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Brennan E, Kahn A, Kopyt M, Khan A, Castillo R. Don't Go Vaping My Heart: A Case of Vaping-Associated Cardiomyopathy and Lung Injury. Cureus 2023; 15:e42723. [PMID: 37654962 PMCID: PMC10466449 DOI: 10.7759/cureus.42723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
The potential adverse effects of electronic cigarette (e-cigarette) use or vaping on pulmonary function have been previously well documented, with the diagnosis of e-cigarette- or vaping-use-associated lung injury (EVALI) has become increasingly common. The potential effects in terms of cardiovascular function and vaping is an area that is less well understood. We present a case of acute respiratory distress and newly onset reduced systolic function in a previously healthy young male.
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Affiliation(s)
- Emmett Brennan
- Internal Medicine, One Brooklyn Health - Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Alexa Kahn
- Cardiology, One Brooklyn Health - Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Morris Kopyt
- Internal Medicine, One Brooklyn Health - Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Abdullah Khan
- Cardiology, One Brooklyn Health - Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ricardo Castillo
- Cardiology, One Brooklyn Health - Brookdale University Hospital Medical Center, Brooklyn, USA
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Pajak A, Bascoy S, Li JC, Benninghoff M, Deitchman A. E-cigarette or Vaping Product Use Associated Lung Injury Among Three Young Adults: A Retrospective Case Series From Delaware. Cureus 2020; 12:e11031. [PMID: 33224641 PMCID: PMC7673280 DOI: 10.7759/cureus.11031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: E-cigarette or vaping associated lung injury (EVALI) is a lung disease associated with an inflammatory response to the vaping fluid. Currently, diagnosis remains elusive without definitive biomarkers. Case presentation: Herein, we describe three cases of EVALI among 18- to 21-year-old patients ranging from mild to severe. All cases presented with a combination of respiratory, gastrointestinal, and constitutional symptoms. Oxygen support and level of medical care varied based on disease severity. Bilateral pulmonary opacities were observed on chest imaging in each case. Additionally, each case had markedly elevated inflammatory markers, specifically C-reactive protein (CRP). None of these patients improved with intravenous (IV) antibiotics and all required IV corticosteroid therapy to achieve clinical improvement. Conclusion: EVALI should be suspected among young, otherwise healthy patients who present with new-onset hypoxia, non-specific gastrointestinal symptoms, and endorse a history of vaping. Though considered a diagnosis of exclusion, diagnosing EVALI requires thorough history taking. Inflammatory studies, CRP, and erythrocyte sedimentation rate (ESR) should be considered adjunctive biomarkers to aid clinicians when the diagnosis remains unclear. Corticosteroids are the mainstay of treatment and patients should have close follow-up whether or not they require hospitalization.
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Affiliation(s)
| | - Soraya Bascoy
- Internal Medicine/Pediatrics Residency Program, ChristianaCare, Newark, USA
| | - Jonathan C Li
- Internal Medicine/Pediatrics Residency Program, ChristianaCare, Newark, USA.,Internal Medicine/Pediatrics Residency Program, University of Pittsburgh Medical Center, Pittsburgh, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Michael Benninghoff
- Department of Pulmonary & Critical Care Medicine, ChristianaCare, Newark, USA
| | - Andrew Deitchman
- Department of Pulmonary & Critical Care Medicine, ChristianaCare, Newark, USA
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De Jesús VR, Chambers DM, Reese C, Braselton M, Espinosa P, Corstvet J, Blount BC. Novel methods for the analysis of toxicants in bronchoalveolar lavage fluid samples from e-cigarette, or vaping, product use-associated lung injury cases: Selected petroleum distillates. Rapid Commun Mass Spectrom 2020; 34:e8898. [PMID: 32672382 PMCID: PMC7719060 DOI: 10.1002/rcm.8898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
RATIONALE Over 2700 e-cigarette, or vaping, product use-associated lung injury (EVALI) cases were reported to the Centers for Disease Control and Prevention (CDC) during August 2019-February 2020. Bronchoalveolar lavage (BAL) fluid samples from 51 EVALI and 99 non-EVALI cases were analyzed for toxicants including petroleum distillates. We describe a novel method to measure petroleum distillates in BAL fluid using gas chromatography-mass spectrometry (GC/MS). METHODS n-Hexane, n-heptane, n-octane, methylcyclopentane, and cyclohexane were measured in BAL fluid specimens by headspace solid-phase microextraction/GC/MS. We created and characterized BAL fluid pools from non-EVALI individuals to determine assay accuracy, precision, linearity, limits of detection (LODs), and analytical specificity. All measurements were conducted in accordance with the rigorous method validation procedures of CDC's Division of Laboratory Sciences. RESULTS Matrix validation experiments showed that calibration curves in BAL fluid and saline had similar slopes, with differences less than 5%. Assay precision ranged from 1.98% to 18%. In addition, the LODs for the five analytes ranged from 0.05 to 0.10 μg/L, and their linearity was confirmed with R2 values >0.99. The analysis of selected petroleum distillates in BAL fluid analysis was shown to be comparable with their analysis in blood in which the 95th percentiles are below detection. CONCLUSIONS We developed and validated a method to quantify petroleum distillates in BAL fluid specimens using GC/MS. The assay provided precise and accurate analyses of EVALI and non-EVALI BAL fluid specimens in support of CDC's EVALI response. This method is applicable to the determination of a broad range of volatile organic compounds in BAL fluid specimens.
