51
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McDonough SR, Rahman I, Sundar IK. Recent updates on biomarkers of exposure and systemic toxicity in e-cigarette users and EVALI. Am J Physiol Lung Cell Mol Physiol 2021; 320:L661-L679. [PMID: 33501893 DOI: 10.1152/ajplung.00520.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Electronic nicotine delivery systems (ENDS), or e-cigarettes, are emerging tobacco products that produce aerosols by heating e-liquids, which most often consist of propylene glycol and vegetable glycerin along with various flavoring compounds, bypassing the combustion that occurs in the use of traditional tobacco cigarettes. These products have seen a drastic increase in popularity in recent years both as smoking cessation devices as well as among younger generations, due in large part to the widespread perception among consumers that e-cigs are significantly less harmful to health than traditional tobacco cigarettes. Due to the novelty of ENDS as well as their rapidly increasing use, research into biomarkers of e-cig exposure and toxicity have lagged behind their popularity, leaving important questions about their potential toxicity unanswered. Research into potential biomarkers of acute and chronic e-cig use, and e-cigarette- or vaping-associated lung injury is necessary for informing both clinical and regulatory decision-making. We aim to provide an updated review of recent research into potential circulating, genomic, transcriptomic, and epigenetic biomarkers of exposure to and toxicity of e-cigs. We additionally highlight research areas that warrant additional study to gain a better understanding of health risks associated with ENDS use, as well as to provide validation of existing data and methods for measuring and analyzing e-cig-associated biomarkers in human and animal biofluids, tissues, and cells. This review also highlights ongoing efforts within the WNY Center for Research on Flavored Tobacco for research into novel biomarkers in extracellular vesicles that may be associated with short- and long-term ENDS use.
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Affiliation(s)
- Samantha R McDonough
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York
| | - Isaac Kirubakaran Sundar
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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52
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Wills TA, Soneji SS, Choi K, Jaspers I, Tam EK. E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. Eur Respir J 2021; 57:13993003.01815-2019. [PMID: 33154031 PMCID: PMC7817920 DOI: 10.1183/13993003.01815-2019] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/10/2020] [Indexed: 12/11/2022]
Abstract
Background Use of electronic cigarettes (e-cigarettes) is prevalent among adolescents and young adults, but there has been limited knowledge about health consequences in human populations. We conduct a systematic review and meta-analysis of results on respiratory disorders from studies of general-population samples and consider the mapping of these results to findings about biological processes linked to e-cigarettes in controlled laboratory studies. Method We conducted a literature search and meta-analysis of epidemiological studies on the association of e-cigarette use with asthma and with COPD. We discuss findings from laboratory studies about effects of e-cigarettes on four biological processes: cytotoxicity, oxidative stress/inflammation, susceptibility to infection and genetic expression. Results Epidemiological studies, both cross-sectional and longitudinal, show a significant association of e-cigarette use with asthma and COPD, controlling for cigarette smoking and other covariates. For asthma (n=15 studies), the pooled adjusted odds ratio (aOR) was 1.39 (95% CI 1.28–1.51); for COPD (n=9 studies) the aOR was 1.49 (95% CI 1.36–1.65). Laboratory studies consistently show an effect of e-cigarettes on biological processes related to respiratory harm and susceptibility to illness, with e-cigarette conditions differing significantly from clean-air controls, although sometimes less than for cigarettes. Conclusions The evidence from epidemiological studies meets established criteria for consistency, strength of effect, temporality, and in some cases a dose–response gradient. Biological plausibility is indicated by evidence from multiple laboratory studies. We conclude that e-cigarette use has consequences for asthma and COPD, which is of concern for respirology and public health. Epidemiological studies show a relationship of e-cigarette use with asthma and COPD, and laboratory studies show their adverse effects on four biological processes. It can be concluded that e-cigarette use is of significant concern for public health.https://bit.ly/3drH4pj
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Affiliation(s)
- Thomas A Wills
- Cancer Prevention Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Samir S Soneji
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth K Tam
- Dept of Medicine, John A. Burns School of Medicine, Honolulu, HI, USA
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53
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Dusautoir R, Zarcone G, Verriele M, Garçon G, Fronval I, Beauval N, Allorge D, Riffault V, Locoge N, Lo-Guidice JM, Anthérieu S. Comparison of the chemical composition of aerosols from heated tobacco products, electronic cigarettes and tobacco cigarettes and their toxic impacts on the human bronchial epithelial BEAS-2B cells. JOURNAL OF HAZARDOUS MATERIALS 2021; 401:123417. [PMID: 32763707 DOI: 10.1016/j.jhazmat.2020.123417] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
The electronic cigarettes (e-cigs) and more recently the heated tobacco products (HTP) provide alternatives for smokers as they are generally perceived to be less harmful than conventional cigarettes. However, it is crucial to compare the health risks of these different emergent devices, in order to determine which product should be preferred to substitute cigarette. The present study aimed to compare the composition of emissions from HTP, e-cigs and conventional cigarettes, regarding selected harmful or potentially harmful compounds, and their toxic impacts on the human bronchial epithelial BEAS-2B cells. The HTP emitted less polycyclic aromatic hydrocarbons and carbonyls than the conventional cigarette. However, amounts of these compounds in HTP aerosols were still higher than in e-cig vapours. Concordantly, HTP aerosol showed reduced cytotoxicity compared to cigarette smoke but higher than e-cig vapours. HTP and e-cig had the potential to increase oxidative stress and inflammatory response, in a manner similar to that of cigarette smoke, but after more intensive exposures. In addition, increasing e-cig power impacted levels of certain toxic compounds and related oxidative stress. This study provides important data necessary for risk assessment by demonstrating that HTP might be less harmful than tobacco cigarette but considerably more harmful than e-cig.
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Affiliation(s)
- Romain Dusautoir
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Gianni Zarcone
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Marie Verriele
- IMT Lille Douai, Univ. Lille, SAGE, F-59000, Lille, France.
| | - Guillaume Garçon
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | | | - Nicolas Beauval
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Delphine Allorge
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | | | - Nadine Locoge
- IMT Lille Douai, Univ. Lille, SAGE, F-59000, Lille, France.
| | - Jean-Marc Lo-Guidice
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
| | - Sébastien Anthérieu
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France.
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54
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McClelland M, McClelland S. Case of a 21-year-old man with persistent lung collapse leading to a pericardectomy linked to vape use. Heart Lung 2020; 50:262-267. [PMID: 33373941 DOI: 10.1016/j.hrtlng.2020.12.012] [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: 09/16/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
This case report describes multiple organ failure in a young man with illicit vape use which he did not initially disclose to his health care providers. His symptoms were not readily diagnosed until he experienced lung collapse and significant heart failure. Treatment plan recommendations varied among health care providers leading to increased anxiety for the patient and his family. It was ultimately determined that illicit vape use along with chronic substance abuse contributed to a respiratory virus causing pulmonary collapse. The pulmonary virus migrated to the patient's heart causing severe restrictive pericarditis ultimately requiring a pericardectomy. Assessment, interventions, and follow-up care occurred during the global Corona-19 pandemic of 2020.
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Affiliation(s)
- Molly McClelland
- College of Health Professions, #425, 4001W. McNichols Rd., Detroit, MI 48221, United States.
| | - Steven McClelland
- North Woodward Internal Medicine, NWIMA, Ste. 100, Clawson, MI 48017, United States.
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55
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Mungia R, Valdez DN. Smoking, Vaping, and the Benefits Cessation in Times of COVID-19: A Public Health Perspective. FRONTIERS IN DENTAL MEDICINE 2020. [DOI: 10.3389/fdmed.2020.618364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of this article is to inform dental practitioners and specialists of the benefits of smoking and vaping cessation in relation to COVID-19 transmission. COVID-19 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has affected more than 31.7 million people globally with infection rates continuing to rise rapidly. Smoking dramatically impairs lung function and gives rise to an increase in susceptibility for infection, allowing for a more difficult recovery due, in part, to the damage SARS-CoV-2 does to the lungs. Tobacco smoking is one of the primary causes of death in the United States (US), however, nearly 40 million adults still smoke cigarettes, with 4.7 million middle and high school students using at least one tobacco product, including electronic cigarettes. COVID-19 is transmitted through salivary droplets, causing severe bilateral pneumonia and significantly reduced lung function, putting smokers and vapers at greater risk through cross-contamination and face touching. So far, data from animal studies suggest that vaping leads to an increased susceptibility to infection, which coincides with evidence of increased rates of chronic bronchitis in vapers. There is yet to be data regarding the benefits of smoking and vaping cessation during the COVID-19 pandemic. However, there is evidence suggesting that 4 weeks or more of smoking cessation intervention reduces the risk of contracting COVID-19 and developing severe complications. Because of these probable connections, dental practitioners should advise their patients to stop smoking and/or vaping via the 5 As Cessation Strategy.
