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Barker CK, Ghera P, Hsu B. The Evolution of a Pediatric Public Health Crisis: E-cigarette or Vaping-Associated Lung Injury. Pediatrics 2024; 153:e2023063484. [PMID: 38629169 DOI: 10.1542/peds.2023-063484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 05/02/2024] Open
Abstract
E-cigarettes and vaping products were first introduced in the United States around 2007, and quickly grew in popularity. By 2014, e-cigarettes had become the most commonly used tobacco product among youth in the United States. An e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak was identified by the Centers for Disease Control and Prevention (CDC) in 2019, with many cases in the adolescent population. The CDC opened a national database of cases and launched a multistate investigation; reported cases reached a peak in September 2019. The CDC investigation found that a vaping liquid additive, vitamin E acetate, was strongly linked to the EVALI outbreak but determined that the decline in cases was likely multifactorial. Due to decreased cases and the identification of a potential cause of the outbreak, the CDC stopped collecting data on EVALI cases as of February 2020. However, e-cigarettes and vaping products have continued to be the most popular tobacco product among youth, though state and national regulations on these products have increased since 2016. While pediatric case series and studies have shown differences in clinical presentation and medical histories between pediatric and adult EVALI cases, the fact that cases are no longer tracked at a national level limits necessary information for pediatric clinicians and researchers. We describe the available literature on the diagnosis, pathophysiology, treatment, and outcomes of EVALI in the pediatric population, and provide clinical and public health recommendations to facilitate prevention and management of EVALI specific to pediatrics.
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Affiliation(s)
| | - Princy Ghera
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benson Hsu
- University of South Dakota, Sioux Falls, South Dakota
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2
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Osman A, Petrescu GS, Tuculină MJ, Dascălu IT, Popescu C, Enescu AȘ, Dăguci C, Cucu AP, Nistor C, Carsote M. Metabolic and Other Endocrine Elements with Regard to Lifestyle Choices: Focus on E-Cigarettes. Metabolites 2023; 13:1192. [PMID: 38132874 PMCID: PMC10745117 DOI: 10.3390/metabo13121192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Our objective was to overview recent data on metabolic/endocrine disorders with respect to e-cigarette (e-cig) use. This is a narrative review; we researched English, full-length, original articles on PubMed (between January 2020 and August 2023) by using different keywords in the area of metabolic/endocrine issues. We only included original clinical studies (n = 22) and excluded case reports and experimental studies. 3 studies (N1 = 22,385; N2 = 600,046; N3 = 5101) addressed prediabetes risk; N1 showed a 1.57-fold increased risk of dual vs. never smokers, a higher risk that was not confirmed in N2 (based on self-reported assessments). Current non-smokers (N1) who were dual smokers still have an increased odd of prediabetes (a 1.27-fold risk increase). N3 and another 2 studies addressed type 2 diabetes mellitus (DM): a lower prevalence of DM among dual users (3.3%) vs. cigarette smoking (5.9%) was identified. 6 studies investigated obesity profile (4 of them found positive correlations with e-cig use). One study (N4 = 373,781) showed that e-cig use was associated with obesity in the general population (OR = 1.6, 95%CI: 1.3-2.1, p < 0.05); another (N5 = 7505, 0.82% were e-cig-only) showed that obesity had a higher prevalence in dual smokers (51%) vs. cig-only (41.2%, p < 0.05), while another (N6 = 3055) found that female (not male) e-cig smokers had higher body mass index vs. non-smokers. Data on metabolic syndrome (MS) are provided for dual smokers (n = 2): one case-control study found that female dual smokers had higher odds of MS than non-smokers. The need for awareness with respect to potential e-cig--associated medical issues should be part of modern medicine, including daily anamnesis. Whether the metabolic/endocrine frame is part of the general picture is yet to be determined. Surveillance protocols should help clinicians to easily access the medical background of one subject, including this specific matter of e-cig with/without conventional cigarettes smoking and other habits/lifestyle elements, especially when taking into consideration metabolism anomalies.
