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Zirek F, Tekin MN, Bayav S, Gurbanov A, Havan M, Fitoz S, Kendirli T, Çobanoğlu N. Diagnosis of interstitial lung disease after surgery in an adolescent. Pediatr Pulmonol 2024. [PMID: 38651921 DOI: 10.1002/ppul.27014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Fazılcan Zirek
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Nur Tekin
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Secahattin Bayav
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Havan
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Suat Fitoz
- Department of Radiology, Division of Pediatric Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
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2
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Zingg JM. Finding vitamin Ex ‡. Free Radic Biol Med 2024; 211:171-173. [PMID: 38081438 DOI: 10.1016/j.freeradbiomed.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Jean-Marc Zingg
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, FL, 33136-6129, USA; Dr. JT Macdonald Foundation Biomedical Nanotechnology Institute, University of Miami, Miami, FL, 33136-6129, USA.
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3
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Manna VJ, Dwyer S, Pizutelli V, Caradonna SJ. Utilizing primary human airway mucociliary tissue cultures to model ramifications of chronic E-cigarette usage. Toxicol In Vitro 2024; 94:105725. [PMID: 37884163 DOI: 10.1016/j.tiv.2023.105725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/27/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023]
Abstract
Electronic cigarettes are battery powered devices that use a vape-liquid to produce a vapor that is inhaled. A consequence of the rise in e-cigarette usage was the 2019 emergence of a vaping-induced respiratory disease denoted as 'e-cigarette or vaping use-associated lung injury' (EVALI). One of the suspected causes of EVALI is Vitamin E Acetate (VEA), which was found to be a diluent in certain illicit vape-pens, whereas nicotine is commonly diluted in equal parts propylene glycol and vegetable glycerin (PG:VG). The prevalent use of e-cigarettes and the emergence of a novel illness has made understanding how e-cigarette vapors affect our respiratory tissues a public health concern. We have designed and produced a simple device that can operate e-cigarettes and deliver the vapor to a chamber containing a standard cell culture multi-well plate. Here we utilize our device to model the response of human airway mucociliary tissue after chronic exposure to vapors produced from either PG:VG or VEA. We note several differences between how PG:VG and VEA vapors interact with and alter airway tissue cultures and suggest potential mechanisms for how VEA-vapors can exacerbate EVALI symptoms. Our device combined with primary human airway tissue cultures make an economical and compact model system that allows for animal-free investigations into the acute and chronic consequences of e-cigarette vapors on primary respiratory cells.
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Affiliation(s)
- Vincent J Manna
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States.
| | - Shannon Dwyer
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
| | - Vanessa Pizutelli
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
| | - Salvatore J Caradonna
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
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4
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Martin A, Tempra C, Yu Y, Liekkinen J, Thakker R, Lee H, de Santos Moreno B, Vattulainen I, Rossios C, Javanainen M, Bernardino de la Serna J. Exposure to Aldehyde Cherry e-Liquid Flavoring and Its Vaping Byproduct Disrupt Pulmonary Surfactant Biophysical Function. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:1495-1508. [PMID: 38186267 PMCID: PMC10809783 DOI: 10.1021/acs.est.3c07874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
Over the past decade, there has been a significant rise in the use of vaping devices, particularly among adolescents, raising concerns for effects on respiratory health. Pressingly, many recent vaping-related lung injuries are unexplained by current knowledge, and the overall implications of vaping for respiratory health are poorly understood. This study investigates the effect of hydrophobic vaping liquid chemicals on the pulmonary surfactant biophysical function. We focus on the commonly used flavoring benzaldehyde and its vaping byproduct, benzaldehyde propylene glycol acetal. The study involves rigorous testing of the surfactant biophysical function in Langmuir trough and constrained sessile drop surfactometer experiments with both protein-free synthetic surfactant and hydrophobic protein-containing clinical surfactant models. The study reveals that exposure to these vaping chemicals significantly interferes with the synthetic and clinical surfactant biophysical function. Further atomistic simulations reveal preferential interactions with SP-B and SP-C surfactant proteins. Additionally, data show surfactant lipid-vaping chemical interactions and suggest significant transfer of vaping chemicals to the experimental subphase, indicating a toxicological mechanism for the alveolar epithelium. Our study, therefore, reveals novel mechanisms for the inhalational toxicity of vaping. This highlights the need to reassess the safety of vaping liquids for respiratory health, particularly the use of aldehyde chemicals as vaping flavorings.
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Affiliation(s)
- Alexia Martin
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
| | - Carmelo Tempra
- Institute
of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague 6 160 00, Czech Republic
| | - Yuefan Yu
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
| | - Juho Liekkinen
- Department
of Physics, University of Helsinki, Helsinki 00560, Finland
| | - Roma Thakker
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
| | - Hayoung Lee
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
| | - Berta de Santos Moreno
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
| | - Ilpo Vattulainen
- Department
of Physics, University of Helsinki, Helsinki 00560, Finland
| | - Christos Rossios
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
| | - Matti Javanainen
- Institute
of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague 6 160 00, Czech Republic
- Institute
of Biotechnology, University of Helsinki, Helsinki 00790, Finland
| | - Jorge Bernardino de la Serna
- National
Heart and Lung Institute, Imperial College
London, Sir Alexander Fleming Building, London SW7 2AZ, U.K.
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5
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Tituana NY, Clavijo CG, Espinoza EF, Tituana VA. E-cigarette use-associated lung injury (EVALI). Pneumologie 2024; 78:58-69. [PMID: 37857323 PMCID: PMC10791482 DOI: 10.1055/a-2161-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 10/21/2023]
Abstract
The prevalence of vaping has overtaken conventional cigarettes as the most frequent form of nicotine consumption among 15-24-year olds. There are currently a large number of both legitimate and illegitimate products and suppliers offering more than 8000 different flavors of vape on the market, whose additives are not tested, studied or regulated and whose safety and toxicity profile remains unknown. In vitro studies have demonstrated a dose-dependent decrease in the viability of normal human bronchial epithelial cells after exposure to vapor from electronic vape devices.Short- and medium-term studies to date indicate that vapor-induced pulmonary lesions are the most serious and commonly reported side effect; such lesions include bilateral ground glass opacities in lung bases with subpleural preservation, bilateral infiltrates, pleural effusion, pneumomediastinum and nodular opacities. Cases of EVALI have been described in patients with daily exposure, as well as in users who reported having been exposed to these substances at least once a month. The most frequently inhaled substances are THC, flavored liquids of unknown content, and nicotine.The clinical manifestations of dyspnea and cough are the most frequent respiratory symptomatology, in addition to constitutional manifestations such as fever and chills, and gastrointestinal manifestations such as vomiting, nausea, abdominal pain and diarrhea. To these can be added the presence of tachypnea, tachycardia, elevated blood pressure, hypoxia, leukocytosis with neutrophilia and elevated ESR.
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Affiliation(s)
- Nathaly Yessenia Tituana
- Medicina, Universidad Catolica de Cuenca Unidad Academica de Medicina y Ciencias de la Salud, Cuenca, Ecuador
| | - Claudia Gabriela Clavijo
- Medicina, Universidad Catolica de Cuenca Unidad Academica de Medicina y Ciencias de la Salud, Cuenca, Ecuador
| | - Evelyn Fernanda Espinoza
- Medicina, Universidad Catolica de Cuenca Unidad Academica de Medicina y Ciencias de la Salud, Cuenca, Ecuador
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6
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Podzolkov VI, Vetluzhskaya MV, Abramova AA, Ishina TI, Garifullina KI. [Vaping and vaping-associated lung injury: A review]. TERAPEVT ARKH 2023; 95:591-596. [PMID: 38159011 DOI: 10.26442/00403660.2023.07.202293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024]
Abstract
Vaping, i.e. the use of electronic nicotine/other substances delivery systems, increases a risk of vaping-associated lung injury. The review describes clinical manifestation, methods of diagnosis and diagnostic criteria, treatment of patients with this disease as well as risk stratification of vapers and approaches to their management based on Worchester classification and clinical guidance. The pathogenetic mechanisms of vaping-associated lung injury have been analyzed.
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Affiliation(s)
- V I Podzolkov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M V Vetluzhskaya
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A A Abramova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - T I Ishina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - K I Garifullina
- Sechenov First Moscow State Medical University (Sechenov University)
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7
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Scott A. Vaping and CBD: can new technology overcome old problems? Thorax 2023; 78:845-847. [PMID: 37268415 DOI: 10.1136/thorax-2023-220137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Aaron Scott
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham, Birmingham, UK
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8
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Gaba M, Kumar N, Arumugam P, Dewan A. Vape-associated lung injury in immediate postoperative period: an upcoming perioperative respiratory risk factor. BMJ Case Rep 2023; 16:e255250. [PMID: 37433689 PMCID: PMC10347437 DOI: 10.1136/bcr-2023-255250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
There has been a rapid increase in e-cigarette usage, especially among young adults. E-cigarettes are often thought to be a safe substitute to traditional smoking and are frequently used as a bridge to smoking cessation. E-cigarette or vaping product use-associated lung injury often presents with subacute or acute respiratory failure. We report a case of a young man in his 20s, who developed rapidly worsening respiratory failure in the postoperative period. This case highlights the importance of recognising this entity on time, especially in the perioperative period, and its impact on patient outcomes.