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56
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Chatterjee S, Caporale A, Tao JQ, Guo W, Johncola A, Strasser AA, Leone FT, Langham MC, Wehrli FW. Acute e-cig inhalation impacts vascular health: a study in smoking naïve subjects. Am J Physiol Heart Circ Physiol 2020; 320:H144-H158. [PMID: 33216614 DOI: 10.1152/ajpheart.00628.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study was designed to investigate the acute effects of nonnicotinized e-cigarette (e-cig) aerosol inhalation in nonsmokers both in terms of blood-based markers of inflammation and oxidative stress and evaluate their association with hemodynamic-metabolic MRI parameters quantifying peripheral vascular reactivity, cerebrovascular reactivity, and aortic stiffness. Thirty-one healthy nonsmokers were subjected to two blood draws and two identical MRI protocols, each one before and after a standardized e-cig vaping session. After vaping, the serum levels of C-reactive protein, soluble intercellular adhesion molecule, and the danger signal machinery high-mobility group box 1 (HMGB1) and its downstream effector and the NLR family pyrin domain containing 3 (NLRP3) inflammasome (as monitored by its adaptor protein ASC) increased significantly relative to the respective baseline (prevaping) values. Moreover, nitric oxide metabolites and reactive oxygen species production decreased and increased, respectively. These observations were paralleled by impaired peripheral vascular reactivity (with reduced flow-mediated dilation and attenuated hyperemic response after a cuff-occlusion test) and metabolic alterations expressed by decreased venous oxygen saturation, postvaping. The current results suggest propagation of inflammation signaling via activation of the danger signaling axis (HMGB1-NLRP3). The findings indicate that a single episode of vaping has adverse impacts on vascular inflammation and function.NEW & NOTWORTHY Endothelial cell signaling and blood biomarkers were found to correlate with functional vascular changes in a single episode e-cigarettes inhalation in healthy adults. This is indicative of the potential of e-cigarettes (even when inhaled acutely) to lead of vascular dysfunction.
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Affiliation(s)
- Shampa Chatterjee
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alessandra Caporale
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Jian Qin Tao
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alyssa Johncola
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Andrew A Strasser
- Department of Psychiatry and Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael C Langham
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Felix W Wehrli
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
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57
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Kizhakke Puliyakote AS, Elliott AR, Sá RC, Anderson KM, Crotty Alexander LE, Hopkins SR. Vaping disrupts ventilation-perfusion matching in asymptomatic users. J Appl Physiol (1985) 2020; 130:308-317. [PMID: 33180648 DOI: 10.1152/japplphysiol.00709.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Inhalation of e-cigarette's aerosols (vaping) has the potential to disrupt pulmonary gas exchange, but the effects in asymptomatic users are unknown. We assessed ventilation-perfusion (V̇A/Q̇) mismatch in asymptomatic e-cigarette users, using magnetic resonance imaging (MRI). We hypothesized that vaping induces V̇A/Q̇ mismatch through alterations in both ventilation and perfusion distributions. Nine young, asymptomatic "Vapers" with >1-yr vaping history, and no history of cardiopulmonary disease, were imaged supine using proton MRI, to assess the right lung at baseline and immediately after vaping. Seven young "Controls" were imaged at baseline only. Relative dispersion (SD/means) was used to quantify the heterogeneity of the individual ventilation and perfusion distributions. V̇A/Q̇ mismatch was quantified using the second moments of the ventilation and perfusion versus V̇A/Q̇ ratio distributions, log scale, LogSDV̇, and LogSDQ̇, respectively, analogous to the multiple inert gas elimination technique. Spirometry was normal in both groups. Ventilation heterogeneity was similar between groups at baseline (Vapers, 0.43 ± 0.13; Controls, 0.51 ± 0.11; P = 0.13) but increased after vaping (to 0.57 ± 0.17; P = 0.03). Perfusion heterogeneity was greater (P = 0.04) in Vapers at baseline (0.53 ± 0.06) compared with Controls (0.44 ± 0.10) but decreased after vaping (to 0.42 ± 0.07; P = 0.005). Vapers had greater (P = 0.01) V̇A/Q̇ mismatch at baseline compared with Controls (LogSDQ̇ = 0.61 ± 0.12 vs. 0.43 ± 0.12), which was increased after vaping (LogSDQ̇ = 0.73 ± 0.16; P = 0.03). V̇A/Q̇ mismatch is greater in Vapers and worsens after vaping. This suggests subclinical alterations in lung function not detected by spirometry.NEW & NOTEWORTHY This research provides evidence of vaping-induced disruptions in ventilation-perfusion matching in young, healthy, asymptomatic adults with normal spirometry who habitually vape. The changes in ventilation and perfusion distributions, both at baseline and acutely after vaping, and the potential implications on hypoxic vasoconstriction are particularly relevant in understanding the pathogenesis of vaping-induced dysfunction. Our imaging-based approach provides evidence of potential subclinical alterations in lung function below thresholds of detection using spirometry.
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Affiliation(s)
- Abhilash S Kizhakke Puliyakote
- Pulmonary Imaging Laboratory, Department of Radiology, UC San Diego Health Sciences, San Diego, California.,Department of Radiology, University of California, San Diego, California
| | - Ann R Elliott
- Pulmonary Imaging Laboratory, Department of Radiology, UC San Diego Health Sciences, San Diego, California.,Department of Medicine, University of California, San Diego, California
| | - Rui C Sá
- Pulmonary Imaging Laboratory, Department of Radiology, UC San Diego Health Sciences, San Diego, California.,Department of Medicine, University of California, San Diego, California
| | - Kevin M Anderson
- Pulmonary Imaging Laboratory, Department of Radiology, UC San Diego Health Sciences, San Diego, California.,Department of Radiology, University of California, San Diego, California
| | | | - Susan R Hopkins
- Pulmonary Imaging Laboratory, Department of Radiology, UC San Diego Health Sciences, San Diego, California.,Department of Radiology, University of California, San Diego, California.,Department of Medicine, University of California, San Diego, California
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58
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Wills TA, Soneji SS, Choi K, Jaspers I, Tam EK. E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. Eur Respir J 2020. [PMID: 33154031 DOI: 10.1183/13993003.01815‐2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Use of electronic cigarettes (e-cigarettes) is prevalent among adolescents and young adults, but there has been limited knowledge about health consequences in human populations. We conduct a systematic review and meta-analysis of results on respiratory disorders from studies of general-population samples and consider the mapping of these results to findings about biological processes linked to e-cigarettes in controlled laboratory studies. METHOD We conducted a literature search and meta-analysis of epidemiological studies on the association of e-cigarette use with asthma and with COPD. We discuss findings from laboratory studies about effects of e-cigarettes on four biological processes: cytotoxicity, oxidative stress/inflammation, susceptibility to infection and genetic expression. RESULTS Epidemiological studies, both cross-sectional and longitudinal, show a significant association of e-cigarette use with asthma and COPD, controlling for cigarette smoking and other covariates. For asthma (n=15 studies), the pooled adjusted odds ratio (aOR) was 1.39 (95% CI 1.28-1.51); for COPD (n=9 studies) the aOR was 1.49 (95% CI 1.36-1.65). Laboratory studies consistently show an effect of e-cigarettes on biological processes related to respiratory harm and susceptibility to illness, with e-cigarette conditions differing significantly from clean-air controls, although sometimes less than for cigarettes. CONCLUSIONS The evidence from epidemiological studies meets established criteria for consistency, strength of effect, temporality, and in some cases a dose-response gradient. Biological plausibility is indicated by evidence from multiple laboratory studies. We conclude that e-cigarette use has consequences for asthma and COPD, which is of concern for respirology and public health.