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Affiliation(s)
- Andrei Osman
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Department ENT & Clinical Emergency County Hospital of Craiova, 200349 Craiova, Romania; (A.O.); (C.P.); (A.-Ș.E.)
| | - Gabriel Sebastian Petrescu
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela Jana Tuculină
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ionela Teodora Dascălu
- Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cristina Popescu
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Department ENT & Clinical Emergency County Hospital of Craiova, 200349 Craiova, Romania; (A.O.); (C.P.); (A.-Ș.E.)
| | - Anca-Ștefania Enescu
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Department ENT & Clinical Emergency County Hospital of Craiova, 200349 Craiova, Romania; (A.O.); (C.P.); (A.-Ș.E.)
| | - Constantin Dăguci
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca-Pati Cucu
- PhD Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest & Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Claudiu Nistor
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy & Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania;
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Raduka A, Gao N, Chatburn RL, Rezaee F. Electronic cigarette exposure disrupts airway epithelial barrier function and exacerbates viral infection. Am J Physiol Lung Cell Mol Physiol 2023; 325:L580-L593. [PMID: 37698113 PMCID: PMC11068398 DOI: 10.1152/ajplung.00135.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
The use of electronic cigarettes (e-cigs), especially among teenagers, has reached alarming and epidemic levels, posing a significant threat to public health. However, the short- and long-term effects of vaping on the airway epithelial barrier are unclear. Airway epithelial cells are the forefront protectors from viruses and pathogens. They contain apical junctional complexes (AJCs), which include tight junctions (TJs) and adherens junctions (AJs) formed between adjacent cells. Previously, we reported respiratory syncytial virus (RSV) infection, the leading cause of acute lower respiratory infection-related hospitalization in children and high-risk adults, induces a "leaky airway" by disrupting the epithelial AJC structure and function. We hypothesized chemical components of e-cigs disrupt airway epithelial barrier and exacerbate RSV-induced airway barrier dysfunction. Using confluent human bronchial epithelial (16HBE) cells and well-differentiated normal human bronchial epithelial (NHBE) cells, we found that exposure to extract and aerosol e-cig nicotine caused a significant decrease in transepithelial electrical resistance (TEER) and the structure of the AJC even at noncytotoxic concentrations. Western blot analysis of 16HBE cells exposed to e-cig nicotine extract did not reveal significant changes in AJC proteins. Exposure to aerosolized e-cig cinnamon or menthol flavors also induced barrier disruption and aggravated nicotine-induced airway barrier dysfunction. Moreover, preexposure to nicotine aerosol increased RSV infection and the severity of RSV-induced airway barrier disruption. Our findings demonstrate that e-cig exposure disrupts the airway epithelial barrier and exacerbates RSV-induced damage. Knowledge gained from this study will provide awareness of adverse e-cig respiratory effects and positively impact the mitigation of e-cig epidemic.NEW & NOTEWORTHY Electronic cigarette (e-cig) use, especially in teens, is alarming and at epidemic proportions, threatening public health. Our study shows that e-cig nicotine exposure disrupts airway epithelial tight junctions and increases RSV-induced barrier dysfunction. Furthermore, exposure to aerosolized flavors exaggerates e-cig nicotine-induced airway barrier dysfunction. Our study confirms that individual and combined components of e-cigs deleteriously impact the airway barrier and that e-cig exposure increases susceptibility to viral infection.
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Affiliation(s)
- Andjela Raduka
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Nannan Gao
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Robert L Chatburn
- Enterprise Respiratory Care Research Cleveland Clinic, Cleveland Clinic Children's, Cleveland, Ohio, United States
| | - Fariba Rezaee
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio, United States
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Yoon SH, Song MK, Kim DI, Lee JK, Jung JW, Lee JW, Lee K. Comparative study of lung toxicity of E-cigarette ingredients to investigate E-cigarette or vaping product associated lung injury. JOURNAL OF HAZARDOUS MATERIALS 2023; 445:130454. [PMID: 37055947 DOI: 10.1016/j.jhazmat.2022.130454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 06/19/2023]
Abstract
No comparative study has yet been performed on the respiratory effects of individual E-cigarette ingredients. Here, lung toxicity of individual ingredients of E-cigarette products containing nicotine or tetrahydrocannabinol was investigated. Mice were intratracheally administered propylene glycol (PG), vegetable glycerin (VG), vitamin E acetate (VEA), or nicotine individually for two weeks. Cytological and histological changes were noticed in PG- and VEA-treated mice that exhibited pathophysiological changes which were associated with symptoms seen in patients with symptoms of E-cigarette or Vaping Use-Associated Lung Injuries (EVALI) or E-cigarette users. Compared to potential human exposure situations, while the VEA exposure condition was similar to the dose equivalent of VEA content in E-cigarettes, the PG condition was about 47-137 times higher than the dose equivalent of the daily PG intake of E-cigarette users. These results reveal that VEA exposure is much more likely to cause problems related to EVALI in humans than PG. Transcriptomic analysis revealed that PG exposure was associated with fibrotic lung injury via the AKT signaling pathway and M2 macrophage polarization, and VEA exposure was associated with asthmatic airway inflammation via the mitogen-activated protein kinase signaling pathway. This study provides novel insights into the pathophysiological effects of individual ingredients of E-cigarettes.
