1
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Escalon JG, Girvin F. Smoking-Related Interstitial Lung Disease and Emphysema. Clin Chest Med 2024; 45:461-473. [PMID: 38816100 DOI: 10.1016/j.ccm.2023.08.016] [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: 06/01/2024]
Abstract
Diagnosis and treatment of patients with smoking-related lung diseases often requires multidisciplinary contributions to optimize care. Imaging plays a key role in characterizing the underlying disease, quantifying its severity, identifying potential complications, and directing management. The primary goal of this article is to provide an overview of the imaging findings and distinguishing features of smoking-related lung diseases, specifically, emphysema/chronic obstructive pulmonary disease, respiratory bronchiolitis-interstitial lung disease, smoking-related interstitial fibrosis, desquamative interstitial pneumonitis, combined pulmonary fibrosis and emphysema, pulmonary Langerhans cell histiocytosis, and E-cigarette or vaping related lung injury.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical College, 525 E 68th Street, New York, NY 10065, USA.
| | - Francis Girvin
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical College, 525 E 68th Street, New York, NY 10065, USA
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2
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Sund LJ, Wood DM, Archer JRH, Blundell MS, Dargan PI. The unseen cloud: a survey of vaping practices and the acquisition of vaping products within the UK. QJM 2023; 116:99-106. [PMID: 36066433 DOI: 10.1093/qjmed/hcac220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/25/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vaping of cannabinoid-based products and informal acquisition of vaping products were associated with the outbreak of E-cigarette or vaping associated lung injury (EVALI) in the USA. Current prevalence of cannabinoid-based vaping within the UK is not known and literature regarding the acquisition of vaping products is limited. AIM To estimate the prevalence of nicotine-based, nicotine-free and cannabinoid-based product vaping within the UK and to determine where vaping products are acquired. DESIGN AND METHODS A voluntary online survey of individuals aged 16 and over within the UK was conducted using a convenience sample. Data were collected on respondent demographics, smoking/vaping history and acquisition of e-liquids/products. RESULTS A total of 2478 responses were included. Median age 45 years (interquartile range 35-57). Prevalence of current vaping of nicotine-based e-liquids, nicotine-free e-liquids and cannabinoid-based products was 14.4%, 11.2% and 5.49%, respectively. Current nicotine-based and nicotine-free vaping was most prevalent in 25-34 years olds (22.4% and 19.2% of respondents). Current cannabinoid-based vaping was most prevalent in 16-24 years olds. The most common 'ever' used cannabinoid-based products were cannabidiol oil/cannabigerol oil and cannabis leaves (4.8%). Specialist vaping stores were the most common source of 'ever' acquisition for all products. 36.8% and 40.5% of respondents who had ever vaped nicotine-based and nicotine-free e-liquids reported prior acquisition from informal sources. CONCLUSION This survey reported a higher prevalence of current cannabinoid-based vaping within the UK (5.5%) than previously reported in the USA (2.0%). In addition to the informal acquisition of vaping products as demonstrated within the survey, these results highlight potential underestimation of the risk of EVALI within the UK.
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Affiliation(s)
- L J Sund
- From the Emergency Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - D M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M S Blundell
- From the Emergency Medicine, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - P I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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3
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Sund LJ, Dargan PI, Archer JRH, Wood DM. E-cigarette or vaping-associated lung injury (EVALI): a review of international case reports from outside the United States of America. Clin Toxicol (Phila) 2023; 61:91-97. [PMID: 36636876 DOI: 10.1080/15563650.2022.2160342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION E-cigarette or vaping-associated lung injury has been reported extensively throughout the United States without a corresponding number of international cases. Cannabinoid-based products have been implicated in the majority of cases. OBJECTIVES To collate published reports of E-cigarette or vaping-associated lung injury outside the United States and to identify the reasons behind the discrepancy in reported cases between the United States and the international community. METHODS PubMed and Healthcare Databases Advanced Search were used to identify published case reports of E-cigarette or vaping-associated lung injury prior to February 2021 using the search terms "e-cigarette", "e-cigarettes", "vaping", "vape" and, "lung injury", "pulmonary", "respiratory". Cases occurring in the United States were excluded. Non-United States case reports were excluded if they did not meet the Centers for Disease Control and Prevention "probable case" criteria. This requires use of a vaping device within 90 days of symptom onset, the presence of pulmonary infiltrates on plain film chest radiography or ground glass opacities on computerised tomography, clinical suspicion that infection was not the underlying cause of lung injury, and the absence of other plausible medical processes to account for the presentation. Patient demographics, nature of exposure, symptomatology and outcome were compared to 125 cases from three regional United States based case series, which were chosen on the basis of having complete data for these comparative factors. RESULTS Seventeen international cases from 13 countries were identified for analysis. There was a male predominance in both non-United States and United States cohorts (76% vs 58-83%), with a marginally higher median patient age in non-United States cases (31 vs 27, 19, 27 years). Reported use of nicotine/flavoured e-liquids was more common in non-United States cases (100% vs 58-67%), and use of cannabinoid-based products was less common (24% vs 78-92%). The most common symptoms across all cohorts were shortness of breath (76% vs 85-91%), cough (59% vs 78-83%) and fever (47% vs 78-83%). The majority of patients were hypoxic (76% vs 69-86%) and required hospital admission (88% vs 90-94%). Fewer of the non-United States patients required intensive care admission (24% vs 55-67%) though their median length of stay was longer (15 days vs 5, 6, 7 days). DISCUSSION Uniformity amongst non-United States cases in regards to nicotine based and/or flavoured e-liquid exposure may underestimate the role of these substances in e-cigarette or vaping-associated lung injury. This is consistent with prior United States based research demonstrating increased presentations to emergency departments prior to the recognised "outbreak" of e-cigarette or vaping-associated lung injury at a time of increased nicotine based e-liquid uptake. A longer length of hospital stay, lower rate of intensive care admission and a higher rate of bronchoscopy in the non-United States cohort could be indicative of clinician inexperience internationally. It is unclear why the non-United States cases also had a lower incidence of gastrointestinal symptoms however this may also be explained by poorer diagnostic awareness. CONCLUSIONS E-cigarette or vaping-associated lung injury is not limited to cannabinoid-based products. Apparent similarities in patient demographics, clinical features, and clinical course between non-United States and United States cases raise concern for underreporting of E-cigarette or vaping- associated lung injury internationally.