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Affiliation(s)
- Thomas A Wills
- Cancer Prevention Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Samir S Soneji
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth K Tam
- Dept of Medicine, John A. Burns School of Medicine, Honolulu, HI, USA
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59
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Chen J, English S, Ogilvie JA, Siu MKM, Tammara A, Haas CJ. All up in smoke: vaping-associated lung injury. J Community Hosp Intern Med Perspect 2020; 10:571-578. [PMID: 33194132 PMCID: PMC7599004 DOI: 10.1080/20009666.2020.1800978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The electronic cigarette (EC), was initially introduced as a safe alternative to conventional cigarette smoking While initially seemingly innocuous, over 2800 E-cigarette, or Vaping, product use-associated lung injury (EVALI) cases have been reported in the USA, with a spectrum of clinical severity ranging from mild dyspnea to overt respiratory failure In this report we highlight three EVALI cases whom presented with dyspnea and a variety of non-specific symptoms. Diagnostic imaging demonstrated bilateral reticular infiltrates and ground-glass opacities with lymphadenopathy. Clinically, patients failed to respond to empiric antibiotics but improved after initiating steroids. Consistent with prior case series, our patients reported exposure to EC liquids containing tetrahydrocannabinol (THC)/cannabidiols (CBD) additives, suggesting Vitamin E acetate as the potentially harmful constituent. In this case series and review, we not only summarize prior clinical studies that have evaluated the effects of vaping on cardiopulmonary function as well as case reports on EVALI, but also discuss the pathophysiology of vaping and EVALI. It remains unclear not only why some individuals develop EVALI, but why the clinical and pathological presentations vary. EVALI remains a significant public health concern and clinicians must maintain a high index of suspicion for this novel phenomenon.
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Affiliation(s)
- Jingjing Chen
- MedStar Health Internal Medicine Residency Program, MedStar Franklin Square Hospital, Baltimore, MD, USA
| | - Samuel English
- MedStar Health Internal Medicine Residency Program, MedStar Franklin Square Hospital, Baltimore, MD, USA
| | - Jennifer A Ogilvie
- MedStar Health Internal Medicine Residency Program, MedStar Franklin Square Hospital, Baltimore, MD, USA
| | - Man Kit M Siu
- MedStar Health Internal Medicine Residency Program, MedStar Franklin Square Hospital, Baltimore, MD, USA
| | - Anita Tammara
- MedStar Health Internal Medicine Residency Program, MedStar Franklin Square Hospital, Baltimore, MD, USA.,School of Medicine, Georgetown University, Washington, DC, USA
| | - Christopher J Haas
- MedStar Health Internal Medicine Residency Program, MedStar Franklin Square Hospital, Baltimore, MD, USA.,School of Medicine, Georgetown University, Washington, DC, USA
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60
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Pinkston R, Zaman H, Hossain E, Penn AL, Noël A. Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air-liquid interface. Respir Res 2020; 21:269. [PMID: 33069224 PMCID: PMC7568376 DOI: 10.1186/s12931-020-01539-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/08/2020] [Indexed: 01/09/2023] Open
Abstract
Backgroud JUUL, an electronic nicotine delivery system (ENDS), which first appeared on the US market in 2015, controled more than 75% of the US ENDS sales in 2018. JUUL-type devices are currently the most commonly used form of ENDS among youth in the US. In contrast to free-base nicotine contained in cigarettes and other ENDS, JUUL contains high levels of nicotine salt (35 or 59 mg/mL), whose cellular and molecular effects on lung cells are largely unknown. In the present study, we evaluated the in vitro toxicity of JUUL crème brûlée-flavored aerosols on 2 types of human bronchial epithelial cell lines (BEAS-2B, H292) and a murine macrophage cell line (RAW 264.7). Methods Human lung epithelial cells and murine macrophages were exposed to JUUL crème brûlée-flavored aerosols at the air–liquid interface (ALI) for 1-h followed by a 24-h recovery period. Membrane integrity, cytotoxicity, extracellular release of nitrogen species and reactive oxygen species, cellular morphology and gene expression were assessed. Results Crème brûlée-flavored aerosol contained elevated concentrations of benzoic acid (86.9 μg/puff), a well-established respiratory irritant. In BEAS-2B cells, crème brûlée-flavored aerosol decreased cell viability (≥ 50%) and increased nitric oxide (NO) production (≥ 30%), as well as iNOS gene expression. Crème brûlée-flavored aerosol did not affect the viability of either H292 cells or RAW macrophages, but increased the production of reactive oxygen species (ROS) by ≥ 20% in both cell types. While crème brûlée-flavored aerosol did not alter NO levels in H292 cells, RAW macrophages exposed to crème brûlée-flavored aerosol displayed decreased NO (≥ 50%) and down-regulation of the iNOS gene, possibly due to increased ROS. Additionally, crème brûlée-flavored aerosol dysregulated the expression of several genes related to biotransformation, inflammation and airway remodeling, including CYP1A1, IL-6, and MMP12 in all 3 cell lines. Conclusion Our results indicate that crème brûlée-flavored aerosol causes cell-specific toxicity to lung cells. This study contributes to providing scientific evidence towards regulation of nicotine salt-based products.
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Affiliation(s)
- Rakeysha Pinkston
- Department of Environmental Toxicology, College of Sciences and Engineering, Southern University and A&M College, Baton Rouge, LA, 70813, USA.,Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Drive, Baton Rouge, LA, 70803, USA
| | - Hasan Zaman
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Drive, Baton Rouge, LA, 70803, USA
| | - Ekhtear Hossain
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Drive, Baton Rouge, LA, 70803, USA
| | - Arthur L Penn
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Drive, Baton Rouge, LA, 70803, USA
| | - Alexandra Noël
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Drive, Baton Rouge, LA, 70803, USA.
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61
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Fryman C, Lou B, Weber AG, Steinberg HN, Khanijo S, Iakovou A, Makaryus MR. Acute Respiratory Failure Associated With Vaping. Chest 2020; 157:e63-e68. [PMID: 32145818 DOI: 10.1016/j.chest.2019.10.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022] Open
Abstract
The use of e-cigarettes to deliver aerosolized nicotine has gained popularity in recent years. Numerous reports have cited the development of acute pulmonary disease linked to vaping nicotine as well as marijuana-based products. As cultural attitudes evolve and policies shift toward the legalization of marijuana, its use has become more prevalent. Given the increased prevalence of marijuana consumption and e-cigarette usage, better insight into its potential to cause lung toxicity is warranted. The clinical, radiographic, and histopathologic characteristics of lung injury associated with vaping, particularly with marijuana-based products, have yet to be well described in the literature. We present eight patients, most of whom were admitted recently to our institution with acute respiratory failure following vaping. The majority of patients were young, with a median age of 31.5 years (range, 24-62 years) and with no known underlying lung disease. This case series highlights common clinical findings as well as the varied radiographic and histopathologic features of acute respiratory failure associated with vaping predominantly marijuana-based products. As more cases of vaping-associated pulmonary injury unfold, data will be available to further characterize this emerging disease entity. Improved understanding of disease pathogenesis and its clinical course will help clinicians determine optimal management and follow-up strategies for this patient population.
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Affiliation(s)
- Craig Fryman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.
| | - Becky Lou
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Andrew G Weber
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Harry N Steinberg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Sameer Khanijo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Annamaria Iakovou
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Mina R Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
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62
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Doukas SG, Kavali L, Menon RS, Izotov BN, Bukhari A. E-cigarette or vaping induced lung injury: A case series and literature review. Toxicol Rep 2020; 7:1381-1386. [PMID: 33102141 PMCID: PMC7577885 DOI: 10.1016/j.toxrep.2020.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction Recently, a rapidly increasing number of e-cigarette or vaping induced lung injury (EVALI) has been reported across the nation. Given the ongoing epidemic, it has been suggested that specific chemical substances used as additives in e-cigarettes could be highly related to EVALI. A history of vaping with positive radiographic changes and low suspicion for active infection are requirements for diagnosis but it still remains a diagnosis of exclusion. The course of the disease, mechanism of lung injury and the optimal management options need to be better understood. Here we aimed to discuss the clinical characteristics recognized in a case series of ten hospitalized EVALI patients with radiological findings of lung injury and provide an up today summary of the known literature of EVALI-induced lung injury. Methods A retrospective chart review was conducted on ten patients who presented to Saint Peter's University Hospital in New Brunswick, NJ from July 2019 to February 2020, with a mean hospital stay of five days. According to the CDC recommended definition of the disease, our cases met the current working definition of confirmed or probable cases of EVALI. Results Ten patients, with mean age 30.8 years (50 % male) and average years of vaping 1.708 with 60 % endorsing a simultaneous history of cannabis-related products use, went under a retrospective review. 3/10 (30 %) had documented medically-managed pulmonary disease history, 8/10 (80 %) presented with the respiratory-related chief complaint, 6/10 (60 %) presented with gastrointestinal symptoms and 7/10 (70 %) had constitutional symptoms. All patients (100 %) were found to have bilateral ground-glass opacities on chest imaging. 9/10 were admitted, 6/10 (60 %) had an oxygen saturation of <95 % requiring oxygen supplementation with 4/10 managed in the intensive care unit. Conclusion EVALI patients with radiological findings of lung injury, although mainly present respiratory symptoms, may very often appear with constitutional and gastrointestinal symptoms. Based on the existing literature and our data it is argued that EVALI may be misdiagnosed and that closer monitoring is required to determine optimal diagnostic and therapeutic management of this condition. Our data and the existing literature suggest that laboratory and epidemiologic findings can be contributory for the diagnosis of the disease.