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Affiliation(s)
- Manish Gaba
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
| | - Naveen Kumar
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
| | - Praveen Arumugam
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
| | - Arun Dewan
- Internal Medicine, Max Smart Super Speciality Hospital, New Delhi, Delhi, India
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9
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Harry-Hernandez S, Thiboutot J, Wahidi MM, Giovacchini CX, De Cardenas J, Meldrum C, Los JG, Illei PB, Shojaee S, Eissenberg T, DiBardino D, Giannini H, Maldonado F, Roller L, Yarmus LB, Kapp CM. Bronchoalveolar Lavage (BAL) and Pathologic Assessment of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): The EVALI-BAL Study, A Multicenter Cohort. J Bronchology Interv Pulmonol 2023; 30:144-154. [PMID: 35993570 DOI: 10.1097/lbr.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND E-cigarette or vaping-use related acute lung injury (EVALI) is a spectrum of radiographic and histologic patterns consistent with acute to subacute lung injury. However, limited data exist characterizing bronchoalveolar lavage (BAL) findings. The goal of this study is to further define the pathologic findings from BAL and biopsy samples of subjects with EVALI across 7 institutions. METHODS A multicentered registry of patients admitted with EVALI who underwent flexible bronchoscopy with BAL+/-transbronchial biopsy from July 2019 to April 2021 was compiled for retrospective evaluation from 7 academic institutions throughout the United States. Radiographic and cytopathologic findings and frequencies were correlated with the substance vaped. RESULTS Data from 21 subjects (42.9% women) who were predominantly White (76.2%) with a median age of 25 years (range, 16 to 68) with EVALI were included in this study. Sixteen patients (76.2%) reported use of tetrahydrocannabinol; the remainder used nicotine. BAL was performed in 19 of the 21 subjects, and transbronchial lung biopsy was performed in 7 subjects. BAL findings revealed neutrophilic predominance (median, 59.5%, range, 3.1 to 98) in most cases. Ten BAL samples demonstrated pulmonary eosinophilia ranging from 0.2% to 49.1% with one subject suggesting a diagnosis of acute eosinophilic pneumonia associated with the use of e-cigarettes. Lipid-laden macrophages were noted in 10 of 15 reports (66.7%). Transbronchial biopsy most frequently demonstrated patterns of organizing pneumonia (57.1%). CONCLUSION EVALI-associated BAL findings typically demonstrate a spectrum of nonspecific inflammatory changes, including neutrophilia, lipid-laden macrophages, and in some cases eosinophilia.
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Affiliation(s)
| | - Jeffrey Thiboutot
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Momen M Wahidi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
| | - Coral X Giovacchini
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Jenna G Los
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Peter B Illei
- Division of Cytopathology, Department of Pathology, Johns Hopkins University Baltimore, MD
| | - Samira Shojaee
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - David DiBardino
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Heather Giannini
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lance Roller
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Christopher M Kapp
- Division of Pulmonary, Department of Medicine, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
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10
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Been T, Alakhtar B, Traboulsi H, Tsering T, Bartolomucci A, Heimbach N, Paoli S, Burnier J, Mann KK, Eidelman DH, Baglole CJ. Chronic low-level JUUL aerosol exposure causes pulmonary immunologic, transcriptomic, and proteomic changes. FASEB J 2023; 37:e22732. [PMID: 36694994 DOI: 10.1096/fj.202201392r] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/18/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
E-cigarettes currently divide public opinion, with some considering them a useful tool for smoking cessation and while others are concerned with potentially adverse health consequences. However, it may take decades to fully understand the effects of e-cigarette use in humans given their relative newness on the market. This highlights the need for comprehensive preclinical studies investigating the effects of e-cigarette exposure on health outcomes. Here, we investigated the impact of chronic, low-level JUUL aerosol exposure on multiple lung outcomes. JUUL is a brand of e-cigarettes popular with youth and young adults. To replicate human exposures, 8- to 12-week-old male and female C57BL/6J mice were exposed to commercially available JUUL products (containing 59 mg/ml nicotine). Mice were exposed to room air, PG/VG, or JUUL daily for 4 weeks. After the exposure period, inflammatory markers were assessed via qRT-PCR, multiplex cytokine assays, and differential cell count. Proteomic and transcriptomic analyses were also performed on samples isolated from the lavage of the lungs; this included unbiased analysis of proteins contained within extracellular vesicles (EVs). Mice exposed to JUUL aerosols for 4 weeks had significantly increased neutrophil and lymphocyte populations in the BAL and some changes in cytokine mRNA expression. However, BAL cytokines did not change. Proteomic and transcriptomic analysis revealed significant changes in numerous biological pathways including neutrophil degranulation, PPAR signaling, and xenobiotic metabolism. Thus, e-cigarettes are not inert and can cause significant cellular and molecular changes in the lungs.
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Affiliation(s)
- Terek Been
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bayan Alakhtar
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Hussein Traboulsi
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Thupten Tsering
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Alexandra Bartolomucci
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Nicole Heimbach
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofia Paoli
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Julia Burnier
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Koren K Mann
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada.,Department of Oncology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - David H Eidelman
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Carolyn J Baglole
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Department of Pathology, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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11
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Soto B, Costanzo L, Puskoor A, Akkari N, Geraghty P. The implications of Vitamin E acetate in E-cigarette, or vaping, product use-associated lung injury. Ann Thorac Med 2023; 18:1-9. [PMID: 36968330 PMCID: PMC10034821 DOI: 10.4103/atm.atm_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/05/2022] [Indexed: 01/26/2023] Open
Abstract
In the summer of 2019, a cluster of cases were observed with users of battery-operated or superheating devices presenting with multiple symptoms, such as dyspnea, cough, fever, constitutional symptoms, gastrointestinal upset, and hemoptysis, that is now termed e-cigarette, or vaping, product use-associated lung injury (EVALI). The Centers for Disease Control and Prevention reported 2807 cases within the USA leading to at least 68 deaths as of February 18, 2020. The heterogeneous presentations of EVALI make diagnosis and treatment difficult; however, treatment focused on identifying and removal of the noxious substance and providing supportive care. Vitamin E acetate (VEA) is a likely cause of this lung injury, and others have reported other components to play a possible role, such as nicotine and vegetable glycerin/propylene glycol. EVALI is usually observed in adolescents, with a history of vaping product usage within 90 days typically containing tetrahydrocannabinol, and presenting on chest radiograph with pulmonary infiltrates or computed tomography scan with ground-glass opacities. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. Here, we review the current literature to detail the major factors contributing to EVALI and primarily discuss the potential role of VEA in EVALI. We will also briefly discuss other constituents other than just VEA, as a small number of EVALI cases are reported without the detection of VEA, but with the same clinical diagnosis.
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Affiliation(s)
- Brian Soto
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Louis Costanzo
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Anoop Puskoor
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Nada Akkari
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
| | - Patrick Geraghty
- Department of Medicine, State University of New York Downstate Health Sciences University, NY, USA
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12
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Rebuli ME, Rose JJ, Noël A, Croft DP, Benowitz NL, Cohen AH, Goniewicz ML, Larsen BT, Leigh N, McGraw MD, Melzer AC, Penn AL, Rahman I, Upson D, Crotty Alexander LE, Ewart G, Jaspers I, Jordt SE, Kligerman S, Loughlin CE, McConnell R, Neptune ER, Nguyen TB, Pinkerton KE, Witek TJ. The E-cigarette or Vaping Product Use-Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:1-17. [PMID: 36584985 PMCID: PMC9819258 DOI: 10.1513/annalsats.202209-796st] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
E-cigarette or vaping product use-associated lung injury (EVALI) is a severe pulmonary illness associated with the use of e-cigarettes or vaping products that was officially identified and named in 2019. This American Thoracic Society workshop was convened in 2021 to identify and prioritize research and regulatory needs to adequately respond to the EVALI outbreak and to prevent similar instances of disease associated with e-cigarette or vaping product use. An interdisciplinary group of 26 experts in adult and pediatric clinical care, public health, regulatory oversight, and toxicology were convened for the workshop. Four major topics were examined: 1) the public health and regulatory response to EVALI; 2) EVALI clinical care; 3) mechanisms contributing to EVALI; and 4) needed actions to address the health effects of EVALI. Oral presentations and group discussion were the primary modes used to identify top priorities for addressing EVALI. Initiatives including a national EVALI case registry and biorepository, integrated electronic medical record coding system, U.S. Food and Drug Administration regulation and enforcement of nicotine e-cigarette standards, regulatory authority over nontobacco-derived e-cigarettes, training in evaluating exogenous exposures, prospective clinical studies, standardized clinical follow-up assessments, ability to more readily study effects of cannabinoid e-cigarettes, and research to identify biomarkers of exposure and disease were identified as critical needs. These initiatives will require substantial federal investment as well as changes to regulatory policy. Overall, the workshop identified the need to address the root causes of EVALI to prevent future outbreaks. An integrated approach from multiple perspectives is required, including public health; clinical, basic, and translational research; regulators; and users of e-cigarettes. Improving the public health response to reduce the risk of another substantial disease-inducing event depends on coordinated actions to better understand the inhalational toxicity of these products, informing the public of the risks, and developing and enforcing regulatory standards for all e-cigarettes.