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Affiliation(s)
- Lachlan J Sund
- Emergency Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom of Great Britain and Northern Ireland
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom of Great Britain and Northern Ireland
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - John R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom of Great Britain and Northern Ireland
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom of Great Britain and Northern Ireland
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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4
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Giovacchini CX, Crotty Alexander LE, Que LG. Electronic Cigarettes: A Pro-Con Review of the Current Literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2843-2851. [PMID: 35872217 DOI: 10.1016/j.jaip.2022.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Electronic cigarettes (e-cigarettes, e-cigs, or electronic nicotine delivery systems) are battery-operated devices typically containing glycerol and/or propylene glycol-based solutions with varying nicotine content, known as e-liquids. Although e-cigarettes were originally developed as a potentially less harmful alternative to traditional combustible tobacco cigarette smokers, several factors have driven their popularity among smokers and nonsmokers alike, including their sleek product designs, innumerable appealing flavors, lack of combustible smoke and odor, and high potential nicotine concentrations. Furthermore, many advocates have promoted the idea that e-cigarettes are safe to use, or at least safer than conventional tobacco, despite limited longitudinal data to support these claims. Here, we examine what is known about the impacts of e-cigarette use on traditional cigarette smoking cessation, lung health, and youth and young adult tobacco product exposure. Upon review of the currently available literature, the negative effects of e-cigarette use seem to outweigh any potential benefit, because the available evidence does not confirm the use of e-cigarettes as an effective strategy for supporting traditional combustible tobacco cigarette smoking cessation, particularly given the emerging adverse effects on lung health and the potential future public health effects of e-cigarette adoption among a burgeoning new generation of tobacco product users.
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Affiliation(s)
- Coral X Giovacchini
- Division of Pulmonary, Allergy, and Critical Care, Duke University Health System, Durham, NC
| | - Laura E Crotty Alexander
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, Calif; Division of Pulmonary, Critical Care, Sleep, and Physiology, University of California San Diego, San Diego, Calif.
| | - Loretta G Que
- Division of Pulmonary, Allergy, and Critical Care, Duke University Health System, Durham, NC.
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Do Not Miss Acute Diffuse Panbronchiolitis for Tree-in-Bud: Case Series of a Rare Lung Disease. Diagnostics (Basel) 2022; 12:diagnostics12071653. [PMID: 35885557 PMCID: PMC9323848 DOI: 10.3390/diagnostics12071653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Acute bronchiolitis is a common disease of infants affecting the small airways. Rarely, acute bronchiolitis may occur in adolescents and adults. Here, we present four unrelated adolescent patients with severe clinical presentation and unique CT imaging with extensive tree-in-bud pattern, representing a rare clinical phenotype of acute diffuse panbronchiolitis. This characteristic disease pattern caused by inhalation injury from waterpipes, smoked tobacco, and cannabinoids must be differentiated from e-cigarette or vaping product-use-associated lung injury (EVALI). Visual diagnosis of CT and an early diagnostic procedure for detection and differentiation of inhaled hazards, including sample storage for future identification of novel noxious agents, are warranted.
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Hopkinson NS. Medicinal licensing of e-cigarettes. Lancet 2022; 399:1602-1603. [PMID: 35358422 DOI: 10.1016/s0140-6736(22)00334-8] [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: 12/22/2021] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nicholas S Hopkinson
- National Heart and Lung Institute, Royal Brompton Hospital Campus, Imperial College London, London, SW3 6NP, UK.