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Affiliation(s)
- Sotirios G Doukas
- Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA.,Department of Forensic Sciences and Laboratory of Toxicology, Medical School, University of Crete, Heraklion, 71003, Greece
| | - Leena Kavali
- Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA
| | - Rohan S Menon
- Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA
| | - Boris N Izotov
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 119048, Moscow, Russian Federation
| | - Amar Bukhari
- Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA.,Department of Medicine, Division of Pulmonary and Critical Care 240 Easton Ave, Adult Ambulatory at Cares Building 4th Floor, New Brunswick, NJ, 08901, USA
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63
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Affiliation(s)
- Michael Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP), Robert-Koch-Platz 9, 10115, Berlin, Deutschland.
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64
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Lechasseur A, Morissette MC. The fog, the attractive and the addictive: pulmonary effects of vaping with a focus on the contribution of each major vaping liquid constituent. Eur Respir Rev 2020; 29:29/157/200268. [PMID: 33060167 DOI: 10.1183/16000617.0268-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/25/2020] [Indexed: 11/05/2022] Open
Abstract
Vaping has become increasingly popular over the past decade. This pragmatic review presents the published biological effects of electronic cigarette vapour inhalation with a focus on the pulmonary effects. Special attention has been devoted to providing the documented effects specific to each major ingredient, namely propylene glycol/glycerol, nicotine and flavouring agents. For each ingredient, findings are divided according to the methodology used, being in vitro studies, animal studies and clinical studies. Finally, we provide thoughts and insights on the current state of understanding of the pulmonary effects of vaping, as well as novel research avenues and methodologies.
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Affiliation(s)
- Ariane Lechasseur
- Quebec Heart and Lung Institute, Université Laval, Quebec, Canada.,Faculty of Medicine, Université Laval, Quebec, Canada
| | - Mathieu C Morissette
- Quebec Heart and Lung Institute, Université Laval, Quebec, Canada.,Dept of Medicine, Université Laval, Quebec, Canada
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65
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Smoking and COVID-19: Adding Fuel to the Flame. Int J Mol Sci 2020; 21:ijms21186581. [PMID: 32916821 PMCID: PMC7555793 DOI: 10.3390/ijms21186581] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, an infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to more than 771,000 deaths worldwide. Tobacco smoking is a major known risk factor for severe illness and even death from many respiratory infections. The effects of smoking on COVID-19 are currently controversial. Here, we provide an overview of the current knowledge on the effects of smoking on the clinical manifestations, disease progression, inflammatory responses, immunopathogenesis, racial ethnic disparities, and incidence of COVID-19. This review also documents future directions of smoking related research in COVID-19. The current epidemiological finding suggests that active smoking is associated with an increased severity of disease and death in hospitalized COVID-19 patients. Smoking can upregulate the angiotensin-converting enzyme-2 (ACE-2) receptor utilized by SARS-CoV-2 to enter the host cell and activate a ‘cytokine storm’ which can lead to worsen outcomes in COVID-19 patients. This receptor can also act as a potential therapeutic target for COVID-19 and other infectious diseases. The COVID-19 pandemic sheds light on a legacy of inequalities regarding gender, racial, and ethnic health disparities associated with active smoking, thus, smoking cessation may help in improving outcomes. In addition, to flatten the COVID-19 curve, staying indoors, avoiding unnecessary social contact, and bolstering the immune defense system by maintaining a healthy diet/living are highly desirable.
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66
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Characterizing vaping posts on Instagram by using unsupervised machine learning. Int J Med Inform 2020; 141:104223. [DOI: 10.1016/j.ijmedinf.2020.104223] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/21/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
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67
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Hage R, Schuurmans MM. Suggested management of e-cigarette or vaping product use associated lung injury (EVALI). J Thorac Dis 2020; 12:3460-3468. [PMID: 32802422 PMCID: PMC7399386 DOI: 10.21037/jtd.2020.03.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- René Hage
- Division of Pulmonology, University Hospital Zurich and Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich and Medical Faculty, University of Zurich, Zurich, Switzerland
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68
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Rothrock AN, Andris H, Swetland SB, Chavez V, Isaak S, Pagane M, Romney J, Rothrock SG. Association of E-cigarettes with adolescent alcohol use and binge drinking-drunkenness: A systematic review and meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:684-698. [PMID: 32795246 DOI: 10.1080/00952990.2020.1771723] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: E-cigarette (ECIG) use has increased substantially in the past decade. Co-use of alcohol and ECIGS may have serious consequences in adolescents. Objectives: To evaluate the association of e-cigarettes (ECIGs) with alcohol use in adolescents. Methods: Searched databases included PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were included if they contained a non-E-cigarette group (NON-ECIG), an ECIG group, detailed rates of alcohol use, binge drinking, or drunkenness and included adolescents. Two independent reviewers extracted data using MOOSE guidelines. Evidence quality across studies was assessed using Cochrane GRADE methodology. Summary effects of ECIG vs. NON-ECIG use on any alcohol use and a composite of binge drinking/drunkenness were calculated using a random-effects model. Results: 28 of 3768 initially identified studies were included: 25 cross-sectional, 3 cohort studies, N = 458,357 total subjects (49.6% females). Pooling of data showed that ECIG users had a higher risk for any alcohol use compared to NON-ECIG users (Odds Ratio/OR 6.62, 95% confidence interval/CI 5.67-7.72) and a higher rate of binge drinking/drunkenness compared to NON-ECIG users (OR 6.73, 95% CI 4.5 - 10.07). The subset of high school ECIG users had higher rates of alcohol use (OR 8.17, 95% CI 5.95-11.2) and binge drinking/drunkenness (OR 7.98, 95% CI 5.98-10.63) compared to NON-ECIG users. Conclusion: ECIG users had a higher risk of alcohol use and binge drinking/drunkenness compared to NON-ECIG users. Our findings indicate that interventions to reduce ECIG use should be coupled with measures to reduce alcohol use in adolescents.Abbreviations: ECIG: e-cigarettes; NON-ECIG: non e-cigarettes.
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Affiliation(s)
| | - Halle Andris
- Lawton Chiles High School , Tallahassee, FL, USA
| | | | | | - Shira Isaak
- Winter Park High School , Winter Park, FL, USA
| | | | - Jake Romney
- Lake Mary Preparatory High School , Lake Mary, FL, USA
| | - Steven G Rothrock
- Department of Emergency Medicine, Dr. P Phillips Hospital, Orlando Health , Orlando, FL, USA
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69
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Lee AC, Chakladar J, Li WT, Chen C, Chang EY, Wang-Rodriguez J, Ongkeko WM. Tobacco, but Not Nicotine and Flavor-Less Electronic Cigarettes, Induces ACE2 and Immune Dysregulation. Int J Mol Sci 2020; 21:ijms21155513. [PMID: 32752138 PMCID: PMC7432384 DOI: 10.3390/ijms21155513] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic caused by the SARS-CoV-2 virus, overlaps with the ongoing epidemics of cigarette smoking and electronic cigarette (e-cig) vaping. However, there is scarce data relating COVID-19 risks and outcome with cigarette or e-cig use. In this study, we mined three independent RNA expression datasets from smokers and vapers to understand the potential relationship between vaping/smoking and the dysregulation of key genes and pathways related to COVID-19. We found that smoking, but not vaping, upregulates ACE2, the cellular receptor that SARS-CoV-2 requires for infection. Both smoking and use of nicotine and flavor-containing e-cigs led to upregulation of pro-inflammatory cytokines and inflammasome-related genes. Specifically, chemokines including CCL20 and CXCL8 are upregulated in smokers, and CCL5 and CCR1 are upregulated in flavor/nicotine-containing e-cig users. We also found genes implicated in inflammasomes, such as CXCL1, CXCL2, NOD2, and ASC, to be upregulated in smokers and these e-cig users. Vaping flavor and nicotine-less e-cigs, however, did not lead to significant cytokine dysregulation and inflammasome activation. Release of inflammasome products, such as IL-1B, and cytokine storms are hallmarks of COVID-19 infection, especially in severe cases. Therefore, our findings demonstrated that smoking or vaping may critically exacerbate COVID-19-related inflammation or increase susceptibility to COVID-19.
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Affiliation(s)
- Abby C. Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; (A.C.L.); (J.C.); (W.T.L.); (C.C.)