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13
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Bonnier A, Nida A, Chong WH, Saha S, Saha BK. Vaping Associated Acute Eosinophilic Pneumonia: A Clinical and Radiologic Mimicker of COVID-19. Prague Med Rep 2023; 124:283-292. [PMID: 37736951 DOI: 10.14712/23362936.2023.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Acute eosinophilic pneumonia (AEP) is a rare cause of respiratory failure. It is primarily a disease of smokers, either a new smoker or an existing one with a recent increase in cigarette consumption. Other risk factors include toxic gas exposure, inhalational illicit drugs, and smoking marijuana. AEP has also been reported in patients with e-cigarette or vaping associated lung injury (EVALI). We present the case of a 20-year-old male who presented to the hospital with acute respiratory failure. The patient has been vaping heavily for the past three months and started smoking three days before presenting to the emergency department. He was hypertensive, tachycardic, tachypneic, and required high-flow nasal cannula to maintain SpO2 > 92%. His condition deteriorated in the first 24 hours following hospitalization requiring noninvasive positive pressure ventilation. Bronchoalveolar lavage revealed an eosinophil count of 36%. Bronchoalveolar lavage (BAL) cytology revealed lipid-laden macrophages. He was diagnosed with AEP due to EVALI, and the patient was treated with high dose corticosteroid with subsequent improvement. Before the bronchoscopic evaluation, the clinical and radiologic findings were consistent with COVID-19, and the patient was tested twice for SARS-CoV-2 PCR. In the appropriate clinical setting, AEP should be considered in the differential diagnoses of community-acquired pneumonia, acute respiratory distress syndrome (ARDS), and COVID-19, especially in this pandemic era.
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Affiliation(s)
- Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, Saint Louis, USA
| | - Anum Nida
- Department of Medicine, Ozarks Medical Center, West Plains, USA
| | - Woon Hean Chong
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| | - Santu Saha
- Department of Medicine, Saha Clinic, Lohagara, Narail, Bangladesh
| | - Biplab K Saha
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, USA.
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14
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Shi J, Dai W, Chavez J, Carreno J, Zhao L, Kleinman MT, Arechavala RJ, Hasen I, Ting A, Bliss B, Monterrosa Mena JE, Kloner RA. One Acute Exposure to E-Cigarette Smoke Using Various Heating Elements and Power Levels Induces Pulmonary Inflammation. Cardiol Res 2022; 13:323-332. [PMID: 36660061 PMCID: PMC9822672 DOI: 10.14740/cr1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background Electronic cigarettes (eC) may not be entirely benign. There is a lack of data on the effect of a single acute exposure of eC vapor using various heating sources and power settings upon lung injury. The purpose of this study was to determine if an acute exposure with eC vapor heated with different heating elements and power levels induced inflammatory changes in the lungs and heart. Methods Rats were exposed to pure air or received a single, 4-h exposure to eC vapor. The devices used either a stainless steel (SS) or nichrome (NC) heating element randomized to a low or high atomization power (45 versus 70 W). Rats were euthanized within 48 h of exposure. Results The eC groups showed accumulation of inflammatory cells in bronchial lumen, near the pleura, and within the alveolar spaces. The numbers of inflammatory cells per field in the lung parenchyma were significantly greater in the rats exposed to eC groups vs. the air group. There were significantly higher inflammatory gene expression changes in the lungs of animals assigned to 70 W power. We observed that eC vapor generated using burnt coils were toxic and could cause acute respiratory distress and myocarditis. Conclusion In conclusion, one 4-h exposure to eC vapor, in the absence of vitamin E oil or nicotine, significantly increased lung inflammation. Effects were seen after exposures to vapor generated using SS and NC heating elements at either high or low power. Vapor from devices with burnt coils can negatively affect the heart and lung.
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Affiliation(s)
- Jianru Shi
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA 90017-2395, USA
| | - Wangde Dai
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA 90017-2395, USA
| | - Jesus Chavez
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Juan Carreno
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Lifu Zhao
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
| | - Michael T. Kleinman
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Rebecca J. Arechavala
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Irene Hasen
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Amanda Ting
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | - Bishop Bliss
- Department of Environmental and Occupational Health, University of California, Irvine, CA 92717, USA
| | | | - Robert A. Kloner
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, CA 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA 90017-2395, USA
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15
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Blagev DP, Callahan SJ, Harris D, Collingridge DS, Hopkins RO, Eve JR, Waddoups L, Aston V, Brown S, Lanspa MJ. Prospectively Assessed Long-Term Outcomes of Patients with E-Cigarette- or Vaping-associated Lung Injury. Ann Am Thorac Soc 2022; 19:1892-1899. [PMID: 35533314 PMCID: PMC9667811 DOI: 10.1513/annalsats.202201-049oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale: E-cigarette- or vaping-associated lung injury (EVALI) was first identified in 2019. The long-term respiratory, cognitive, mood disorder, and vaping behavior outcomes of patients with EVALI remain unknown. Objectives: To determine the long-term respiratory, cognitive, mood disorder, and vaping behavior outcomes of patients with EVALI. Methods: We prospectively enrolled patients with EVALI from two health systems. We assessed outcomes at 1 year after onset of EVALI using validated instruments measuring cognitive function, depression, anxiety, post-traumatic stress, respiratory disability, coronavirus disease (COVID-19) infection, pulmonary function, and vaping behaviors. We used multivariable regression to identify risk factors of post-EVALI vaping behaviors and to identify whether admission to the intensive care unit (ICU) was associated with cognitive, respiratory, or mood symptoms. Results: Seventy-three patients completed 12-month follow-up. Most patients were male (66.7%), young (mean age, 31 ± 11 yr), and White (85%) and did not need admission to the ICU (59%). At 12 months, 39% (25 of 64) had cognitive impairment, whereas 48% (30 of 62) reported respiratory limitations. Mood disorders were common, with 59% (38 of 64) reporting anxiety and/or depression and 62% (39 of 63) having post-traumatic stress. Four (6.4%) of 64 reported a history of COVID-19 infection. Despite the history of EVALI, many people continued to vape. Only 38% (24 of 64) reported quitting all vaping and smoking behaviors. Younger age was associated with reduced vaping behavior after EVALI (odds ratio, 0.93; P = 0.02). ICU admission was not associated with cognitive impairment, dyspnea, or mood symptoms. Conclusions: Patients with EVALI, despite their youth, commonly have significant long-term respiratory disability; cognitive impairment; symptoms of depression, anxiety, post-traumatic stress; and persistent vaping.
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Affiliation(s)
- Denitza P. Blagev
- Pulmonary and Critical Care Medicine Division, Department of Medicine
- Department of Research
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Sean J. Callahan
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Dixie Harris
- Pulmonary and Critical Care Medicine Division, Department of Medicine
- Telecritical Care Division, Department of Intermountain Telehealth, and
| | | | - Ramona O. Hopkins
- Neuroscience Center, Department of Psychology, Brigham Young University, Provo, Utah
| | - Jacqueline R. Eve
- Enterprise Analytics, Intermountain Healthcare, Salt Lake City, Utah
| | - Lindsey Waddoups
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah; and
| | | | - Samuel Brown
- Pulmonary and Critical Care Medicine Division, Department of Medicine
- Department of Research
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Michael J. Lanspa
- Pulmonary and Critical Care Medicine Division, Department of Medicine
- Department of Research
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah; and
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16
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Garg I, Vidholia A, Garg A, Singh S, Agahi A, Laroia A, Saboo SS, Comellas AP, Hoffman EA, Nagpal P. E-cigarette or vaping product use-associated lung injury: A review of clinico-radio-pathological characteristics. Respir Investig 2022; 60:738-749. [PMID: 35963780 DOI: 10.1016/j.resinv.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 01/12/2023]
Abstract
Aggressive, albeit false marketing of electronic nicotine delivery systems (ENDS) or vaping devices as safer alternatives to cigarette smoking, combined with lack of regulations, has led to its mass adoption, especially among youth. A sudden increase in acute lung injuries was noted in 2019 which was linked to ENDS. It was termed by the Centers for Disease Control and Prevention (CDC) as electronic cigarette or vaping product use-associated lung injury (EVALI). Analysis of bronchoalveolar lavage fluid samples linked EVALI to vitamin E acetate (VEA), which is used as a diluting agent for marijuana oils. Patients with EVALI present with a combination of non-specific respiratory, gastrointestinal, and systemic symptoms. Laboratory results may show elevated inflammatory biomarkers. EVALI is a diagnosis of exclusion and must meet the following criteria: i) history of vaping within last 90 days, ii) abnormal chest imaging, iii) negative evaluation for infection, and iv) no other plausible diagnosis. A spectrum of computed tomography (CT) chest findings has been reported in EVALI, ranging from diffuse alveolar damage to organizing pneumonia, characterized by bilateral ground-glass opacities, consolidation, and septal thickening. A similar spectrum is seen on histopathology, characterized by lipid-laden alveolar macrophages, with varying degrees of infiltrative inflammatory cells and fibrin deposition. Early and accurate identification of the EVALI pattern can help optimize patient care. For example, in diffuse alveolar damage (DAD), a lower threshold for ventilation support and corticosteroid may improve outcomes. Here, we review the etiopathogenesis, clinical management, histopathology, and imaging features of EVALI.
