Confirmed E-cigarette or vaping product use associated lung injury (EVALI) with lung biopsy; A case report and literature review

Demographic, Clinical, and Behavioral Factors Associated With Electronic Nicotine Delivery Systems Use in a Large Cohort in the United States

Introduction

Our primary purpose is to understand comorbidities and health outcomes associated with electronic nicotine delivery systems (ENDS) use.

Methods

Study participants were Kaiser Permanente (KP) members from eight US regions who joined the Kaiser Permanente Research Bank (KPRB) from September 2015 through December 2019 and completed a questionnaire assessing demographic and behavioral factors, including ENDS and traditional cigarette use. Medical history and health outcomes were obtained from electronic health records. We used multinomial logistic regression to estimate odd ratios (ORs) and 95% confidence intervals (CIs) of current and former ENDS use according to member characteristics, behavioral factors, and clinical history. We used Cox regression to estimate hazard ratios (HRs) and 95% CIs comparing risk of health outcomes according to ENDS use.

Results

Of 119 593 participants, 1594 (1%) reported current ENDS use and 5603 (5%) reported past ENDS use. ENDS users were more likely to be younger, male, gay or lesbian, and American Indian / Alaskan Native or Asian. After adjustment for confounding, current ENDS use was associated with current traditional cigarette use (OR = 39.55; CI:33.44-46.77), current marijuana use (OR = 6.72; CI:5.61-8.05), history of lung cancer (OR = 2.64; CI:1.42-4.92), non-stroke cerebral vascular disease (OR = 1.55; CI:1.21-1.99), and chronic obstructive pulmonary disease (OR = 2.16; CI:1.77-2.63). Current ENDS use was also associated with increased risk of emergency room (ER) visits (HR = 1.17; CI: 1.05-1.30) and death (HR = 1.84; CI:1.02-3.32).

Conclusions

Concurrent traditional cigarette use, marijuana use, and comorbidities were prevalent among those who used ENDS, and current ENDS use was associated with an increased risk of ER visits and death. Additional research focused on health risks associated with concurrent ENDS and traditional cigarette use in those with underlying comorbidities is needed.

E-cigarette, or vaping, product use associated lung injury and the risks and benefits of a thorough infectious work-up

As of February 2020, over 2800 cases of lung injury associated with vapes have been reported in all 50 states (Cullen et al., 2019) [1]. This case is about a 29-year-old female with a five-year history of vaping tetrahydrocannabinol (THC) who presented with symptoms consistent with e-cigarette, or vaping, product-use associated lung injury (EVALI). This case report is unique because this patient clinically improved on a lower dose of corticosteroids compared to other reported cases of EVALI. Additionally, this case report highlights the importance and difficulty of excluding other disease processes prior to treating patients for EVALI, particularly during the coronavirus disease 2019 (COVID-19) global pandemic.

•

Patients with EVALI may experience resolution of their disease with a lower dose of systemic corticosteroids.

•

EVALI is a diagnosis of exclusion that requires a thorough infectious disease workup, which may hinder timely treatment.

•

While steroids have been used to treat EVALI, there are currently no evidence-based treatment guidelines for EVALI.