- Research Service, VA San Diego Healthcare System San Diego, La Jolla, CA 92161, USA
| | - Jaideep Chakladar
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; (A.C.L.); (J.C.); (W.T.L.); (C.C.)
- Research Service, VA San Diego Healthcare System San Diego, La Jolla, CA 92161, USA
| | - Wei Tse Li
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; (A.C.L.); (J.C.); (W.T.L.); (C.C.)
- Research Service, VA San Diego Healthcare System San Diego, La Jolla, CA 92161, USA
| | - Chengyu Chen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; (A.C.L.); (J.C.); (W.T.L.); (C.C.)
- Research Service, VA San Diego Healthcare System San Diego, La Jolla, CA 92161, USA
| | - Eric Y. Chang
- Department of Radiology, Radiology Service, VA San Diego Healthcare System San Diego, University of California San Diego, La Jolla, CA 92093, USA;
| | - Jessica Wang-Rodriguez
- Department of Pathology, Pathology Service, VA San Diego Healthcare System San Diego, University of California San Diego, La Jolla, CA 92093, USA;
| | - Weg M. Ongkeko
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA; (A.C.L.); (J.C.); (W.T.L.); (C.C.)
- Research Service, VA San Diego Healthcare System San Diego, La Jolla, CA 92161, USA
- Correspondence: ; Tel.: +1-858-552-8585 (ext. 7165)
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70
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Rao DR, Maple KL, Dettori A, Afolabi F, Francis JK, Artunduaga M, Lieu TJ, Aldy K, Cao DJ, Hsu S, Feng SY, Mittal V. Clinical Features of E-cigarette, or Vaping, Product Use-Associated Lung Injury in Teenagers. Pediatrics 2020; 146:peds.2019-4104. [PMID: 32393606 PMCID: PMC7961805 DOI: 10.1542/peds.2019-4104] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the United States in 2019, there was an outbreak of electronic cigarette, or vaping, product use-associated lung injury (EVALI). The manifestations of EVALI in adolescents are not well characterized. We describe the diagnosis, evaluation, and management of EVALI in adolescents hospitalized at a tertiary care, university-affiliated children's hospital. METHODS A multidisciplinary committee developed an EVALI algorithm on the basis of guidelines from the Centers for Disease Control and Prevention. A retrospective chart review was conducted on patients diagnosed with EVALI. Descriptive analyses included sociodemographic characteristics, clinical presentation, laboratory and imaging results, pulmonary function testing, oxygen requirements, and clinic follow-up. RESULTS Thirteen hospitalized adolescents were diagnosed with confirmed or probable EVALI. The majority were female (54%) with a mean age of 15.9 years. Sixty-nine percent of patients presented with respiratory symptoms, whereas gastrointestinal symptoms were prominent in 85% of patients. Vaping Δ-9-tetrahydrocannabinol was reported in 92% of patients, and vaping nicotine was reported in 62% of patients. All had bilateral ground-glass opacities on the chest computed tomography (CT) scan. Treatment with glucocorticoids led to clinical improvement in 11 of 12 patients. Treatment with glucocorticoids led to improvement in both forced expiratory volume in 1 second and forced vital capacity (P < .05). Four patients required home oxygen on the basis of 6-minute walk test results. CONCLUSIONS Diagnosis of EVALI should be suspected on the basis of vaping history and clinical presentation. Glucocorticoid treatment led to an improvement in symptoms and lung function. The 6-minute walk test may help determine oxygen needs at discharge.
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Affiliation(s)
- Devika R. Rao
- Division of Respiratory Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Kendra L. Maple
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Dettori
- Division of Respiratory Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Folashade Afolabi
- Division of Respiratory Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Jenny K.R. Francis
- Division of Developmental-Behavioral Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Maddy Artunduaga
- Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Tiffany J. Lieu
- Division of Pediatric Hospital Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kim Aldy
- Division of Medical Toxicology, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,North Texas Poison Center, Parkland Health and Hospital System, Dallas, Texas
| | - Dazhe James Cao
- Division of Medical Toxicology, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,North Texas Poison Center, Parkland Health and Hospital System, Dallas, Texas
| | - Stephanie Hsu
- Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
| | - Sing Yi Feng
- Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,North Texas Poison Center, Parkland Health and Hospital System, Dallas, Texas
| | - Vineeta Mittal
- Division of Pediatric Hospital Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas;,Children’s Health Medical Center Dallas, Dallas, Texas
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71
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Winnicka L, Shenoy MA. EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review. J Gen Intern Med 2020; 35:2130-2135. [PMID: 32246394 PMCID: PMC7351931 DOI: 10.1007/s11606-020-05813-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/19/2020] [Indexed: 01/15/2023]
Abstract
Electronic cigarettes are a novel and emerging product increasingly used by the general public. However, despite their popularity, they remain poorly studied and with likely serious health risks. EVALI, or "electronic cigarette or vaping product use-associated lung injury," is a recently described entity at the forefront of current investigations. Though EVALI has been linked to vitamin E acetate, a constituent of THC vaping products, electronic cigarettes likely pose a host of other pulmonary toxicities. The presentation, diagnostic work-up, treatment, and pathophysiology of EVALI are herein described, as well as the general pulmonary toxicity profile of electronic cigarettes.
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Affiliation(s)
- Lydia Winnicka
- Department of Pulmonary and Critical Care Medicine, NYU Winthrop Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA.
| | - Mangalore Amith Shenoy
- Department of Pulmonary and Critical Care Medicine, NYU Winthrop Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA
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72
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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: 65] [Impact Index Per Article: 16.3] [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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Affiliation(s)
- Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA.
| | - Kim Aldy
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Stephanie Hsu
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Molly McGetrick
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Guido Verbeck
- Department of Chemistry, University of North Texas, Denton, TX, USA
| | - Imesha De Silva
- Department of Chemistry, University of North Texas, Denton, TX, USA
| | - Sing-Yi Feng
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
- Department of Pediatrics, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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73
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Miyashita L, Foley G. E-cigarettes and respiratory health: the latest evidence. J Physiol 2020; 598:5027-5038. [PMID: 32495367 DOI: 10.1113/jp279526] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/09/2020] [Indexed: 12/17/2022] Open
Abstract
The E-cigarette market continues to expand at an alarming rate with thousands of flavours available for purchase and continuously evolving devices. Now that it is a multi-billion dollar industry and one without stringent regulation, there is rising concern over the safety of vaping products. Since June 2019, over 2800 cases of E-cigarette-associated acute lung toxicity have been reported in the USA, over 60 of which resulted in death. Many argue that E-cigarettes offer a safer alternative to smoking, but we are evidently far from fully understanding the potential hazards that they pose to respiratory health. Although the risk of an outbreak in the UK has been considered low due to tighter E-cigarette regulations, we cannot fully eliminate the possibility of similar events occurring in the future. With evidence frequently emerging of the harmful effects of E-cigarettes to pulmonary health, there is an urgent need to define the long-term implications of vaping. Studies show that E-cigarette exposure can disrupt pulmonary homeostasis, with reports of gas exchange disturbance, reduced lung function, increased airway inflammation and oxidative stress, downregulation of immunity, and increased risk of respiratory infection. In this review, the latest research on the effect of E-cigarette use on respiratory health will be presented.
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Affiliation(s)
- Lisa Miyashita
- Centre for Genomics and Child Health, the Blizard Institute, 4 Newark Street, Whitechapel, E1 2AT, London
| | - Gary Foley
- Centre for Genomics and Child Health, the Blizard Institute, 4 Newark Street, Whitechapel, E1 2AT, London
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75
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Bolt HM. Electronic cigarettes and vaping: toxicological awareness is increasing. Arch Toxicol 2020; 94:1783-1785. [PMID: 32440856 PMCID: PMC7240249 DOI: 10.1007/s00204-020-02786-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Hermann M Bolt
- Department of Toxicology, Leibniz Research Centre for Working Environment and Human Factors at TU, Dortmund (IfADo), Ardeystr. 67, 44139, Dortmund, Germany.
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76
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Vaping-Related Acute Parenchymal Lung Injury: A Systematic Review. Chest 2020; 158:1555-1565. [PMID: 32442559 DOI: 10.1016/j.chest.2020.03.085] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury.
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Affiliation(s)
- Claudio Nardiello
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Internal Medicine (Pulmonology), University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Rory E Morty
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Internal Medicine (Pulmonology), University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
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78
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Javelle E. Electronic cigarette and vaping should be discouraged during the new coronavirus SARS-CoV-2 pandemic. Arch Toxicol 2020. [PMID: 32303807 DOI: 10.1007/s00204‐020‐02744‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Affiliation(s)
- Emilie Javelle
- Laveran Military Hospital, Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.