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Affiliation(s)
- Sung-Hoon Yoon
- Inhalation Toxicology Center for Airborne Risk Factor, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do 56212, Republic of Korea
| | - Mi-Kyung Song
- Inhalation Toxicology Center for Airborne Risk Factor, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do 56212, Republic of Korea; Department of Human and Environmental Toxicology, University of Science & Technology, Daejeon 34113, Republic of Korea
| | - Dong Im Kim
- Inhalation Toxicology Center for Airborne Risk Factor, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do 56212, Republic of Korea
| | - Jeom-Kyu Lee
- Division of Allergy and Respiratory Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Ji-Won Jung
- Division of Allergy and Respiratory Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Joong Won Lee
- Division of Allergy and Respiratory Disease Research, Department of Chronic Disease Convergence Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Kyuhong Lee
- Inhalation Toxicology Center for Airborne Risk Factor, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do 56212, Republic of Korea; Department of Human and Environmental Toxicology, University of Science & Technology, Daejeon 34113, Republic of Korea.
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Vaping-Associated Lung Injury: A Review. Medicina (B Aires) 2022; 58:medicina58030412. [PMID: 35334588 PMCID: PMC8949983 DOI: 10.3390/medicina58030412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Since commercial development in 2003, the usage of modern electronic cigarette (e-cigarette) continues to increase amongst people who have never smoked, ex-smokers who have switched to e-cigarettes, and dual-users of both conventional cigarettes and e-cigarettes. With such an increase in use, knowledge of the irritative, toxic and potential carcinogenic effects on the lungs is increasing. This review article will discuss the background of e-cigarettes, vaping devices and explore their popularity. We will further summarise the available literature describing the mechanism of lung injury caused by e-cigarette or vaping use.
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Shelton CM, Black H, Proctor J, Hagemann TM. A Comprehensive Review of Vaping Use in Pediatric Patients and Recent Changes in Regulatory Laws. J Pediatr Pharmacol Ther 2022; 27:109-119. [DOI: 10.5863/1551-6776-27.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022]
Abstract
The use of electronic cigarettes (e-cigarettes), also known as vapes, by adolescents and young adults has dramatically increased over the past several years. E-cigarettes continue to be the most used form of tobacco among youth. As a result of this concerning trend, policies at both the state and federal levels have been implemented to limit availability in this population. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has had some positive and negative effects on the youth vaping epidemic with adolescent consumers reporting limited access to retail sites during the stay-at-home executive orders, but easier access with online purchasing because age verification was often not required. Complications resulting from vaping have been reported and include e-cigarette or vaping product use–associated lung injury (EVALI) and thrombotic events. Data suggest that the use of vaping devices can lead to both short- and long-term respiratory morbidity in the pediatric population. This review serves to provide a comprehensive examination of vaping use in pediatric patients and recent changes in regulatory laws to equip pharmacists with the knowledge to be aware of the different devices and products available, ask their pediatric patients regularly about use, and counsel and educate on the potential harmful effects.
