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Bravo-Gutiérrez OA, Falfán-Valencia R, Ramírez-Venegas A, Sansores RH, Ponciano-Rodríguez G, Pérez-Rubio G. Lung Damage Caused by Heated Tobacco Products and Electronic Nicotine Delivery Systems: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084079. [PMID: 33924379 PMCID: PMC8070637 DOI: 10.3390/ijerph18084079] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
The tobacco industry promotes electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) as a safer alternative to conventional cigarettes with misleading marketing sustained by studies with conflict of interest. As a result, these devices sell without regulations and warnings about their adverse effects on health, with a growing user base targeting young people. This systematic review aimed to describe the adverse effects on the respiratory system in consumers of these devices. We conducted a systematic review and bibliometric analysis of 79 studies without conflict of interest evaluating ENDS and HTP effects in the respiratory system in experimental models, retrieved from the PubMed database. We found that the damage produced by using these devices is involved in pathways related to pulmonary diseases, involving mechanisms previously reported in conventional cigarettes as well as new mechanisms particular to these devices, which challenges that the tobacco industry’s claims. The present study provides significant evidence to suggest that these devices are an emerging public health problem and that they should be regulated or avoided.
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Affiliation(s)
- Omar Andrés Bravo-Gutiérrez
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico; (O.A.B.-G.); (R.F.-V.)
| | - Ramcés Falfán-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico; (O.A.B.-G.); (R.F.-V.)
| | - Alejandra Ramírez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico;
| | - Raúl H. Sansores
- Clínica de Enfermedades Respiratorias, Fundación Médica Sur, Mexico City 14080, Mexico;
| | - Guadalupe Ponciano-Rodríguez
- Public Health Department, Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico;
| | - Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico; (O.A.B.-G.); (R.F.-V.)
- Correspondence: ; Tel.: +52-55-5487-1700 (ext. 5152)
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Sangani R, Rojas E, Forte M, Zulfikar R, Prince N, Tasoglou A, Goldsmith T, Casuccio G, Boyd J, Olfert IM, Flanagan M, Sharma S. Electronic Cigarettes and Vaping-Associated Lung Injury (EVALI): A Rural Appalachian Experience. Hosp Pract (1995) 2021; 49:79-87. [PMID: 33136442 PMCID: PMC8371980 DOI: 10.1080/21548331.2020.1843282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
Background: Electronic cigarette use has increased dramatically since their introduction in 2007. Respiratory complications, particularly lipoid pneumonia, have been reported as early as 2012. An outbreak of pulmonary injury in 2019 has been reported in patients using vaping products.Research Question: To describe a rural Appalachian tertiary center's experience of EVALI and to identify novel mechanisms of pulmonary injury patterns.Study Design and Methods: We present a consecutive case series of 17 patients admitted to our rural, academic, tertiary care institution with EVALI from August 2019 to March 2020. Demographics, baseline characteristics, co-morbidities, vaping behavior, and hospital course were recorded. Broncho-alveolar lavage specimens were assessed for lipid-laden macrophages and hemosiderin-laden macrophages with stains for Oil-Red-O (n = 15) and Prussian Blue (n = 14) respectively.The patient volunteered e-liquid materials (n = 6), and vapors were analyzed using a proton transfer reaction time-of-flight mass spectrometer (PTR-TOF-MS) to describe the chemical profile. Post-discharge interviews were conducted.Results: The most common CT finding was bilateral ground-glass opacities with a predilection for lower lung zones. The most frequent pulmonary injury pattern was lipoid pneumonia. The majority of EVALI patients were critically ill requiring ventilation or ECMO. The most severely ill patients were noted to be positive for iron stains in macrophages and showed higher volatile organic compound (VOC) levels in chemical analysis.Interpretation: Based on our experience, EVALI in rural Appalachia presented with relatively severe respiratory failure. Worse outcomes appear to be correlated to high levels of VOCs, iron deposition in lungs, and concomitant infection.
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Affiliation(s)
- Rahul Sangani
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Edward Rojas
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michael Forte
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Rafia Zulfikar
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nicole Prince
- C. Eugene Bennett Department of Chemistry, West Virginia University, Morgantown, WV, USA
- Department of Orthopedics, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Travis Goldsmith
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Jonathan Boyd
- Department of Orthopedics, West Virginia University School of Medicine, Morgantown, WV, USA
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA
- Occupational and Environmental Health, West Virginia University School of Public Health, Morgantown, WV, USA
- Center of Inhalation Toxicology (Itox, WVU Robert C. Byrd Health Science Center, Morgantown, USA
| | - I. Mark Olfert
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA
- Center of Inhalation Toxicology (Itox, WVU Robert C. Byrd Health Science Center, Morgantown, USA
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, USA
| | - Melina Flanagan
- Department of Pathology, Anatomy, and Laboratory Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Sunil Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
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Akkanti BH, Hussain R, Patel MK, Patel JA, Dinh K, Zhao B, Elzamly S, Pelicon K, Petek K, Salas de Armas IA, Akay M, Kar B, Gregoric ID, Buja LM. Deadly combination of Vaping-lnduced lung injury and Influenza: case report. Diagn Pathol 2020; 15:83. [PMID: 32646452 PMCID: PMC7346855 DOI: 10.1186/s13000-020-00998-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND E-cigarette and vaping use-associated acute lung injury (EVALI) has been recently recognized as a complication in individuals who use vaping devices. Another consideration is that EVALI may have an adverse influence on the outcome of intercurrent respiratory infections. We document this deadly combination in the case of a young man who had EVALI and simultaneous 41 Influenza-A infection leading to severe Acute Respiratory Distress Syndrome (ARDS). CASE PRESENTATION A 27-year-old male with a history of tobacco and vaping use was admitted to hospital after two weeks of flu-like symptoms, diarrhea and vomiting. A chest x-ray was consistent with multifocal pneumonia, and microbiological tests were positive for Influenza-A and methicillin-sensitive Staphalacoccus aureus (MSSA). Bronchoscopy provided evidence of acute inhalational injury. After admission, he acutely decompensated with severe hypoxia and hypotension; he required intubation, sedation and vasopressors. He developed sepsis with acute kidney failure, liver failure, biventricular systolic dysfunction and severe rhabdomyolysis. He was placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) initially and later changed to Veno-Arterial (VA) ECMO. Nevertheless, the patient continued to deteriorate, and he expired two weeks after admission. CONCLUSION This case documents that EVALI can act as a major factor leading a respiratory infection to progress into severe ARDS with a fatal outcome.
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Affiliation(s)
- Bindu H Akkanti
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Rahat Hussain
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Manish K Patel
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Jayeshkumar A Patel
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Kha Dinh
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St. MSB 2.276, Houston, TX, 77030, USA
| | - Shaimaa Elzamly
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St. MSB 2.276, Houston, TX, 77030, USA
| | - Kevin Pelicon
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Klemen Petek
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Ismael A Salas de Armas
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Mehmet Akay
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Biswajit Kar
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Igor D Gregoric
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St. MSB 2.276, Houston, TX, 77030, USA.
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