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79
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Electronic cigarette and vaping should be discouraged during the new coronavirus SARS-CoV-2 pandemic. Arch Toxicol 2020; 94:2261-2262. [PMID: 32303807 PMCID: PMC7165073 DOI: 10.1007/s00204-020-02744-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 10/25/2022]
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80
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Ruszkiewicz JA, Zhang Z, Gonçalves FM, Tizabi Y, Zelikoff JT, Aschner M. Neurotoxicity of e-cigarettes. Food Chem Toxicol 2020; 138:111245. [PMID: 32145355 PMCID: PMC7089837 DOI: 10.1016/j.fct.2020.111245] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.
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Affiliation(s)
- Joanna A Ruszkiewicz
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Ziyan Zhang
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Filipe Marques Gonçalves
- Biochemistry Graduate Program, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington DC, United States
| | - Judith T Zelikoff
- Department of Environmental Medicine, New York University School of Medicine, Manhattan, NY, United States
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States.
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81
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Soteriades S, Barbouni A, Rachiotis G, Grevenitou P, Mouchtouri V, Pinaka O, Dadouli K, Hadjichristodoulou C. Prevalence of Electronic Cigarette Use and its Determinants among 13-to-15-Year-Old Students in Greece: Results from the 2013 Global Youth Tobacco Survey (GYTS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1671. [PMID: 32143414 PMCID: PMC7084902 DOI: 10.3390/ijerph17051671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Electronic cigarette use has increased over the past decade. Its potential role in smoking cessation, in addiction and as a 'gateway' to tobacco smoking is subject to intense research. This cross-sectional study, carried out in 2013, aims to present the habits of students aged 13-15 in Greece with regard to e-cigarettes and investigate potential risk factors and the relationship between e-cigarettes, tobacco smoking and other nicotine products. It is the first such study to be carried out in Greece. The survey was based on the standardized methodology of the Global Youth Tobacco Survey. All potential associations were investigated using multiple logistic regression. In total 2.8% of the 4096 participating students were current e-cigarette users and 12.3% of them were ever users. E-cigarette use was associated with male gender, being older, current use of combustible tobacco products and e-cigarette use in the family. Ever e-cigarette use, being older, female gender and higher pocket money were associated with an increased susceptibility to tobacco smoking. E-cigarette prevalence in Greece in 2013 was similar to that of other, developed countries. The smoking and vaping habits of adolescents must be monitored in order to assess trends over time and whether any policy alterations are necessary.
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Affiliation(s)
- Soteris Soteriades
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Anastasia Barbouni
- Department of Public Health, University of West Attica, 196 Alexandras Ave., 11521 Athens, Greece
| | - George Rachiotis
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Panoraia Grevenitou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Varvara Mouchtouri
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Ourania Pinaka
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
| | - Christos Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Katsigra Building, 22 Papakyriazi St., 41222 Larissa, Greece (C.H.)
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82
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Laucks P, Salzman GA. The Dangers of Vaping. MISSOURI MEDICINE 2020; 117:159-164. [PMID: 32308243 PMCID: PMC7144697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As our nation turns away from smoking tobacco and toward legalization of marijuana, vaporization of both plants has increased in popularity. There are medical and cultural implications of this new trend which are just recently being reported and investigated. The purpose of this article is to review the scientific and sociological literature as it pertains to the vaporization of both marijuana and tobacco products and the potential medical and cultural implications of this new phenomenon.
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Affiliation(s)
- Peter Laucks
- Peter Laucks, DO, MSMEd, is in the Department of Internal Medicine, Pulmonary and Critical Care Fellowship at Truman Medical Centers, Kansas City, Missouri. Gary A. Salzman, MD, MSMA member since 2007, is Professor of Medicine; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Gary A Salzman
- Peter Laucks, DO, MSMEd, is in the Department of Internal Medicine, Pulmonary and Critical Care Fellowship at Truman Medical Centers, Kansas City, Missouri. Gary A. Salzman, MD, MSMA member since 2007, is Professor of Medicine; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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83
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Eissenberg T, Bhatnagar A, Chapman S, Jordt SE, Shihadeh A, Soule EK. Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes. Am J Public Health 2020; 110:161-162. [PMID: 31913680 PMCID: PMC6951374 DOI: 10.2105/ajph.2019.305424] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Thomas Eissenberg
- Thomas Eissenberg is with the Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA. Aruni Bhatnagar is with the American Heart Association Tobacco Regulation Center, University of Louisville, Louisville, KY. Simon Chapman is with the School of Public Health, University of Sydney, Australia. Sven-Eric Jordt is with the Department of Anesthesiology, Duke University School of Medicine, Durham, NC. Alan Shihadeh is with the Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon. Eric K. Soule is with the Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | - Aruni Bhatnagar
- Thomas Eissenberg is with the Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA. Aruni Bhatnagar is with the American Heart Association Tobacco Regulation Center, University of Louisville, Louisville, KY. Simon Chapman is with the School of Public Health, University of Sydney, Australia. Sven-Eric Jordt is with the Department of Anesthesiology, Duke University School of Medicine, Durham, NC. Alan Shihadeh is with the Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon. Eric K. Soule is with the Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | - Simon Chapman
- Thomas Eissenberg is with the Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA. Aruni Bhatnagar is with the American Heart Association Tobacco Regulation Center, University of Louisville, Louisville, KY. Simon Chapman is with the School of Public Health, University of Sydney, Australia. Sven-Eric Jordt is with the Department of Anesthesiology, Duke University School of Medicine, Durham, NC. Alan Shihadeh is with the Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon. Eric K. Soule is with the Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | - Sven-Eric Jordt
- Thomas Eissenberg is with the Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA. Aruni Bhatnagar is with the American Heart Association Tobacco Regulation Center, University of Louisville, Louisville, KY. Simon Chapman is with the School of Public Health, University of Sydney, Australia. Sven-Eric Jordt is with the Department of Anesthesiology, Duke University School of Medicine, Durham, NC. Alan Shihadeh is with the Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon. Eric K. Soule is with the Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | - Alan Shihadeh
- Thomas Eissenberg is with the Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA. Aruni Bhatnagar is with the American Heart Association Tobacco Regulation Center, University of Louisville, Louisville, KY. Simon Chapman is with the School of Public Health, University of Sydney, Australia. Sven-Eric Jordt is with the Department of Anesthesiology, Duke University School of Medicine, Durham, NC. Alan Shihadeh is with the Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon. Eric K. Soule is with the Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | - Eric K Soule
- Thomas Eissenberg is with the Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA. Aruni Bhatnagar is with the American Heart Association Tobacco Regulation Center, University of Louisville, Louisville, KY. Simon Chapman is with the School of Public Health, University of Sydney, Australia. Sven-Eric Jordt is with the Department of Anesthesiology, Duke University School of Medicine, Durham, NC. Alan Shihadeh is with the Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon. Eric K. Soule is with the Department of Health Education and Promotion, East Carolina University, Greenville, NC
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84
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Chand HS, Muthumalage T, Maziak W, Rahman I. Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury. Front Pharmacol 2020; 10:1619. [PMID: 31992985 PMCID: PMC6971159 DOI: 10.3389/fphar.2019.01619] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
New emerging tobacco products, especially electronic cigarettes (E-Cig) or electronic nicotine delivery systems (ENDS), have gained a huge popularity, particularly in younger populations. The lack of sufficient evidence-based health effect studies has promoted widespread use/abuse with the assumption that E-Cig or ENDS and/or vaping products are safer and less toxic than conventional tobacco smoking. However, the recent escalation in acute lung injuries and their associated fatalities among ENDS or vaping product users has now brought attention to this silent epidemic via investigation into the constituents of ENDS/vaping products and their toxic effects on pulmonary health. Accordingly, CDC has declared an “outbreak” of the e-cigarette or vaping product use associated lung injury (EVALI). EVALI is characterized by sterile exogenous pneumonitis like reaction with substantial involvement of innate immune mechanisms. Vitamin-E acetate (VEA) is found in counterfeit cartridges and bronchoalveolar lavage fluid of EVALI patients. Other reports implicated the presence of aromatic/volatile hydrocarbons and oils consisting of medium-chain triglycerides (MCT oil), including terpenes and mineral oil in tetrahydrocannabinol (THC) containing counterfeit vaping products. These compounds are involved in oxidative stress and inflammatory responses in the lung. Here, we provide the perspectives on the recent case reports on EVALI, etiology, and discuss pulmonary toxicity as well as the mechanisms underlying EVALI susceptibility and lung pathophysiology.