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Affiliation(s)
- Chasity M. Shelton
- Department of Clinical Pharmacy and Translational Science (CMS, TMH), The University of Tennessee Health Science Center, Memphis, TN
| | - Haley Black
- College of Pharmacy (HB, JP), The University of Tennessee Health Science Center, Memphis, TN
| | - Johnathon Proctor
- College of Pharmacy (HB, JP), The University of Tennessee Health Science Center, Memphis, TN
| | - Tracy M. Hagemann
- Department of Clinical Pharmacy and Translational Science (CMS, TMH), The University of Tennessee Health Science Center, Memphis, TN
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Abstract
Purpose of Review The purpose of this review was to describe the state-of-the-literature on research specific to cannabis vaping among youth and young adults. Recent Findings Out of 1801 records identified, a total of 202 articles met eligibility criteria for inclusion in this review. Most of this literature (46.0% of studies) was specific to the health effects of cannabis vaping, particularly EVALI (e-cigarette and vaping associated lung injury). Other research areas identified in the review included the etiology (24.3%) and epidemiology (24.8%) of cannabis vaping, in addition to articles on regulation (8.4%) and marketing (5.5%) of the same. Summary Cannabis vaping is increasingly common among youth and young adults and more prevalent is settings where recreational use for adults has been legalized. The literature documents a number of negative health effects of cannabis vaping for young people, along with risk factors and reasons for the same. Supplementary Information The online version contains supplementary material available at 10.1007/s40429-022-00413-y.
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Wu C, Liao T, Chen Y, Kuo P. Treatment of electronic cigarette or vaping product use-associated lung injury (EVALI) by corticosteroid and low-dose pirfenidone: Report of a case. Respirol Case Rep 2021; 9:e0845. [PMID: 34584727 PMCID: PMC8453260 DOI: 10.1002/rcr2.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Electronic (e)-cigarette or vaping product use-associated lung injury (EVALI) is a novel and potentially lethal disease first reported in the United States. We report the case of a 56-year-old man who presented to our hospital with dyspnoea and cough lasting for 2 months after using an e-cigarette for approximately 50 puffs over 2 weeks. Physical examination revealed crackles in the left lower lung. High-resolution computed tomography (HRCT) showed consolidation and ground-glass opacities in both lungs. The baseline forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were 65.7% and 63.9% of the predicted, respectively. Lung biopsy revealed organizing pneumonia with focal fibrosis. In addition to prednisolone, he was treated with a low-dose pirfenidone (200 mg three times per day) due to the persistence of a mild cough, exertional dyspnoea and basal crackles after discharge. His symptoms and FVC significantly improved, but the recovery of the DLCO was slow. The follow-up HRCT demonstrated only minimal fibrotic changes. To our knowledge, this was the first reported case of EVALI successfully treated with a combination of corticosteroid and antifibrotic agents.
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Affiliation(s)
- Chia‐Hao Wu
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Ting‐Yu Liao
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Yung‐Hsuan Chen
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Ping‐Hung Kuo
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
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Wei X, Iakovou A, Makaryus MR, Khanijo S. Pulmonary Function Testing in Patients With E-Cigarette, or Vaping, Product Use-Associated Lung Injury. Cureus 2021; 13:e17019. [PMID: 34522500 PMCID: PMC8425488 DOI: 10.7759/cureus.17019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 12/03/2022] Open
Abstract
In 2019 there was an outbreak of respiratory illnesses amongst people who used E-cigarettes. This phenomenon was labeled 'EVALI' which stands for "Electronic cigarette (E-cigarette), or Vaping, Product Use-Associated Lung Injury" and is a life-threatening illness of the lungs associated with E-cigarette use. It is believed to be caused by certain chemicals in E-cigarette cartridges, such as vitamin E acetate, but the exact pathophysiological mechanism is yet to be elucidated. Since 2019, the CDC has recorded over 2800 cases in the United States with over 60 deaths. Though many people recover from EVALI, the long-term implications on pulmonary health are unknown. The purpose of this retrospective study was to demonstrate the pulmonary function test (PFT) findings in a group of patients who recovered from a diagnosis of EVALI. We reviewed the cases of 23 adult patients who presented to two major academic hospitals of the Northwell Health System with confirmed EVALI and followed up in our outpatient clinics with PFTs. Most patients had significantly reduced diffusion capacity (DLCO) demonstrating loss of functioning alveolar units. Given that average follow-up was over a month after discharge, this leads us to believe that EVALI can lead to persistent lung damage. However, further follow-up would be necessary to identify the full impact of E-cigarette use on the pulmonary function.