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Affiliation(s)
- Ishan Garg
- Pathology, Arkana Laboratories, 10810 Executive Center Dr #100, Little Rock, AR 72211, USA
| | - Aditi Vidholia
- Department of Pathology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Ankita Garg
- Department of Anesthesiology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, Baba Kharak Singh Rd, Connaught Place, New Delhi 110001, India
| | - Shuchita Singh
- Shanti Hospital, Rajeev Nagar, Agra, Uttar Pradesh 282005, India
| | - Alireza Agahi
- Department of Pathology, Mayo Clinic, 201 1(st) St SW, Rochester, MN 55905, USA
| | - Archana Laroia
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Sachin S Saboo
- Radiology, South Texas Radiology Group, San Antonio, TX 78230, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 375 Newton Rd, Iowa City, IA 52242, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 375 Newton Rd, Iowa City, IA 52242, USA; Roy J. Carver Department of Biomedical Engineering, University of Iowa College of Engineering, 375 Newton Rd, Iowa City, IA 52242, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Radiology, University of Wisconsin-Madison, Madison, WI 53706, USA.
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17
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Jebastin Thangaiah J, Booth CN, Brainard JA, Elsheikh TM, Reynolds JP, Ondrejka SL, Thilagar BP, Mukhopadhyay S, Doxtader EE. Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury. Am J Clin Pathol 2022; 158:723-729. [DOI: 10.1093/ajcp/aqac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use–associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI.
Methods
Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case.
Results
We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218).
Conclusions
ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non–vaping-related cases.
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Affiliation(s)
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Tarik M Elsheikh
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | | | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Bright P Thilagar
- Division of General Internal Medicine , Mayo Clinic, Rochester, MN , USA
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Erika E Doxtader
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
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18
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Casamento Tumeo C, Schiavino A, Paglietti MG, Petreschi F, Ottavianelli A, Onofri A, Cherchi C, Tomà P, Cutrera R. E-cigarette or Vaping product use Associated Lung Injury (EVALI) in a 15 year old female patient - case report. Ital J Pediatr 2022; 48:119. [PMID: 35854320 PMCID: PMC9297547 DOI: 10.1186/s13052-022-01314-6] [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: 04/21/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-cigarettes are devices which allow to aerosolize liquids containing nicotine or other substances. Ever since they were released on the market in 2006, the number of users have been constantly increasing, especially among adolescents, ranging from 7,6% to 9,3% in the age group 18-24 years old from 2014 to 2019. Hand in hand with the spread of E-cigarettes many have been the efforts to understand their impact on health. EVALI (E-cigarette or Vaping product use Associated Lung Injury) is an emerging condition with a heterogeneous presentation with several reported cases worldwide. We mean to report a case of EVALI in a 15-year-old female Caucasian patient, who's currently attending her clinic follow-up at Bambino Gesù Pediatric Hospital in Rome. CASE PRESENTATION The patient was admitted to the Emergency Room due to acute respiratory failure in November 2020. At admittance, she was severely dyspneic (HR 120 bpm, SatO2 75%). As she was hospitalized amid the COVID-19 pandemics, she underwent a nasopharyngeal swab for SARS-CoV2, which turned out negative, and a chest CT scan. Chest CT scan showed a central ground grass pattern with peripheral sparing. At the anamnestic recall, it was disclosed she was an e-cigarette smoker and occasional marijuana user. The microbiological work-up proved only positive for Rhinovirus. Her clinical and radiological case was discussed with our radiologist who suspected EVALI. She was assisted through HFNC, antibiotical therapy and corticosteroids with a dramatic recovery within the first 48 h. CONCLUSIONS EVALI started being recognized a specifically nosological entity in summer 2019, with increasing cases being reported. No diagnostic criteria have been agreed upon yet, but its usual presentation includes respiratory, gastrointestinal and systemic symptoms of different degree and the diagnosis can be hypothesised in case the patient has an evocative clinical and radiological presentation and has been an E-cigarette smoker in previous 90 days. Due to the novelty of the condition and its heterogeneous presentation it is of interest to report the cases in which EVALI is identified to raise awareness about this emerging new-age disease.
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Affiliation(s)
- Chiara Casamento Tumeo
- Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy.
| | - Alessandra Schiavino
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Maria Giovanna Paglietti
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Francesca Petreschi
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Alessandra Ottavianelli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alessandro Onofri
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Claudio Cherchi
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, Rome, Italy
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19
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Abstract
Widespread uptake of vaping has signaled a sea change in the future of nicotine consumption. Vaping has grown in popularity over the past decade, in part propelled by innovations in vape pen design and nicotine flavoring. Teens and young adults have seen the biggest uptake in use of vape pens, which have superseded conventional cigarettes as the preferred modality of nicotine consumption. Relatively little is known, however, about the potential effects of chronic vaping on the respiratory system. Further, the role of vaping as a tool of smoking cessation and tobacco harm reduction remains controversial. The 2019 E-cigarette or Vaping Use-Associated Lung Injury (EVALI) outbreak highlighted the potential harms of vaping, and the consequences of long term use remain unknown. Here, we review the growing body of literature investigating the impacts of vaping on respiratory health. We review the clinical manifestations of vaping related lung injury, including the EVALI outbreak, as well as the effects of chronic vaping on respiratory health and covid-19 outcomes. We conclude that vaping is not without risk, and that further investigation is required to establish clear public policy guidance and regulation.
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Affiliation(s)
- Andrea Jonas
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Stanford University, Stanford, CA, USA
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20
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Navas-Nacher EL, Estrella ML, Giachello AL, Payne TJ, Walker KL, Hart JL, Rodriguez CJ, Groom A, Landry RL, Kesh A, Vu THT, Sears CG, Tompkins LK, Robertson RM. Perceptions of electronic cigarettes among ethno-culturally diverse Latino adults in four US urban centers. ETHNICITY & HEALTH 2022; 27:1207-1221. [PMID: 33249917 PMCID: PMC8240696 DOI: 10.1080/13557858.2020.1844155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/13/2020] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to examine perceptions including knowledge, attitudes, and beliefs about e-cigarettes among ethno-culturally diverse Latino adults living in the US, a rapidly growing minority group for which we know little about their e-cigarette perceptions. DESIGN A total of 25 focus groups with Latinos (n = 180; ages 18-64 years) were conducted in 2014. E-cigarettes users and non-users were recruited via purposive sampling techniques. Participants completed brief questionnaires on sociodemographic factors and tobacco use. Focus group discussions were conducted in English and Spanish, audio-recorded, and transcribed. Data were analyzed using thematic analysis procedures. RESULTS Participants were of diverse Latino backgrounds. Over one-third (35%) reported current cigarette smoking and 8% reported current e-cigarette or hookah use. Nonsmokers reported experimenting with e-cigarettes and hookah during social occasions. Participants' perceptions towards e-cigarettes were generally formed in comparison to conventional cigarettes. Perceived benefits of using e-cigarettes included their utility as a smoking cessation aid, higher social acceptability, and lower harm compared to conventional cigarettes. Negative perceptions of e-cigarettes included lower overall satisfaction compared to conventional cigarettes and high content of toxins. Socio-cultural factors (e.g. gender roles, familismo, and simpatía) also influenced perceptions of e-cigarette of study participants. CONCLUSIONS Overall, Latino adults knew relatively little about the potential health risks associated with e-cigarette use. The limited knowledge about and misinformation of e-cigarettes among this rapidly growing minority group have important public health implications. Findings may inform culturally tailored health communication campaigns, which are much needed among underserved US Latino populations in light of low effectiveness of tobacco control and regulatory efforts.