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Affiliation(s)
- Hitendra S Chand
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Thivanka Muthumalage
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
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85
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Wilhite R, Patel T, Karle E, Shankar S, Krvavac A. Diffuse Alveolar Hemorrhage: An Uncommon Manifestation of Vaping-associated Lung Injury. Cureus 2019; 11:e6519. [PMID: 32025438 PMCID: PMC6991143 DOI: 10.7759/cureus.6519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Vaping involves the use of a device to deliver aerosolized nicotine and tetrahydrocannabinol (THC) oils to the lungs. Vaping continues to increase in popularity; however, because it is a novel drug delivery system there is little evidence regarding its safety and long-term consequences. Here, we present a 22-year-old Caucasian male who was admitted with acute hypoxic respiratory failure and massive hemoptysis. Contrasted computed tomography of the chest demonstrated ground glass opacities throughout all lung fields and bilateral pulmonary emboli. Bronchoalveolar lavage revealed increased red blood cell counts in serial aliquots, consistent with the diagnosis of diffuse alveolar hemorrhage (DAH). An extensive workup did not reveal an etiology for the DAH. However, further history was obtained, and the patient divulged daily vaping of THC. E-cigarette, or vaping, product use associated lung injury (EVALI) consists of a myriad of different lung injury patterns. Our case illustrates an uncommon presentation of EVALI with DAH and multiple pulmonary emboli.
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Affiliation(s)
- Rodger Wilhite
- Pulmonary, Critical Care and Environmental Medicine, University of Missouri Health Care, Columbia, USA
| | - Tarang Patel
- Internal Medicine, University of Missouri Health Care, Columbia, USA
| | - Ethan Karle
- Internal Medicine, University of Missouri Health Care, Columbia, USA
| | - Shyam Shankar
- Pulmonary, Critical Care and Environmental Medicine, University of Missouri Health Care, Columbia, USA
| | - Armin Krvavac
- Pulmonary and Critical Care Medicine, University of Missouri Health Care, Columbia, USA
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86
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D'Amario D, Migliaro S, Borovac JA, Vergallo R, Galli M, Restivo A, Bonini M, Romagnoli E, Leone AM, Crea F. Electronic Cigarettes and Cardiovascular Risk: Caution Waiting for Evidence. Eur Cardiol 2019; 14:151-158. [PMID: 31933682 PMCID: PMC6950284 DOI: 10.15420/ecr.2019.16.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
Electronic cigarettes use is a growing trend in contemporary societies, with the propensity to compete with traditional tobacco smoking. Some preclinical studies demonstrated the toxic and detrimental effects of electronic cigarettes liquid components. Its impact on human health remains unknown and insufficiently studied. While some studies suggest that electronic cigarettes use might be associated with endothelial dysfunction, impaired platelet function and increased risk of adverse clinical events, other studies did not confirm these findings and epidemiological data mostly suggest that the use of electronic cigarettes appears to be safer than that of traditional tobacco cigarettes. This article provides an up-to-date overview of the current state of knowledge regarding electronic cigarettes and their impact on human health, with special emphasis on their effect on cardiovascular diseases.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Josip Andjelo Borovac
- Department of Pathophysiology, University Hospital of Split Split, Croatia.,Department of Cardiology, University Hospital of Split Split, Croatia
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
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87
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Fonseca Fuentes X, Kashyap R, Hays JT, Chalmers S, Lama von Buchwald C, Gajic O, Gallo de Moraes A. VpALI-Vaping-related Acute Lung Injury: A New Killer Around the Block. Mayo Clin Proc 2019; 94:2534-2545. [PMID: 31767123 DOI: 10.1016/j.mayocp.2019.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/14/2019] [Indexed: 01/21/2023]
Abstract
The use of electronic cigarettes, known as vaping, has become increasingly popular over the past decade, particularly in the adolescent and young adult population, often exposing users to harmful chemicals. Vaping has been associated with a heterogeneous group of pulmonary disease. Recently, a multistate epidemic has emerged surrounding vaping-related acute lung injury, prompting the Centers for Disease Control and Prevention to list an official health advisory. In this review, we describe the current literature on the epidemiology, clinical significance, as well as recommended evaluation and treatment of vaping-related lung injury.
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Affiliation(s)
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - J Taylor Hays
- Department of General Internal Medicine, Nicotine Dependence Center, Mayo Clinic, Rochester, MN
| | - Sarah Chalmers
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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88
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Chaumont M, Tagliatti V, Channan EM, Colet JM, Bernard A, Morra S, Deprez G, Van Muylem A, Debbas N, Schaefer T, Faoro V, van de Borne P. Short halt in vaping modifies cardiorespiratory parameters and urine metabolome: a randomized trial. Am J Physiol Lung Cell Mol Physiol 2019; 318:L331-L344. [PMID: 31721596 PMCID: PMC7052663 DOI: 10.1152/ajplung.00268.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Propylene glycol and glycerol are e-cigarette constituents that facilitate liquid vaporization and nicotine transport. As these small hydrophilic molecules quickly cross the lung epithelium, we hypothesized that short-term cessation of vaping in regular users would completely clear aerosol deposit from the lungs and reverse vaping-induced cardiorespiratory toxicity. We aimed to assess the acute effects of vaping and their reversibility on biological/clinical cardiorespiratory parameters [serum/urine pneumoproteins, hemodynamic parameters, lung-function test and diffusing capacities, transcutaneous gas tensions (primary outcome), and skin microcirculatory blood flow]. Regular e-cigarette users were enrolled in this randomized, investigator-blinded, three-period crossover study. The periods consisted of nicotine-vaping (nicotine-session), nicotine-free vaping (nicotine-free-session), and complete cessation of vaping (stop-session), all maintained for 5 days before the session began. Multiparametric metabolomic analyses were used to verify subjects' protocol compliance. Biological/clinical cardiorespiratory parameters were assessed at the beginning of each session (baseline) and after acute vaping exposure. Compared with the nicotine- and nicotine-free-sessions, a specific metabolomic signature characterized the stop-session. Baseline serum club cell protein-16 was higher during the stop-session than the other sessions (P < 0.01), and heart rate was higher in the nicotine-session (P < 0.001). Compared with acute sham-vaping in the stop-session, acute nicotine-vaping (nicotine-session) and acute nicotine-free vaping (nicotine-free-session) slightly decreased skin oxygen tension (P < 0.05). In regular e-cigarette-users, short-term vaping cessation seemed to shift baseline urine metabolome and increased serum club cell protein-16 concentration, suggesting a decrease in lung inflammation. Additionally, acute vaping with and without nicotine decreased slightly transcutaneous oxygen tension, likely as a result of lung gas exchanges disturbances.
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Affiliation(s)
- Martin Chaumont
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Vanessa Tagliatti
- Department of Human Biology and Toxicology, University of Mons, Mons, Belgium
| | - El Mehdi Channan
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marie Colet
- Department of Human Biology and Toxicology, University of Mons, Mons, Belgium
| | - Alfred Bernard
- Laboratory of Toxicology and Applied Pharmacology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Sofia Morra
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Guillaume Deprez
- Department of Clinical Chemistry, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Van Muylem
- Chest Department, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nadia Debbas
- Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Schaefer
- Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
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89
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Vaping is a risk factor for spontaneous pneumothorax: Two cases. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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90
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Abstract
Electronic cigarettes (e-cigarettes) are alternative, non-combustible tobacco products that generate an inhalable aerosol containing nicotine, flavors, propylene glycol, and vegetable glycerin. Vaping is now a multibillion dollar industry that appeals to current smokers, former smokers, and young people who have never smoked. E-cigarettes reached the market without either extensive preclinical toxicology testing or long term safety trials that would be required of conventional therapeutics or medical devices. Their effectiveness as a smoking cessation intervention, their impact at a population level, and whether they are less harmful than combustible tobacco products are highly controversial. Here, we review the evidence on the effects of e-cigarettes on respiratory health. Studies show measurable adverse biologic effects on organ and cellular health in humans, in animals, and in vitro. The effects of e-cigarettes have similarities to and important differences from those of cigarettes. Decades of chronic smoking are needed for development of lung diseases such as lung cancer or chronic obstructive pulmonary disease, so the population effects of e-cigarette use may not be apparent until the middle of this century. We conclude that current knowledge of these effects is insufficient to determine whether the respiratory health effects of e-cigarette are less than those of combustible tobacco products.