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Affiliation(s)
- Víctor R. De Jesús
- Corresponding Author: Víctor R. De Jesús, PhD, Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, , Phone: 770-488-7963, Fax: 770-488-0181
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De Jesús VR, Silva LK, Newman CA, Blount BC. Novel methods for the analysis of toxicants in bronchoalveolar lavage fluid samples from e-cigarette, or vaping, product use associated lung injury ( EVALI) cases: Terpenes. Rapid Commun Mass Spectrom 2020; 34:e8879. [PMID: 32632930 PMCID: PMC7719058 DOI: 10.1002/rcm.8879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
RATIONALE Over 2800 e-cigarette, or vaping, product use-associated lung injury (EVALI) cases were reported to the Centers for Disease Control and Prevention (CDC) during August 2019 to February 2020. Bronchoalveolar lavage (BAL) fluid samples from 51 EVALI and 99 non-EVALI cases were analyzed for toxicants including terpenes. We describe a novel method to measure selected terpenes in BAL fluid by gas chromatography/tandem mass spectrometry (GC/MS/MS). METHODS α-Pinene, β-pinene, β-myrcene, 3-carene, and limonene were measured in BAL fluid specimens by headspace solid-phase microextraction/gas chromatography/tandem mass spectrometry. We created and characterized BAL fluid pools from non-EVALI individuals to determine assay accuracy, precision, linearity, limits of detection, and analytical specificity. All measurements were conducted in accordance with the CDC's Division of Laboratory Sciences rigorous method validation procedures. RESULTS Matrix validation experiments showed that calibration curves in BAL fluid and saline had similar slopes, with differences of less than 7%. The assay precision ranged from 2.52% to 5.30%. In addition, the limits of detection for the five analytes ranged from 1.80 to 16.8 ng/L, and the linearity was confirmed with R2 values >0.99. CONCLUSIONS We developed and validated a method to quantify selected terpenes in BAL fluid specimens using GC/MS/MS. The assay provided accurate and precise analyses of EVALI and non-EVALI BAL fluid specimens in support of CDC's EVALI response. This method is applicable to the determination of a broad range of terpenes in BAL fluid specimens.
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Affiliation(s)
- Víctor R. De Jesús
- Corresponding Author: Víctor R. De Jesús, PhD, Tobacco and Volatiles Branch, Division of Laboratory Sciences, Centers for Disease Control and Prevention, , Phone: 770-488-7963, Fax: 770-488-0181
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Casey AM, Muise ED, Crotty Alexander LE. Vaping and e-cigarette use. Mysterious lung manifestations and an epidemic. Curr Opin Immunol 2020; 66:143-150. [PMID: 33186869 PMCID: PMC7755270 DOI: 10.1016/j.coi.2020.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022]
Abstract
Electronic (e)-cigarette use and the practice of vaping has rapidly expanded both in adult smokers and previously nicotine naïve youths. Research has focused on harm reduction in adults using e-cigarettes to stop or reduce traditional cigarette use, but the short and long-term safety of these products has not been established. Vaping has more recently been associated with a growing list of pulmonary complications with the most urgent being the e-cigarette or vaping product use-associated lung injury (EVALI) epidemic. This review details the inhalant toxicology of vaping products, the described lung diseases associated with vaping with a focus on EVALI, and the predicted long-term consequences of e-cigarette use, including increased asthma severity.