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Affiliation(s)
- Elena L. Navas-Nacher
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mayra L. Estrella
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aida L. Giachello
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas J. Payne
- Cancer Institute & Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, MS, USA
| | - Kandi La Walker
- Department of Communication, University of Louisville, Louisville, KY, USA
| | - Joy L. Hart
- Department of Communication, University of Louisville, Louisville, KY, USA
| | | | - Allison Groom
- American Heart Association, Tobacco Regulation and Addiction Center (A-TRAC), Dallas, TX, USA
| | - Robyn L. Landry
- American Heart Association, Tobacco Regulation and Addiction Center (A-TRAC), Dallas, TX, USA
| | - Anshula Kesh
- American Heart Association, Tobacco Regulation and Addiction Center (A-TRAC), Dallas, TX, USA
| | - Thanh-Huyen T. Vu
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Clara G. Sears
- Department of Communication, University of Louisville, Louisville, KY, USA
| | | | - Rose Marie Robertson
- American Heart Association, Tobacco Regulation and Addiction Center (A-TRAC), Dallas, TX, USA
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21
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Torous VF, Ly A. Correlation between cytology Oil Red O staining and lung biopsy specimens: utility of the lipid-laden macrophage index. J Am Soc Cytopathol 2022; 11:226-233. [PMID: 35597768 DOI: 10.1016/j.jasc.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Oil Red O staining is used for enumeration of the lipid-laden macrophage index (LLMI) as a surrogate for aspiration. As part of quality improvement efforts aimed at optimizing resource utilization, the utility of this stain in current cytopathology practice was re-evaluated. The objective of this study was to explore the clinical utility of Oil Red O staining in bronchoalveolar lavage (BAL) samples by correlating the LLMI with findings in concurrent histologic tissue samples. MATERIALS AND METHODS Lung transbronchial biopsy specimens that suggested aspiration that were submitted with concurrent BAL cytology samples were retrieved. Lung tissue biopsies were reviewed for the presence of foamy alveolar macrophages (graded as 0, 1+, and 2+), foreign material, and giant cells. The concurrent BAL was reviewed with consensus determination of the LLMI. RESULTS A total of 53 cases were identified. On histology, 13 cases (24.5%) were found to have no foamy alveolar macrophages, 23 cases (43.4%) were found to have 1+ foamy alveolar macrophages, and 17 cases (32.1%) were found to have 2+ foamy alveolar macrophages. Six cases (11.3%) were found to have foreign material, and 10 cases (18.9%) were found to have multinucleated giant cells. The average LLMI score was 16, with 44 (83.0%) in the low range (LLMI <40) and 9 (17.0%) in the intermediate range (LLMI of 40-90). CONCLUSIONS None of the cases in our study had an LLMI that exceeded the cutoff value for which aspiration would be suspected. We found no correlation of the LLMI with lung biopsies that suggested aspiration.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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22
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Rebuli ME. Phosphatidylethanolamines as biomarkers of e-cigarette or vaping product use-associated lung injury. Pediatr Pulmonol 2022; 57:1792-1794. [PMID: 35488453 DOI: 10.1002/ppul.25951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/09/2022] [Accepted: 04/28/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Meghan E Rebuli
- Department of Pediatrics, Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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23
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Hayes D, Board A, Calfee CS, Ellington S, Pollack LA, Kathuria H, Eakin MN, Weissman DN, Callahan SJ, Esper AM, Crotty Alexander LE, Sharma NS, Meyer NJ, Smith LS, Novosad S, Evans ME, Goodman AB, Click ES, Robinson RT, Ewart G, Twentyman E. Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury. Chest 2022; 162:256-264. [DOI: 10.1016/j.chest.2022.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/17/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
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24
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Mandal G, Lale A, Greco R. E-vape and E-Cigarettes-Associated Lung Injury (EVALI) in the COVID-19 Pandemic: A Diagnostic Dilemma and Therapeutic Challenge. Cureus 2022; 14:e26200. [PMID: 35754440 PMCID: PMC9216167 DOI: 10.7759/cureus.26200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 12/15/2022] Open
Abstract
E-vape and e-cigarettes-associated lung injury (EVALI) is a diagnostic dilemma and even more obscure during the coronavirus disease 2019 (COVID-19) pandemic. A rise was seen in EVALI cases at the beginning of the COVID-19 pandemic. Still, the non-specific presentation, or the overlapping symptoms of COVID-19 and EVALI, can negate the possible diagnosis of EVALI because of a clinician's predisposition toward infectious etiologies, and it becomes even more challenging during a viral pandemic. The patient's social history remains the key distinctive point in diagnosing EVALI. Systemic steroids are generally used along with supportive care to treat patients with EVALI. This case report demonstrates the dilemma in diagnosing EVALI in a 19-year-old female during the COVID-19 pandemic.
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25
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Esteban-Lopez M, Perry MD, Garbinski LD, Manevski M, Andre M, Ceyhan Y, Caobi A, Paul P, Lau LS, Ramelow J, Owens F, Souchak J, Ales E, El-Hage N. Health effects and known pathology associated with the use of E-cigarettes. Toxicol Rep 2022; 9:1357-1368. [PMID: 36561957 PMCID: PMC9764206 DOI: 10.1016/j.toxrep.2022.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/25/2022] Open
Abstract
In recent years, new nicotine delivery methods have emerged, and many users are choosing electronic cigarettes (e-cigarettes) over traditional tobacco cigarettes. E-cigarette use is very popular among adolescents, with more than 3.5 million currently using these products in the US. Despite the increased prevalence of e-cigarette use, there is limited knowledge regarding the health impact of e-cigarettes on the general population. Based on published findings by others, E-cigarette is associated with lung injury outbreak, which increased health and safety concerns related to consuming this product. Different components of e-cigarettes, including food-safe liquid solvents and flavorings, can cause health issues related to pneumonia, pulmonary injury, and bronchiolitis. In addition, e-cigarettes contain alarmingly high levels of carcinogens and toxicants that may have long-lasting effects on other organ systems, including the development of neurological manifestations, lung cancer, cardiovascular disorders, and tooth decay. Despite the well- documented potential for harm, e-cigarettes do not appear to increase susceptibility to SARS-CoV- 2 infection. Furthermore, some studies have found that e-cigarette users experience improvements in lung health and minimal adverse effects. Therefore, more studies are needed to provide a definitive conclusion on the long-term safety of e-cigarettes. The purpose of this review is to inform the readers about the possible health-risks associated with the use of e-cigarettes, especially among the group of young and young-adults, from a molecular biology point of view.
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Key Words
- AEC, airway epithelial cells
- AM, alveolar macrophages
- BAL, bronchial alveolar lavage
- CC16, Clara cell protein 16
- CM, cardiomyocyte
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CS, cigarette smoke
- CSC, Cancer Stem Cell
- CYP, cytochrome P450
- E-cigarettes
- E2F1, E2F transcription factor 1
- EMT, epithelial-to-mesenchymal transition
- ENDS, electronic nicotine delivery system
- EVALI
- EVALI, e-cigarette or vaping product use-associated lung injury
- FDA, Food and Drug Administration
- FOXO3, forkhead box O3
- HNSCC, head and neck squamous cancer cells
- HUVEC, human umbilical vein endothelial cells
- Health risks
- IL, interleukin
- LDL, low-density lipoprotein
- MCP-1, monocyte chemoattractant protein-1
- MMP9, matrix metallopeptidase 9
- MPP, Mycoplasma pneumoniae pneumonia
- NET, neutrophil extracellular traps
- NK, natural killer
- NOX, NADPH oxidase
- NQO-1, NAD(P)H quinone dehydrogenase 1
- Nicotine
- Nrf2, nuclear factor erythroid 2-related factor 2
- OGG1/2, 8-oxoguanine glycosylase
- OS, oxidative stress
- Oct4,, Octamer-binding transcription factor 4
- PAFR, platelet-activating factor receptor
- PAHs, polycyclic aromatic hydrocarbons
- PG, propylene glycol
- ROS, reactive oxygen species
- Sox2,, SRY (sex determining region Y)-box 2
- THC, Tetrahydrocannabinol
- TNF‐α, tumor necrosis factor alpha
- VAPI, vaping-associated pulmonary injury
- VG, vegetable glycerin
- Vaping
- XPC, xeroderma pigmentosum complementation group C
- Yap1, Yes associated protein 1
- ZEB, zinc finger E-box binding homeobox
- ZO-1, zonula occludens-1
- e-cigarettes, electronic cigarettes
- e-liquid, e-cigarette liquid
- e-vapor, e-cigarette vapor
- iPSC-EC, induced pluripotent stem cell-derived endothelial cells
- pAMPK, phospho-AMP-activated protein kinase
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Affiliation(s)
- Maria Esteban-Lopez
- Departments of Human and Molecular Genetics, Florida International University, Miami, FL 33199, USA
| | - Marissa D. Perry
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Luis D. Garbinski
- Cell Biology and Pharmacology and Florida International University, Miami, FL 33199, USA
| | - Marko Manevski
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Mickensone Andre
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Yasemin Ceyhan
- Departments of Human and Molecular Genetics, Florida International University, Miami, FL 33199, USA
| | - Allen Caobi
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Patience Paul
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Lee Seng Lau
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Julian Ramelow
- Herbert Wertheim College of Medicine, Biological Sciences in the College of Arts, Science and Education and the Biomolecular Sciences Institute, Florida International University, Miami, FL 33199, USA
| | - Florida Owens
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Joseph Souchak
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Evan Ales
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Nazira El-Hage
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA,Correspondence to: Department of Immunology and Nanomedicine, Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
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Collins PD, Meadows CIS, Lams BE, Agarwal S, Wyncoll DLA. Diffuse "tree-in-bud" Pattern on High Resolution CT in Severe Vaping-Induced Lung Injury. Am J Respir Crit Care Med 2022; 206:501-502. [PMID: 35704280 DOI: 10.1164/rccm.202112-2666im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Patrick D Collins
- Guy's and Saint Thomas' NHS Foundation Trust, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland;
| | - Christopher I S Meadows
- Guy's and Saint Thomas' NHS Foundation Trust, 8945, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Boris Ea Lams
- Guy's and Saint Thomas' NHS Foundation Trust, 8945, Department of Respiratory Medicine, London, United Kingdom of Great Britain and Northern Ireland.,Guy's and Saint Thomas NHS Foundation Trust, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland
| | - Sangita Agarwal
- Guy's and Saint Thomas' Hospitals NHS Trust, 8945, Department of Rheumatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Duncan L A Wyncoll
- Guy's and St Thomas' NHS Foundation Trust, Department of Critical Care Medicine, London, United Kingdom of Great Britain and Northern Ireland
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Davis LC, Sapey E, Thickett DR, Scott A. Predicting the pulmonary effects of long-term e-cigarette use: are the clouds clearing? Eur Respir Rev 2022; 31:210121. [PMID: 35022257 PMCID: PMC9488959 DOI: 10.1183/16000617.0121-2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/16/2021] [Indexed: 12/15/2022] Open
Abstract
Commercially available since 2007, e-cigarettes are a popular electronic delivery device of ever-growing complexity. Given their increasing use by ex-smokers, smokers and never-smokers, it is important to evaluate evidence of their potential pulmonary effects and predict effects of long-term use, since there has been insufficient time to study a chronic user cohort. It is crucial to evaluate indicators of harm seen in cigarette use, and those potentially unique to e-cigarette exposure. Evaluation must also account for the vast variation in e-cigarette devices (now including at least five generations of devices) and exposure methods used in vivo and in vitroThus far, short-term use cohort studies, combined with in vivo and in vitro models, have been used to probe for the effects of e-cigarette exposure. The effects and mechanisms identified, including dysregulated inflammation and decreased pathogen resistance, show concerning overlaps with the established effects of cigarette smoke exposure. Additionally, research has identified a signature of dysregulated lipid processing, which is unique to e-cigarette exposure.This review will evaluate the evidence of pulmonary effects of, and driving mechanisms behind, e-cigarette exposure, which have been highlighted in emerging literature, and highlight the gaps in current knowledge. Such a summary allows understanding of the ongoing debate into e-cigarette regulation, as well as prediction and potential mitigation of future problems surrounding e-cigarette use.
