1
|
Hofmann JJ, Poulos VC, Zhou J, Sharma M, Parraga G, McIntosh MJ. Review of quantitative and functional lung imaging evidence of vaping-related lung injury. Front Med (Lausanne) 2024; 11:1285361. [PMID: 38327710 PMCID: PMC10847544 DOI: 10.3389/fmed.2024.1285361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction The pulmonary effects of e-cigarette use (or vaping) became a healthcare concern in 2019, following the rapid increase of e-cigarette-related or vaping-associated lung injury (EVALI) in young people, which resulted in the critical care admission of thousands of teenagers and young adults. Pulmonary functional imaging is well-positioned to provide information about the acute and chronic effects of vaping. We generated a systematic review to retrieve relevant imaging studies that describe the acute and chronic imaging findings that underly vaping-related lung structure-function abnormalities. Methods A systematic review was undertaken on June 13th, 2023 using PubMed to search for published manuscripts using the following criteria: [("Vaping" OR "e-cigarette" OR "EVALI") AND ("MRI" OR "CT" OR "Imaging")]. We included only studies involving human participants, vaping/e-cigarette use, and MRI, CT and/or PET. Results The search identified 445 manuscripts, of which 110 (668 unique participants) specifically mentioned MRI, PET or CT imaging in cases or retrospective case series of patients who vaped. This included 105 manuscripts specific to CT (626 participants), three manuscripts which mainly used MRI (23 participants), and two manuscripts which described PET findings (20 participants). Most studies were conducted in North America (n = 90), with the remaining studies conducted in Europe (n = 15), Asia (n = 4) and South America (n = 1). The vast majority of publications described case studies (n = 93) and a few described larger retrospective or prospective studies (n = 17). In e-cigarette users and patients with EVALI, key CT findings included ground-glass opacities, consolidations and subpleural sparing, MRI revealed abnormal ventilation, perfusion and ventilation/perfusion matching, while PET showed evidence of pulmonary inflammation. Discussion and conclusion Pulmonary structural and functional imaging abnormalities were common in patients with EVALI and in e-cigarette users with or without respiratory symptoms, which suggests that functional MRI may be helpful in the investigation of the pulmonary health effects associated with e-cigarette use.
Collapse
Affiliation(s)
| | | | - Jiahai Zhou
- Robarts Research Institute, London, ON, Canada
| | - Maksym Sharma
- Robarts Research Institute, London, ON, Canada
- Department of Medical Biophysics, London, ON, Canada
| | - Grace Parraga
- Robarts Research Institute, London, ON, Canada
- Department of Medical Biophysics, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
| | - Marrissa J. McIntosh
- Robarts Research Institute, London, ON, Canada
- Department of Medical Biophysics, London, ON, Canada
| |
Collapse
|
2
|
Marrocco A, Singh D, Christiani DC, Demokritou P. E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs. Crit Rev Toxicol 2022; 52:188-220. [PMID: 35822508 PMCID: PMC9716650 DOI: 10.1080/10408444.2022.2082918] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.
Collapse
Affiliation(s)
- Antonella Marrocco
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - David C. Christiani
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
- Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, 170 Piscataway, NJ 08854, USA
| |
Collapse
|
3
|
Pediatric electronic cigarette or vaping product use-associated lung injury (EVALI): updates in the coronavirus disease 2019 (COVID-19) pandemic era. Pediatr Radiol 2022; 52:2009-2016. [PMID: 35982339 PMCID: PMC9388356 DOI: 10.1007/s00247-022-05454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/25/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
Electronic cigarette or vaping product use-associated lung injury (EVALI) is a toxic inhalational injury that surged in late 2019 and early 2020, immediately prior to the coronavirus disease 2019 (COVID-19) pandemic. Although EVALI cases have significantly decreased, they are still encountered, especially among adolescents. While several characteristic imaging findings and patterns of EVALI have been described, some of them can overlap with the imaging features of COVID-19 pneumonia. We provide a comprehensive review of EVALI that includes the latest updates and highlight the important role of radiologists as contributors to the appropriate and timely care of pediatric patients with this diagnosis.