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Affiliation(s)
- Jeffrey E Gotts
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sven-Eric Jordt
- Department of Anesthesiology, Duke University, Durham, NC, USA
- Yale Center for the Study of Tobacco Products and Addiction, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, CA, USA
| | - Robert Tarran
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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91
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Bonilla A, Blair AJ, Alamro SM, Ward RA, Feldman MB, Dutko RA, Karagounis TK, Johnson AL, Folch EE, Vyas JM. Recurrent spontaneous pneumothoraces and vaping in an 18-year-old man: a case report and review of the literature. J Med Case Rep 2019; 13:283. [PMID: 31495337 PMCID: PMC6732835 DOI: 10.1186/s13256-019-2215-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Primary spontaneous pneumothorax is a common disorder occurring in young adults without underlying lung disease. Although tobacco smoking is a well-documented risk factor for spontaneous pneumothorax, an association between electronic cigarette use (that is, vaping) and spontaneous pneumothorax has not been noted. We report a case of spontaneous pneumothoraces correlated with vaping. Case presentation An 18-year-old Caucasian man presented twice with recurrent right-sided spontaneous pneumothoraces within 2 weeks. He reported a history of vaping just prior to both episodes. Diagnostic testing was notable for a right-sided spontaneous pneumothorax on chest X-ray and computed tomography scan. His symptoms improved following insertion of a chest tube and drainage of air on each occasion. In the 2-week follow-up visit for the recurrent episode, he was asymptomatic and reported that he was no longer using electronic cigarettes. Conclusions Providers and patients should be aware of the potential risk of spontaneous pneumothorax associated with electronic cigarettes.
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Affiliation(s)
- Alex Bonilla
- Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Alexander J Blair
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Suliman M Alamro
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rebecca A Ward
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Infectious Disease, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michael B Feldman
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Richard A Dutko
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Infectious Disease, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Theodora K Karagounis
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Adam L Johnson
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Erik E Folch
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jatin M Vyas
- Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. .,Division of Infectious Disease, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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92
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Iskandar AR, Zanetti F, Marescotti D, Titz B, Sewer A, Kondylis A, Leroy P, Belcastro V, Torres LO, Acali S, Majeed S, Steiner S, Trivedi K, Guedj E, Merg C, Schneider T, Frentzel S, Martin F, Ivanov NV, Peitsch MC, Hoeng J. Application of a multi-layer systems toxicology framework for in vitro assessment of the biological effects of Classic Tobacco e-liquid and its corresponding aerosol using an e-cigarette device with MESH™ technology. Arch Toxicol 2019; 93:3229-3247. [PMID: 31494692 DOI: 10.1007/s00204-019-02565-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023]
Abstract
We previously proposed a systems toxicology framework for in vitro assessment of e-liquids. The framework starts with the first layer aimed at screening the potential toxicity of e-liquids, followed by the second layer aimed at investigating the toxicity-related mechanism of e-liquids, and finally, the third layer aimed at evaluating the toxicity-related mechanism of the corresponding aerosols. In this work, we applied this framework to assess the impact of the e-liquid MESH Classic Tobacco and its aerosol compared with that of cigarette smoke (CS) from the 3R4F reference cigarette. In the first layer, we evaluated the cytotoxicity profile of the MESH Classic Tobacco e-liquid (containing humectants, nicotine, and flavors) and its Base e-liquid (containing humectant and nicotine only) in comparison with total particulate matter (TPM) of 3R4F CS using primary bronchial epithelial cell cultures. In the second layer, the same culture model was used to explore changes in specific markers using high-content screening assays to identify potential toxicity-related mechanisms induced by the MESH Classic Tobacco and Base e-liquids beyond cell viability in comparison with the 3R4F CS TPM-induced effects. Finally, in the third layer, we compared the impact of exposure to the MESH Classic Tobacco or Base aerosols with 3R4F CS using human organotypic air-liquid interface buccal and small airway epithelial cultures. The results showed that the cytotoxicity of the MESH Classic Tobacco liquid was similar to the Base liquid but lower than 3R4F CS TPM at comparable nicotine concentrations. Relative to 3R4F CS exposure, MESH Classic Tobacco aerosol exposure did not cause tissue damage and elicited lower changes in the mRNA, microRNA, and protein markers. In the context of tobacco harm reduction strategy, the framework is suitable to assess the potential-reduced impact of electronic cigarette aerosol relative to CS.
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Affiliation(s)
- Anita R Iskandar
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland.
| | - Filippo Zanetti
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Diego Marescotti
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Bjorn Titz
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Alain Sewer
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Athanasios Kondylis
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Patrice Leroy
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Vincenzo Belcastro
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Laura Ortega Torres
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Stefano Acali
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Shoaib Majeed
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Sandro Steiner
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Keyur Trivedi
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Emmanuel Guedj
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Celine Merg
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Thomas Schneider
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Stefan Frentzel
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Florian Martin
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Nikolai V Ivanov
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Manuel C Peitsch
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Julia Hoeng
- Philip Morris International R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
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93
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Wang Q, Khan NA, Muthumalage T, Lawyer GR, McDonough SR, Chuang TD, Gong M, Sundar IK, Rehan VK, Rahman I. Dysregulated repair and inflammatory responses by e-cigarette-derived inhaled nicotine and humectant propylene glycol in a sex-dependent manner in mouse lung. FASEB Bioadv 2019; 1:609-623. [PMID: 31825014 PMCID: PMC6902908 DOI: 10.1096/fba.2019-00048] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nicotine inhalation via electronic cigarettes (e‐cigs) is an emerging concern. However, little is known about the acute toxicity in the lungs following inhalation of nicotine‐containing e‐cig aerosols. We hypothesized that acute exposure to aerosolized nicotine causes lung toxicity by eliciting inflammatory and dysregulated repair responses. Adult C57BL/6J mice were exposed 2 hours daily for 3 days to e‐cig aerosols containing propylene glycol (PG) with or without nicotine. Acute exposure to nicotine‐containing e‐cig aerosols induced inflammatory cell influx (neutrophils and CD8a+ T lymphocytes), and release of pro‐inflammatory cytokines in bronchoalveolar lavage fluid in a sex‐dependent manner. Inhalation of e‐cig aerosol containing PG alone significantly augmented the lung levels of various homeostasis/repair mediators (PPARγ, ADRP, ACTA2, CTNNB1, LEF1, β‐catenin, E‐cadherin, and MMP2) in a sex‐dependent manner when compared to air controls. These findings were accompanied by an increase in protein abundance and altered gene expression of lipogenic markers (PPARγ, ADRP) and myogenic markers (fibronectin, α‐smooth muscle actin and β‐catenin), suggesting a dysregulated repair response in mouse lungs. Furthermore, exposure to nicotine‐containing e‐cig aerosols or PG alone differentially affected the release of pro‐inflammatory cytokines in healthy and COPD human 3D EpiAirway tissues. Overall, acute exposure to nicotine‐containing e‐cig aerosols was sufficient to elicit a pro‐inflammatory response and altered mRNA and protein levels of myogenic, lipogenic, and extracellular matrix markers in mouse lung in a sex‐dependent manner. Thus, acute exposure to inhaled nicotine via e‐cig leads to dysregulated repair and inflammatory responses, which may lead to airway remodeling in the lungs.
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Affiliation(s)
- Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Naushad Ahmad Khan
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Thivanka Muthumalage
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Gina R Lawyer
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Samantha R McDonough
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Tsai-Der Chuang
- Department of Pediatrics and Molecular Toxicology, David Geffen School of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ming Gong
- Department of Pediatrics and Molecular Toxicology, David Geffen School of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Isaac K Sundar
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Virender K Rehan
- Department of Pediatrics and Molecular Toxicology, David Geffen School of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
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94
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Alqahtani F, Alqahtani M, Albaqawi AH, Al‐Kheraif AA, Javed F. Comparison of cotinine levels in the peri‐implant sulcular fluid among cigarette and waterpipe smokers, electronic‐cigarette users, and nonsmokers. Clin Implant Dent Relat Res 2019; 21:702-707. [DOI: 10.1111/cid.12813] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Fawaz Alqahtani
- Department of Prosthodontics, College of DentistryPrince Sattam Bin Abdul‐Aziz University Al‐Kharj Saudi Arabia
| | - Mana Alqahtani
- Faculty of MedicineUniversity of Tabuk Tabuk Saudi Arabia
| | - Ahmed Heji Albaqawi
- Department of Prosthodontics Dental ScienceCollege of Dentistry, Hail University Hail Saudi Arabia
| | - Abdulaziz A. Al‐Kheraif
- Dental Biomaterials Research Chair, Dental Health DepartmentCollege of Applied Medical Sciences, King Saud University Riyadh Saudi Arabia
| | - Fawad Javed
- Department of Orthodontics, Eastman Institute for Oral HealthUniversity of Rochester Rochester New York
- Laboratory for Periodontal‐, Implant‐, Phototherapy (LA‐PIP), School of Dental MedicineStony Brook University Stony Brook New York
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95
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Affiliation(s)
- Jeffrey E Gotts
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
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