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Affiliation(s)
- Xingyu Wei
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell/North Shore University Hospital and Long Island Jewish Medical Center, Hempstead, USA
| | - Annamaria Iakovou
- Pulmonary and Critical Care Medicine, Northwell Health, Manhasset, USA
| | - Mina R Makaryus
- Pulmonary and Critical Care Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell/North Shore University Hospital and Long Island Jewish Medical Center, Hempstead, USA
| | - Sameer Khanijo
- Pulmonary and Critical Care Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell/North Shore University Hospital and Long Island Jewish Medical Center, Hempstead, USA
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Affiliation(s)
- Raymen R Assaf
- Pediatric Emergency Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Kelly D Young
- Pediatric Emergency Medicine, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90502, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Kaslow JA, Rosas-Salazar C, Moore PE. E-cigarette and vaping product use-associated lung injury in the pediatric population: A critical review of the current literature. Pediatr Pulmonol 2021; 56:1857-1867. [PMID: 33821574 DOI: 10.1002/ppul.25384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Use of electronic nicotine delivery systems (ENDS), also known as e-cigarettes, in the adolescent population has significantly increased over the past several years. This rise led to an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the summer of 2019. Since that time, numerous case reports and case series on vaping and EVALI have been published but the majority of literature highlights the adult population with few articles focusing on pediatric patients. Given the addictive nature of these products and the lack of full understanding of the human health effects, there is concern that use of ENDS may have lasting impacts on users, especially adolescents and young adults. The goal of this review is to critically assess published data on ENDS use in children, report our institutional experience, discuss the reasons why the use of ENDS have increased among young individuals, outline the current understanding of EVALI as it pertains to the pediatric population, and discuss future opportunities for health policy implementation.
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Affiliation(s)
- Jacob A Kaslow
- Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian Rosas-Salazar
- Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul E Moore
- Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Smith ML, Gotway MB, Crotty Alexander LE, Hariri LP. Vaping-related lung injury. Virchows Arch 2020; 478:81-88. [PMID: 33106908 PMCID: PMC7590536 DOI: 10.1007/s00428-020-02943-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
The use of electronic nicotine delivery systems has increased in popularity dramatically over the past decade. Although lung diseases caused by vaping have been reported since the modern invention of the electronic cigarette, in the summer of 2019, patients began to present to health care centers at epidemic levels with an acute respiratory illness relating to vaping, which the Center for Disease Control termed E-cigarette or vaping product use-associated lung injury (EVALI). This review discusses electronic nicotine delivery systems as well as the etiology, clinical presentation, imaging findings, pathologic features, treatment, and long-term consequences of EVALI. We conclude with the practical impact EVALI has had on the practice of pathology.
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Affiliation(s)
- Maxwell L Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Michael B Gotway
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Laura E Crotty Alexander
- Pulmonary Critical Care Section at the VA San Diego Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health Sciences, San Diego, CA, USA
| | - Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Corcoran A, Carl JC, Rezaee F. The importance of anti-vaping vigilance-EVALI in seven adolescent pediatric patients in Northeast Ohio. Pediatr Pulmonol 2020; 55:1719-1724. [PMID: 32462762 PMCID: PMC7384027 DOI: 10.1002/ppul.24872] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/25/2020] [Indexed: 11/10/2022]
Abstract
As of 18 February 2020, the e-cigarette or vaping product use-associated lung injury (EVALI) epidemic has claimed the lives of 68 patients in the USA with the total number of reported cases standing at 2807 to date. We present the clinical and radiologic findings, course of illness, and treatment of EVALI in seven adolescent patients in Northeast Ohio. Five of our patients required supplemental oxygen with four requiring intensive care unit care for respiratory support during admission. Three patients were treated with systemic steroids while inpatient. Bilateral opacities were seen on radiographic imaging of all seven of our patients. All patients were discharged alive on room air. However, impaired diffusing capacity of the lungs for carbon monoxide (DLCO) with nonobstructive spirometry was seen in patients that were tested postdischarge. This suggests that although recovery from the acute illness process of EVALI is achieved, there may be long-term impact on lung function in these patients. We recommend close follow-up with a pediatric pulmonologist where spirometry and DLCO can be performed.
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Affiliation(s)
- Aoife Corcoran
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio
| | - John C Carl
- Centre for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio
| | - Fariba Rezaee
- Centre for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio.,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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