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Affiliation(s)
- Alicia M Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02215, United States
| | - Eleanor D Muise
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02215, United States
| | - Laura E Crotty Alexander
- Pulmonary Critical Care Section, VA San Diego Healthcare System, La Jolla, CA 92161, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, United States.
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Chawla H, Weiler T. E-cigarette or Vaping Product Use-Associated Lung Injury Presenting as Sub-Acute Hypoxemia Without Increased Work of Breathing. Cureus 2020; 12:e9855. [PMID: 32963897 PMCID: PMC7500740 DOI: 10.7759/cureus.9855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 15-year-old male with a history of mild intermittent asthma presented with fatigue, coughing, vomiting and anorexia which was progressive in nature over the past month. The patient was found to have evolving chest x-ray infiltrates bilaterally, and hypoxemia without accessory muscle use. The patient was placed on non-invasive continuous positive airway pressure (CPAP) for hypoxemia. A CT scan showed bilateral infiltrates in a pattern consistent with E-cigarette or Vaping product use-Associated Lung Injury (EVALI). Upon further history taking, the patient admitted to electronic cigarette (e-cigarette) use with a new tetrahydrocannabinol (THC) cartridge prior to the onset of symptoms. The patient was started on methylprednisolone after which his oxygen requirement improved. This case highlights the need to continue to be diligent regarding the use of e-cigarettes in the pediatric population, and be aware of the constitutional symptoms that are associated with their use.
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Affiliation(s)
| | - Thomas Weiler
- Pediatrics/Critical Care, Presbyterian Hospital, Albuquerque, USA
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Abstract
PURPOSE OF REVIEW This review highlights epidemiologic changes in e-cigarette use in adolescents, discusses recent advances in aerosolized nicotine delivery, and provides and updated profile of research related to the lung-specific harm of e-cigarettes. RECENT FINDINGS In the past decade, nicotine-containing e-cigarettes have emerged as the most popular tobacco and nicotine delivery modality among adolescents in the United States. The surge in popularity of these devices has coincided with an outbreak of vaping-related lung injury, bringing e-cigarette use to national attention, and creating a great deal of confusion regarding their potential for respiratory harm. Newer pod-based devices and formulations of e-liquids have resulted in products appeal to youth and deliver nicotine with increasing efficiency. E-liquid aerosols are associated with direct harm to respiratory epithelium and have been shown to alter pulmonary function, inflammation, mucociliary clearance, and lung histology. SUMMARY Although the long-term harms of regular e-cigarette use are unknown, numerous studies including early longitudinal data suggest e-cigarette use is associated with incidence of respiratory disease, independent of concurrent traditional cigarette use. Improved understanding and recognition of harm will contribute to the basis of further studies examining the role of e-cigarettes on chronic respiratory disease and will inform future prevention education.
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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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Abstract
The United States Federal Centers for Disease Control and Prevention (CDC) has been working with state investigators on reported cases of lung illnesses linked to e-cigarette or vaping products. Symptoms of difficulty breathing, shortness of breath, chest pains, gastrointestinal sickness leading to serious lung damage and death has been linked to the risk behavior of using vaping products bought on the streets in healthy young people. CDC has detected vitamin E acetate as a chemical of concern among people with the lung injury. Vitamin E acetate is a condensing agent in vaping products, and all injured lung fluid samples appear to harbor this agent. The mysterious outbreak is identified in individuals vaping within the 90 days, ranging over a few days to developing over several weeks. There is growing evidence that vaping is hazardous to your health including immediate health dangers such as death from respiratory causes, long term health effects, cardiovascular events, depression which increases the risk of suicidal thoughts and suicide. This review article summarizes the growing knowledge of acute respiratory complications associated with vaping.
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Affiliation(s)
- F Brian Boudi
- Cardiology, University of Arizona College of Medicine, Phoenix, USA
| | - Sonia Patel
- Psychology, Arizona State University, Phoenix, USA
| | - Ava Boudi
- Miscellaneous, Arizona State University, Phoenix, USA
| | - Connie Chan
- Internal Medicine, University of Arizona College of Medicine, Phoenix, USA
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