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Affiliation(s)
- Lauren C Davis
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- PIONEER, Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care, Birmingham, UK
- Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David R Thickett
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aaron Scott
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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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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29
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Han DH, Seo DC. Identifying risk profiles for marijuana vaping among U.S. young adults by recreational marijuana legalization status: A machine learning approach. Drug Alcohol Depend 2022; 232:109330. [PMID: 35123363 DOI: 10.1016/j.drugalcdep.2022.109330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study attempted to identify risk profiles of marijuana vaping by state-level recreational marijuana legalization (RML) status among U.S. young adults (YA). METHODS Data were drawn from the most recent two waves of restricted use files of the Population Assessment of Tobacco and Health Study with state identifiers. We analyzed 6155 young adult (18-24 years) respondents who were naïve to marijuana vaping at Wave 4 and had matched data at Wave 5. We employed a two-stage machine learning approach to predict marijuana vaping initiation at Wave 5 with predictors measured at Wave 4. RESULTS Among YA who had never vaped marijuana at Wave 4, 19% of those who lived in the states with RML and 15% of those who lived in the states without RML reported marijuana vaping at Wave 5. Substance-use-related predictors were rarely found as leading predictors in the states with RML. In the states without RML, substance use behaviors, including electronic nicotine delivery systems and smokeless tobacco use, and the presence of externalizing symptoms emerged as predictors for marijuana vaping. Results also revealed that nonlinear interactions between the predictors of marijuana vaping. CONCLUSIONS Our results highlight the importance of accounting for the RML status in developing risk profiles of marijuana vaping. Externalizing symptoms may be a behavioral endophenotype of marijuana vaping in the states without RML. Machine learning appears to be a promising analytical approach to identify complex interactions between factors in predicting an emerging risk behavior such as marijuana vaping.
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Affiliation(s)
- Dae-Hee Han
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Dong-Chul Seo
- Indiana University School of Public Health, Bloomington, IN, USA.
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30
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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: 7] [Impact Index Per Article: 3.5] [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.
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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
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31
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Lim W, Suhail M, Diaz K. A Case of E-cigarette or Vaping Product Use-Associated Lung Injury Mimicking Miliary Tuberculosis. Cureus 2022; 14:e22406. [PMID: 35345753 PMCID: PMC8942045 DOI: 10.7759/cureus.22406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
E-cigarette usage or vaping is becoming more popular as an alternative option to cigarette smoking. Vaping is associated with a wide degree of pulmonary injuries such as asthma, chronic obstructive pulmonary disease or E-cigarette or vaping product use-associated lung injury (EVALI). E-cigarette or vaping product use-associated lung injury is an acute or subacute respiratory illness that can be severe and life-threatening. Miliary tuberculosis, on the other hand, is a rare form of tuberculosis that results from hematogenous dissemination of Mycobacterium tuberculosis, affecting multiple organs and systems. It is characterized by the presence of small, firm white nodules resembling millet seeds. We report a case of a young patient presenting to the hospital with features suggestive of miliary tuberculosis in the CT scan of the chest. Diagnosis of EVALI was reached after extensive diagnostic workup including tuberculosis revealed negative.
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32
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Abstract
The use of electronic (e)-cigarettes was initially considered a beneficial solution to conventional cigarette smoking cessation. However, paradoxically, e-cigarette use is rapidly growing among nonsmokers, including youth and young adults. In 2019, this rapid growth resulted in an epidemic of hospitalizations and deaths of e-cigarette users (vapers) due to acute lung injury; this novel disease was termed e-cigarette or vaping use-associated lung injury (EVALI). Pathophysiologic mechanisms of EVALI likely involve cytotoxicity and neutrophilic inflammation caused by inhaled chemicals, but further details remain unknown. The undiscovered mechanisms of EVALI are a barrier to identifying biomarkers and developing therapeutics. Furthermore, adverse effects of e-cigarette use have been linked to chronic lung diseases and systemic effects on multiple organs. In this comprehensive review, we discuss the diverse spectrum of vaping exposures, epidemiological and clinical reports, and experimental findings to provide a better understanding of EVALI and the adverse health effects of chronic e-cigarette exposure.
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Affiliation(s)
- Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA;
| | - Laura E Crotty Alexander
- University of California at San Diego, La Jolla, California, USA.,Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; .,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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33
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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.
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34
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O'Callaghan M, Helly F, Tarling E, Keane MP, McCarthy C. Methionine supplementation; potential for improving alveolar macrophage function through reverse cholesterol transport? Eur Respir J 2021; 59:13993003.02594-2021. [PMID: 34857611 DOI: 10.1183/13993003.02594-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Marissa O'Callaghan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Feargal Helly
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Elizabeth Tarling
- Division of Cardiology, University of California, Los Angeles, California, USA
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland .,School of Medicine, University College Dublin, Dublin, Ireland
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35
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Kubachka KM, Wilson RA. Elemental Analysis of Tetrahydrocannabinol and Nicotine E-Liquids Related to EVALI. ACS OMEGA 2021; 6:32090-32100. [PMID: 34870030 PMCID: PMC8638013 DOI: 10.1021/acsomega.1c04868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
During the e-cigarette, or vaping, product use-associated lung injury (EVALI) investigation, the U.S. FDA's Forensic Chemistry Center (FCC) received numerous sample submissions from various states and other sources. Many of these products were linked directly to patients, while others were not; both categories included used and unused products. Elemental analysis using inductively coupled plasma mass spectrometry (ICP-MS) preceded by microwave-assisted decomposition was carried out on the cartridge contents of 65 of these submitted samples. Challenges encountered included limited sample, high sample viscosity, and adhesion, which necessitated sample preparation techniques not commonly used during routine elemental analysis. The elemental concentrations of contaminants including Pb, As, Cd, Cr, Ni, Cu, and Sn in tetrahydrocannabinol (THC) e-liquids associated with EVALI were determined. Nicotine e-liquid samples collected alongside the THC e-liquid samples were analyzed in tandem during method development. Several THC e-liquid samples contained Pb greater than 0.5 μg/g, while others had part per million levels of Ni, Cu, and/or Cr. This study presents the first detailed report of elemental concentrations in multiple THC e-liquid samples including those from informal/illicit sources and also delves into the method considerations needed for testing a viscous, hydrophobic sample matrix in limited quantity.
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36
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Rice AJ. Non-neoplastic respiratory fluid cytology including cell differential counts for interstitial lung disease. Cytopathology 2021; 33:44-56. [PMID: 34628692 DOI: 10.1111/cyt.13067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022]
Abstract
Bronchioloalveolar lavage (BAL) is a non-invasive and well-tolerated procedure that plays a key role in the diagnosis of a variety of non-neoplastic pulmonary diseases, including acute respiratory failure, infection, diffuse parenchymal lung disease (DLPD), paediatric and occupational lung disease, and in the evaluation of the lung allograft. A variety of analytic techniques are commonly performed on BAL fluid, including cytology, cell differential count, microbiology and virology, as well as a number of additional techniques in specific circumstances.
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Affiliation(s)
- Alexandra J Rice
- Department of Histopathology, Royal Brompton Hospital, London, UK
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37
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Dong J, Huang J, Liu J, Tang Y, Sivapalan D, Lai K, Zhong N, Luo W, Chen R. Limited Clinical Utility of Lipid-Laden Macrophage Index of Induced Sputum in Predicting Gastroesophageal Reflux-Related Cough. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:799-807. [PMID: 34486263 PMCID: PMC8419643 DOI: 10.4168/aair.2021.13.5.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common cause of chronic cough (CC). However, the diagnosis of GERD associated with CC based on 24-hour esophageal pH-monitoring or favorable response to empirical anti-reflux trials is invasive and time-consuming. Lipid-laden macrophages (LLMs) are supposed to be a biomarker for micro-aspiration of gastric content in the respiratory tract. This study was conducted to collect LLMs by the sputum induction technique and observe the relationship among the amount of LLMs, cough severity, parameters of 24-hour esophageal pH-monitoring and therapeutic response. The 24-hour esophageal pH-monitoring and sputum induction were performed on 57 patients with suspected GERD associated with CC. Thirty-four patients were followed up after empirical anti-reflux trials of 8 weeks to record the therapeutic response. Lipid-laden macrophage index (LLMI), a semiquantitative counting of LLMs, showed no significant correlation with the values of 24-hour esophageal pH monitoring at the proximal or remote electrode. No difference in LLMI or DeMeester score, as well as cough symptom association probability, were found between the responders and the non-responders. Reflux symptoms were more common in the responders (50%) compared to the non-responders (6%) (P < 0.05). Our study suggests that LLMI shows limited utility in clinically diagnosing GERD associated with CC as an underlying etiology or in predicting response to anti-reflux therapy. Anti-reflux therapy is more effective for CC patients with reflux symptoms than for those without.