Collapse
|
4
|
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.
Collapse
|
5
|
Patel P, Ferkol T. An Adolescent with Respiratory Distress. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:4502-4504. [PMID: 34893195 DOI: 10.1016/j.jaip.2021.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Priya Patel
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa; Division of Pulmonary, Allergy & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Thomas Ferkol
- Department of Pediatrics, Washington University, St Louis, Mo; Department of Cell Biology and Physiology, Washington University, St Louis, Mo
| |
Collapse
|
6
|
Mersha AG, Kennedy M, Eftekhari P, Gould GS. Predictors of Adherence to Smoking Cessation Medications among Current and Ex-Smokers in Australia: Findings from a National Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212225. [PMID: 34831981 PMCID: PMC8619677 DOI: 10.3390/ijerph182212225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022]
Abstract
Background: Adherence to smoking cessation medications (SCMs) improve the rate of successful quitting. This study aimed to evaluate the level of adherence to SCMs and associated factors among smokers and ex-smokers in Australia. Method: A cross-sectional study using an online survey was conducted in Australia. Descriptive statistics were used to present the overall characteristics of participants. Cross-tabulation with Pearson’s chi-square test was performed to evaluate the possible associations between factors. To explore barriers and facilitators of adherence to SCMs, logistic regressions were conducted. Results: Among 201 participants, 57 (28.4%) were found to be adherent to SCMs. The odds of being adherent were found to be higher among participants with good social support (AOR = 3.28, 95% CI of 2.30–6.27). Participants who did not experience anxiety symptoms had higher odds of being adherent to SCMs as compared to smokers who had anxiety symptoms (AOR = 4.41, 95% CI of 3.64–14.68). Having previous experience of using SCMs improved adherence four-fold (AOR = 3.87, 95% CI of 1.11–13.44). Level of nicotine dependence showed a direct association with adherence (AOR = 3.53, 95% CI of 1.40–8.95). Not relapsing while on the medications improved adherence (AOR = 2.88, 95% CI of 1.21–6.88). Conclusion: In a study of smokers and ex-smokers in Australia, the self-reported level of adherence to SCMs was found to be low. Adherence was associated with social, psychological, and medication-related factors. Smoking cessation interventions are recommended to include strategies that can address medication adherence.
Collapse
Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Correspondence:
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Maclean JC, Buckell J. Information and sin goods: Experimental evidence on cigarettes. HEALTH ECONOMICS 2021; 30:289-310. [PMID: 33220157 PMCID: PMC8312502 DOI: 10.1002/hec.4189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/05/2020] [Accepted: 10/25/2020] [Indexed: 06/11/2023]
Abstract
We test the importance of information source on consumer choice in the context of sin goods, specifically electronic and tobacco cigarettes, among adult smokers. We proxy choice with intentions to vape and quit smoking in the next 30 days. We experimentally vary the information source: government, private companies, physicians, and no source. Our findings suggest that information source matters in the context of cigarettes choice for adult smokers. Private companies appear to be an important information source for cigarettes among adult smokers.
Collapse
Affiliation(s)
- Johanna Catherine Maclean
- Department of Economics, Temple University, Philadelphia, Pennsylvania, USA
- National Bureau of Economic Research, Cambridge, Massachusetts, USA
- Institute of Labor Economics, Bonn, Germany
| | - John Buckell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Health Behaviours, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
10
|
Kwan LY, Eaton DL, Andersen SL, Dow-Edwards D, Levin ED, Talpos J, Vorhees CV, Li AA. This is your teen brain on drugs: In search of biological factors unique to dependence toxicity in adolescence. Neurotoxicol Teratol 2020; 81:106916. [DOI: 10.1016/j.ntt.2020.106916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
|