/mmwr.mm6925a5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tattan-Birch H, Brown J, Shahab L, Jackson SE. Association of the US Outbreak of Vaping-Associated Lung Injury With Perceived Harm of e-Cigarettes Compared With Cigarettes. JAMA Netw Open 2020; 3:e206981. [PMID: 32539148 PMCID: PMC7296387 DOI: 10.1001/jamanetworkopen.2020.6981] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
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Alexander LEC, Bellinghausen AL, Eakin MN. What are the mechanisms underlying vaping-induced lung injury? J Clin Invest 2020; 130:2754-2756. [PMID: 32391805 PMCID: PMC7260008 DOI: 10.1172/jci138644] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Messina MD, Levin TL, Blumfield E. Cytotoxic lesion of the splenium of the corpus callosum in a patient with EVALI. Clin Imaging 2020; 66:73-76. [PMID: 32464507 DOI: 10.1016/j.clinimag.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
Since first recognized in July 2019, numerous cases of a lung illness associated with electronic-cigarette use or vaping particularly tetrahydrocannabinol in adolescents and adults have been reported. As of January 2020, the Center for Disease Control has reported over 2500 cases of electronic-cigarette or vaping product use-associated lung injury (EVALI), including 60 deaths. Affected patients most commonly present with respiratory or gastrointestinal complaints although neurological symptoms including headache, confusion and lethargy have been reported. We present a new as yet unpublished finding in the brain of a previously healthy teenage boy with EVALI. Brain imaging may be warranted in this patient population.
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Sabatino V, Russo U, D'Amuri F, Bevilacqua A, Pagnini F, Milanese G, Gentili F, Nizzoli R, Tiseo M, Pedrazzi G, De Filippo M. Pneumothorax and pulmonary hemorrhage after CT-guided lung biopsy: incidence, clinical significance and correlation. Radiol Med 2020; 126:170-177. [PMID: 32377914 DOI: 10.1007/s11547-020-01211-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the incidence and clinical significance of pneumothorax (PTX) and pulmonary hemorrhage (PH) after CT-guided lung biopsy (CT-LB). To test correlations of PTX and chest tube insertion (CTI) with PH and other imaging and procedural parameters. METHODS Pre-procedural CT and CT-LB scans of 904 patients were examined. Incidence of PTX and PH and PH location (type-1 along needle track; type-2 perilesional) and severity according to its thickness (low grade < 6 mm; high grade > 6 mm) were recorded. PTX was considered clinically significant if treated with CTI, PH if treated with endoscopic/endovascular procedure. Binary logistic regression analyses were used to determine the effects of different imaging and procedural parameters on the likelihood to develop PTX, CTI and PH and to define their correlation. RESULTS PTX occurred in 306/904 cases (33.8%); CTI was required in 18/306 (5.9%). PH occurred in 296/904 cases (32.7%), and no case required treatment. Nodule-to-pleura distance (ORPTX = 1.052; ORCTI = 1.046; ORPH 1.077), emphysema (ORPTX = 1.287; ORPH = 0.573), procedure time (ORPTX = 1.019; ORCTI = 1.039; ORPH = 1.019), target size (ORPTX = 0.982; ORPH = 0.968) and needle gauge (ORPTX = 0.487; ORCTI = 4.311; ORPH = 2.070) showed statistically significant correlation to PTX, CTI and PH. Type-1 PH showed a protective effect against PTX and CTI (ORPTX = 0.503; ORCTI = 0.416). CONCLUSION PTX and PH have similar incidence after CT-guided lung biopsy. PH along needle track may represent a protective factor against development of PTX and against PTX requiring CTI.
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Werner AK, Koumans EH, Chatham-Stephens K, Salvatore PP, Armatas C, Byers P, Clark CR, Ghinai I, Holzbauer SM, Navarette KA, Danielson ML, Ellington S, Moritz ED, Petersen EE, Kiernan EA, Baldwin GT, Briss P, Jones CM, King BA, Krishnasamy V, Rose DA, Reagan-Steiner S. Hospitalizations and Deaths Associated with EVALI. N Engl J Med 2020; 382:1589-1598. [PMID: 32320569 PMCID: PMC8826745 DOI: 10.1056/nejmoa1915314] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND As of January 7, 2020, a total of 2558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) had been reported to the Centers for Disease Control and Prevention (CDC). METHODS In a national study, we compared the characteristics of patients with fatal cases of EVALI with those of patients with nonfatal cases to improve the ability of clinicians to identify patients at increased risk for death from the condition. Health departments reported cases of EVALI to the CDC and included, when available, data from medical-record abstractions and patient interviews. Analyses included all the patients with fatal or nonfatal cases of EVALI that were reported to the CDC as of January 7, 2020. We also present three case reports of patients who died from EVALI to illustrate the clinical characteristics common among such patients. RESULTS Most of the patients with fatal or nonfatal cases of EVALI were male (32 of 60 [53%] and 1666 of 2498 [67%], respectively). The proportion of patients with fatal or nonfatal cases was higher among those who were non-Hispanic white (39 of 49 [80%] and 1104 of 1818 [61%], respectively) than among those in other race or ethnic groups. The proportion of patients with fatal cases was higher among those 35 years of age or older (44 of 60 [73%]) than among those younger than 35 years, but the proportion with nonfatal cases was lower among those 35 years of age or older (551 of 2514 [22%]). Among the patients who had an available medical history, a higher proportion of those with fatal cases than those with nonfatal cases had a history of asthma (13 of 57 [23%] vs. 102 of 1297 [8%]), cardiac disease (26 of 55 [47%] vs. 115 of 1169 [10%]), or a mental health condition (32 of 49 [65%] vs. 575 of 1398 [41%]). A total of 26 of 50 patients (52%) with fatal cases had obesity. Half the patients with fatal cases (25 of 54 [46%]) were seen in an outpatient setting before hospitalization or death. CONCLUSIONS Chronic conditions, including cardiac and respiratory diseases and mental health conditions, were common among hospitalized patients with EVALI.
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Pray IW, Atti SK, Tomasallo C, Meiman JG. E-cigarette, or Vaping, Product Use-Associated Lung Injury Among Clusters of Patients Reporting Shared Product Use - Wisconsin, 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:236-240. [PMID: 32134907 PMCID: PMC7367091 DOI: 10.15585/mmwr.mm6909a4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Layden JE, Ghinai I, Pray I, Kimball A, Layer M, Tenforde MW, Navon L, Hoots B, Salvatore PP, Elderbrook M, Haupt T, Kanne J, Patel MT, Saathoff-Huber L, King BA, Schier JG, Mikosz CA, Meiman J. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. N Engl J Med 2020; 382:903-916. [PMID: 31491072 DOI: 10.1056/nejmoa1911614] [Citation(s) in RCA: 536] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.
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