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Affiliation(s)
- Junguo Dong
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junfeng Huang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Nanshan School of Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaxing Liu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yufang Tang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dhinesan Sivapalan
- International College of Education, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kefang Lai
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nanshan Zhong
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Luo
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Ruchong Chen
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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38
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Park HR, Vallarino J, O'Sullivan M, Wirth C, Panganiban RA, Webb G, Shumyatcher M, Himes BE, Park JA, Christiani DC, Allen J, Lu Q. Electronic cigarette smoke reduces ribosomal protein gene expression to impair protein synthesis in primary human airway epithelial cells. Sci Rep 2021; 11:17517. [PMID: 34471210 PMCID: PMC8410828 DOI: 10.1038/s41598-021-97013-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/05/2021] [Indexed: 12/27/2022] Open
Abstract
The widespread use of electronic cigarettes (e-cig) is a serious public health concern; however, mechanisms by which e-cig impair the function of airway epithelial cells-the direct target of e-cig smoke-are not fully understood. Here we report transcriptomic changes, including decreased expression of many ribosomal genes, in airway epithelial cells in response to e-cig exposure. Using RNA-seq we identify over 200 differentially expressed genes in air-liquid interface cultured primary normal human bronchial epithelial (NHBE) exposed to e-cig smoke solution from commercial e-cig cartridges. In particular, exposure to e-cig smoke solution inhibits biological pathways involving ribosomes and protein biogenesis in NHBE cells. Consistent with this effect, expression of corresponding ribosomal proteins and subsequent protein biogenesis are reduced in the cells exposed to e-cig. Gas chromatography/mass spectrometry (GC/MS) analysis identified the presence of five flavoring chemicals designated as 'high priority' in regard to respiratory health, and methylglyoxal in e-cig smoke solution. Together, our findings reveal the potential detrimental effect of e-cig smoke on ribosomes and the associated protein biogenesis in airway epithelium. Our study calls for further investigation into how these changes in the airway epithelium contribute to the current epidemic of lung injuries in e-cig users.
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Affiliation(s)
- Hae-Ryung Park
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Jose Vallarino
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Michael O'Sullivan
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Charlotte Wirth
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Ronald A Panganiban
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Gabrielle Webb
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Maya Shumyatcher
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jin-Ah Park
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - David C Christiani
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA
| | - Joseph Allen
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA.
- Harvard T.H. Chan School of Public Health, Room 404-L401 Park Drive, Boston, MA, 02215, USA.
| | - Quan Lu
- Program in Molecular and Integrative Physiological Sciences, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02215, USA.
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Bonner E, Chang Y, Christie E, Colvin V, Cunningham B, Elson D, Ghetu C, Huizenga J, Hutton SJ, Kolluri SK, Maggio S, Moran I, Parker B, Rericha Y, Rivera BN, Samon S, Schwichtenberg T, Shankar P, Simonich MT, Wilson LB, Tanguay RL. The chemistry and toxicology of vaping. Pharmacol Ther 2021; 225:107837. [PMID: 33753133 PMCID: PMC8263470 DOI: 10.1016/j.pharmthera.2021.107837] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
Vaping is the process of inhaling and exhaling an aerosol produced by an e-cigarette, vape pen, or personal aerosolizer. When the device contains nicotine, the Food and Drug Administration (FDA) lists the product as an electronic nicotine delivery system or ENDS device. Similar electronic devices can be used to vape cannabis extracts. Over the past decade, the vaping market has increased exponentially, raising health concerns over the number of people exposed and a nationwide outbreak of cases of severe, sometimes fatal, lung dysfunction that arose suddenly in otherwise healthy individuals. In this review, we discuss the various vaping technologies, which are remarkably diverse, and summarize the use prevalence in the U.S. over time by youths and adults. We examine the complex chemistry of vape carrier solvents, flavoring chemicals, and transformation products. We review the health effects from epidemiological and laboratory studies and, finally, discuss the proposed mechanisms underlying some of these health effects. We conclude that since much of the research in this area is recent and vaping technologies are dynamic, our understanding of the health effects is insufficient. With the rapid growth of ENDS use, consumers and regulatory bodies need a better understanding of constituent-dependent toxicity to guide product use and regulatory decisions.
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Affiliation(s)
- Emily Bonner
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Yvonne Chang
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Emerson Christie
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Victoria Colvin
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Brittany Cunningham
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Daniel Elson
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Christine Ghetu
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Juliana Huizenga
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Sara J Hutton
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Siva K Kolluri
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Stephanie Maggio
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Ian Moran
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Bethany Parker
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Yvonne Rericha
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Brianna N Rivera
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Samantha Samon
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Trever Schwichtenberg
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Prarthana Shankar
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Michael T Simonich
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Lindsay B Wilson
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Robyn L Tanguay
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA.
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Abstract
Toxic inhalants include various xenobiotics. Irritants cause upper and lower respiratory tract injuries. Highly water-soluble agents injure the upper respiratory tract, while low water-soluble inhalants injure the lower track. Asphyxiants are divided into simple asphyxiants and chemical asphyxiants. Simple asphyxiants displace oxygen, causing hypoxia, while chemical asphyxiants also impair the body's ability to use oxygen. Cyanide is a classic chemical asphyxiant. Treatment includes hydroxocobalamin. Electronic cigarette or vaping use-associated lung injury (EVALI) is a relatively new illness. Patients present with respiratory symptoms and gastrointestinal distress. EVALI appears to be associated with vaping cannabinoids. Treatment is supportive and may include steroids.
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Affiliation(s)
- Evan S Schwarz
- Washington University School of Medicine, 660 South Euclid, Campus Box 8072, St Louis, MO 63110, USA.
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Adapa S, Gayam V, Konala VM, Annangi S, Raju MP, Bezwada V, McMillan C, Dalal H, Mandal A, Naramala S. Cannabis Vaping-Induced Acute Pulmonary Toxicity: Case Series and Review of Literature. J Investig Med High Impact Case Rep 2021; 8:2324709620947267. [PMID: 32755249 PMCID: PMC7543135 DOI: 10.1177/2324709620947267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The use of cannabis for recreational as well as medicinal use is on the rise
recently with more states legalizing it. We conducted a review analysis of the
literature published on acute respiratory failure from vaping cannabis oil. We
have also summarized the clinical details (age, length of stay, mode of
ventilation, common clinical findings, and steroid use) along with common
laboratory abnormalities. This article aims to educate health care providers on
the clinical manifestations and management strategies for vaping-induced acute
respiratory failure. We also discussed the different available formulations of
cannabis oil and key ingredients responsible for the vaping-associated lung
injury.
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Affiliation(s)
| | - Vijay Gayam
- Interfaith Medical Center, Brooklyn, NY, 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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43
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Electronic cigarettes: Modern instruments for toxic lung delivery and posing risk for the development of chronic disease. Int J Biochem Cell Biol 2021; 137:106039. [PMID: 34242684 DOI: 10.1016/j.biocel.2021.106039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/18/2021] [Accepted: 07/04/2021] [Indexed: 02/07/2023]
Abstract
Following the emergence of electronic cigarette, or vaping product use associated lung injury (EVALI) in 2019 in the US, regulation of e-cigarettes has become globally tighter and the collective evidence of the detrimental effects of vaping has grown. The danger of cellular distress and altered homeostasis is heavily associated with the modifiable nature of electronic cigarette devices. An array of harmful chemicals and elevated concentrations of metals have been detected in e-cigarette aerosols which have been linked to various pathogeneses. Vaping is linked to increased inflammation, altered lipid homeostasis and mitochondrial dysfunction whilst also increasing microbial susceptibility whilst the long-term damage is yet to be observed. The scientific evidence is mounting and highlighting that, along with traditional tobacco cigarette smoking, electronic cigarette vaping is not a safe practice.
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Cano Aguirre MDP, Esperanza Barrios A, Martínez Muñiz F, Alonso Viteri S, Muñiz González F, Segoviano Mateo R, Algaba Calderón Á. Hemoptysis induced by vaping. Arch Bronconeumol 2021; 57:505-506. [PMID: 35698965 DOI: 10.1016/j.arbr.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/28/2020] [Indexed: 06/15/2023]
Affiliation(s)
- María Del Puerto Cano Aguirre
- Servicio de Neumología, Hospital Universitario de Torrejón, Torrejónde Ardoz, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain.
| | - Alba Esperanza Barrios
- Servicio de Neumología, Hospital Universitario de Torrejón, Torrejónde Ardoz, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Soledad Alonso Viteri
- Servicio de Neumología, Hospital Universitario de Torrejón, Torrejónde Ardoz, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Rocío Segoviano Mateo
- Servicio de Medicina Interna, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Ángela Algaba Calderón
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
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45
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Mado H, Reichman-Warmusz E, Wojnicz R. The vaping product use associated lung injury: is this a new pulmonary disease entity? REVIEWS ON ENVIRONMENTAL HEALTH 2021; 36:145-157. [PMID: 34981704 DOI: 10.1515/reveh-2020-0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/24/2020] [Indexed: 06/14/2023]
Abstract
In the summer of 2019, an epidemic of e-cigarette or vaping product use associated lung injury (EVALI) broke out in the United States of America. EVALI is a lung disease that can be severe and life-threatening. It should be emphasized that EVALI is not a clinical diagnosis, but surveillance case definition. Due to the profile of users of such devices, the pathology mainly affects young adults, although cases of EVALI have been reported in almost all age groups, from teenage children to seniors. The worst prognosis is in patients over 35 years of age, with accompanying diseases. A significant number of patients declared the use of products containing tetrahydrocannabinol (THC). The most likely factor responsible for the occurrence of EVALI is vitamin E acetate, which is sometimes added to liquids necessary for the use of electronic cigarette type devices, especially those liquids that contain THC. Nevertheless, it is possible that other substances used in liquids may also be a causative factor. Typical for EVALI are respiratory, gastrointestinal and systemic symptoms, while in imaging tests, a characteristic feature of EVALI is the presence of opacities on the chest radiogram and ground-glass clouds on computed tomography scans. In the course of this disease, respiratory failure often occurs (58%). In the vast majority of cases oxygen substitution is necessary. Currently, the best treatment of EVALI is considered to be the administration of systemic glucocorticosteroids. Over 90% of patients with EVALI required hospitalization, while the mortality rate was about 2.42%. Median age of the fatalities was 51 years. The aim of this review is to summarise the available information on EVALI and to consider possible causative factors and pathomechanism.
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Affiliation(s)
- Hubert Mado
- Department of Histology and Cell Pathology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Edyta Reichman-Warmusz
- Department of Histology and Cell Pathology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Romuald Wojnicz
- Department of Histology and Cell Pathology in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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MacMurdo M, Lin C, Saeedan MB, Doxtader EE, Mukhopadhyay S, Arrossi V, Reynolds J, Ghosh S, Choi H. e-Cigarette or Vaping Product Use-Associated Lung Injury: Clinical, Radiologic, and Pathologic Findings of 15 Cases. Chest 2021; 157:e181-e187. [PMID: 32505323 DOI: 10.1016/j.chest.2020.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Since mid-2019, > 2,000 cases of e-cigarette or vaping product use-associated lung injury (EVALI) have been reported. Although initial reports suggested that this entity may be a form of inhalation-related lipoid pneumonia, subsequent studies indicate that EVALI represents various patterns of acute lung injury. Cases of EVALI continue to be reported, and public awareness of the epidemic is increasingly high. However, evidence surrounding optimal management of EVALI remains limited. In this case series, we report 15 cases of EVALI across a spectrum of severity, highlighting key radiologic, pathologic, and cytologic findings, and discuss management implications. In line with national findings, most patients with EVALI in the series vaped liquids containing tetrahydrocannabinol. Our imaging and pathologic findings support the notion that EVALI is a form of acute lung injury.
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Affiliation(s)
| | - Charlie Lin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Mnahi Bin Saeedan
- Section of Thoracic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Erika E Doxtader
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Valeria Arrossi
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Jordan Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Subha Ghosh
- Section of Thoracic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Humberto Choi
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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47
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Kligerman SJ, Kay FU, Raptis CA, Henry TS, Sechrist JW, Walker CM, Vargas DB, Filev PD, Chung MS, Digumarthy SR, Ropp AM, Mohammed TL, Pope KW, Marquis KM, Chung JH, Kanne JP. CT Findings and Patterns of E-Cigarette or Vaping Product Use-Associated Lung Injury: A Multicenter Cohort of 160 Cases. Chest 2021; 160:1492-1511. [PMID: 33957099 PMCID: PMC8546241 DOI: 10.1016/j.chest.2021.04.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 04/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND E-cigarette and vaping-induced lung injury (EVALI) causes a spectrum of CT lung injury patterns. Relative frequencies and associations with vaping behavior are unknown. RESEARCH QUESTION What are the frequencies of imaging findings and CT patterns in EVALI and what is the relationship to vaping behavior? STUDY DESIGN AND METHODS CT scans of 160 subjects with EVALI from 15 institutions were retrospectively reviewed. CT findings and patterns were defined and agreed on via consensus. The parenchymal organizing pneumonia (OP) pattern was defined as regional or diffuse ground-glass opacity (GGO) ± consolidation without centrilobular nodules (CNs). An airway-centered OP pattern was defined as diffuse CNs with little or no GGO, whereas a mixed OP pattern was a combination of the two. Other patterns included diffuse alveolar damage (DAD), acute eosinophilic-like pneumonia, and pulmonary hemorrhage. Cases were classified as atypical if they did not fit into a pattern. Imaging findings, pattern frequencies, and injury severity were correlated with substance vaped (marijuana derives [tetrahydrocannabinol] [THC] only, nicotine derivates only, and both), vaping frequency, regional geography, and state recreational THC legality. One-way analysis of variance, χ2 test, and multivariable analyses were used for statistical analysis. RESULTS A total of 160 patients (79.4% men) with a mean age of 28.2 years (range, 15-68 years) with EVALI underwent CT scan. Seventy-seven (48.1%), 15 (9.4%), and 68 (42.5%) patients admitted to vaping THC, nicotine, or both, respectively. Common findings included diffuse or lower lobe GGO with subpleural (78.1%), lobular (59.4%), or peribronchovascular (PBV) sparing (40%). Septal thickening (50.6%), lymphadenopathy (63.1%), and CNs (36.3%) were common. PBV sparing was associated with younger age (P = .02). Of 160 subjects, 156 (97.5%) had one of six defined patterns. Parenchymal, airway-centered, and mixed OP patterns were seen in 89 (55.6%), 14 (8.8%), and 32 (20%) patients, respectively. Acute eosinophilic-like pneumonia (six of 160, 3.8%), DAD (nine of 160, 5.6%), pulmonary hemorrhage (six of 160, 3.8%), and atypical (four of 160, 2.5%) patterns were less common. Increased vaping frequency was associated with more severe injury (P = .008). Multivariable analysis showed a negative association between vaping for > 6 months and DAD pattern (P = .03). Two subjects (1.25%) with DAD pattern died. There was no relation between pattern and injury severity, geographic location, and state legality of recreational use of THC. INTERPRETATION EVALI typically causes an OP pattern but exists on a spectrum of acute lung injury. Vaping habits do not correlate with CT patterns except for negative correlation between vaping > 6 months and DAD pattern. PBV sparing, not previously described in acute lung injury, is a common finding.
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Affiliation(s)
- Seth J Kligerman
- Department of Radiology, University of California, San Diego, San Diego, CA.
| | - Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, TX
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology/Washington University School of Medicine, St. Louis, MO
| | - Travis S Henry
- Department of Radiology, University of California, San Francisco, San Francisco, CA
| | - Jacob W Sechrist
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Peter D Filev
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | | | | | - Alan M Ropp
- Department of Radiology, University of Virginia, VA
| | | | - Kristen W Pope
- Department of Radiology, University of Kansas Medical Center, KS
| | - Kaitlin M Marquis
- Mallinckrodt Institute of Radiology/Washington University School of Medicine, St. Louis, MO
| | | | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, WI
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48
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Nemeh H, Coba V, Chulkov M, Gupta A, Yeldo N, Chamogeorgakis T, Tanaka D, Allenspach L, Simanovski J, Shanti C. Lung Transplantation for the Treatment of Vaping-Induced, Irreversible, End-Stage Lung Injury. Ann Thorac Surg 2021; 111:e353-e355. [DOI: 10.1016/j.athoracsur.2020.07.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022]
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49
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Niu S, Colon GR, Molberg K, Chen H, Carrick K, Yan S, Sarode V, Lucas E. Significance of Oil-Red-O positive macrophages in bronchoalveolar lavage in diagnosing E-cigarettes or vaping product use-associated lung injury: A case series. Diagn Cytopathol 2021; 49:876-884. [PMID: 33900686 DOI: 10.1002/dc.24760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lipid-laden macrophages detected by Oil-Red-O (ORO) stain in fresh bronchoalveolar lavage (BAL) specimens have been proposed as a potential diagnostic marker for E-cigarettes or vaping product use-associated lung injury (EVALI). However, studies are few, and the sensitivity and specificity of the test have not been thoroughly investigated. METHODS We performed ORO stain on fresh BAL specimens from six confirmed EVALI and 36 non-EVALI patients. After semi-quantitative analysis, the sensitivity and specificity of ORO-positive macrophages (OPM) for detection of EVALI were calculated. RESULTS No significant difference in cytomorphology or raw macrophage count was observed between EVALI and non-EVALI groups (49% vs 55% of all nucleated cells). However, with ORO stain, all EVALI specimens (6/6) showed a high percentage (≥50% of all macrophages) of OPM (mean 87%), and large (≥25% of host macrophage nuclear size) lipid droplets (mean 42%), while the majority of non-EVALI specimens showed a low percentage of OPM (32/36, mean 10%), and small lipid droplets (34/36, mean 6%). The differences between the two groups in both high OPM and large lipid droplet rates are statistically significant (P < .0001 for both comparisons). The combined sensitivity and specificity of high OPM and large lipid droplets for diagnosing EVALI were 100% and 94%, respectively. CONCLUSION In BAL specimens obtained from patients with clinically suspected EVALI, a high percentage of OPM with large lipid droplets showed high sensitivity and specificity for the diagnosis of EVALI and may serve as a potentially useful tool in the evaluation of vaping-related lung injury, improving diagnostic accuracy.
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Affiliation(s)
- Shuang Niu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Glorimar Rivera Colon
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Kyle Molberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Hao Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Kelley Carrick
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, Parkland Hospital, Dallas, Texas, USA
| | - Shirley Yan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Venetia Sarode
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pathology, Parkland Hospital, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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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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