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7
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Pediatric hypersensitivity pneumonitis: literature update and proposal of a diagnostic algorithm. Ital J Pediatr 2022; 48:51. [PMID: 35346317 PMCID: PMC8962565 DOI: 10.1186/s13052-022-01239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a rare disease in childhood with the prevalence of 4 cases per 1 million children and an incidence of 2 cases per year. The average age of diagnosis at pediatric age is approximately 10 years. The pathogenesis of HP is characterized by an immunological reaction caused by recurrent exposure to triggering environmental agents (mostly bird antigens in children). The clinical picture of HP is complex and variable in children, often presenting in subacute forms with cough and exertion dyspnea. A diagnosis of HP should be considered in patients with an identified exposure to a triggering antigen, respiratory symptoms, and radiologic signs of interstitial lung disease. Blood tests and pulmonary function tests (PFT) support the diagnosis. Bronchoscopy (with bronchoalveolar lavage and tissue biopsy) may be needed in unclear cases. Antigen provocation test is rarely required. Of note, the persistence of symptoms despite various treatment regimens may support HP diagnosis. The avoidance of single/multiple triggers is crucial for effective treatment. No evidence- based guidelines for treatment are available; in particular, the role of systemic glucocorticoids in children is unclear. With adequate antigen avoidance, the prognosis in children with HP is generally favorable.
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8
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Smith JM, Smedley M, Kansra S, Kulkarni H. Vaping induced lung injury in a 14-year-old girl. Pediatr Pulmonol 2022; 57:320-321. [PMID: 34637611 DOI: 10.1002/ppul.25705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/12/2021] [Accepted: 09/11/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Jonathan M Smith
- Department of Research and Innovation, Children's Clinical Research Fellow, Leeds Children's Hospital, Leeds, UK
| | - Matthew Smedley
- Consultant Radiologist, Department of Radiology, Sheffield Children's Hospital, Sheffield, UK
| | - Sonal Kansra
- Department of Respiratory Paediatrics, Consultant, Sheffield Children's Hospital, Sheffield, UK
| | - Hemant Kulkarni
- Department of Respiratory Paediatrics, Consultant, Sheffield Children's Hospital, Sheffield, UK
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9
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Brown S, Nwokoro C, Bush A, Lenney W, Vestbo J, Pao C, Thavagnanam S. Another public health catastrophe. Lancet 2021; 398:2243. [PMID: 34922664 DOI: 10.1016/s0140-6736(21)02730-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Sarah Brown
- Department of Paediatric Respiratory Medicine, Barts Health NHS Trust, Royal London Hospital, London, E1 1FR, UK.
| | - Chinedu Nwokoro
- Department of Paediatric Respiratory Medicine, Barts Health NHS Trust, Royal London Hospital, London, E1 1FR, UK
| | - Andrew Bush
- Royal Brompton Hospital, London, UK; Department of Paediatric Respiratory Medicine, National Heart & Lung Institute, London, UK
| | - Warren Lenney
- Paediatric Child Health, Keele University, Keele, UK
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Caroline Pao
- Department of Paediatric Respiratory Medicine, Barts Health NHS Trust, Royal London Hospital, London, E1 1FR, UK
| | - Surendran Thavagnanam
- Department of Paediatric Respiratory Medicine, Barts Health NHS Trust, Royal London Hospital, London, E1 1FR, UK
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Devresse A, Gohy S, Robert A, Kanaan N. How to manage cigarette smoking in kidney transplant candidates and recipients? Clin Kidney J 2021; 14:2295-2303. [PMID: 34754426 PMCID: PMC8572985 DOI: 10.1093/ckj/sfab072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 01/15/2023] Open
Abstract
Tobacco smoking is a frequent problem affecting many kidney transplant (KT) candidates and recipients. The negative impact of active smoking on KT outcomes has been demonstrated. Consequently, most guidelines strongly recommend quitting smoking before considering kidney transplantation. However, nicotine addiction is a complex multifactorial disease and only 3–5% of the patients who try to quit by themselves achieve prolonged abstinence. Smoking cessation programmes (SCPs) have proven their efficacy in the general population to increase the rate of quitting and should therefore be proposed to all smoking KT candidates and recipients. Nevertheless, SCPs have not been evaluated in the KT field and not all KT centres have easy access to these programmes. In this work, we aim to review the current knowledge on the subject and provide an overview of the available interventions to help smoking patients quit. We detail non-pharmaceutical and pharmaceutical approaches and discuss their use in KT candidates and recipients.
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Affiliation(s)
- Arnaud Devresse
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sophie Gohy
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Arnaud Robert
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nada Kanaan
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Bourke M, Sharif N, Narayan O. Association between electronic cigarette use in children and adolescents and coughing a systematic review. Pediatr Pulmonol 2021; 56:3402-3409. [PMID: 34407315 DOI: 10.1002/ppul.25619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The use of electronic cigarettes (e-cigarettes) among adolescents is increasing worldwide. E-cigarettes are marketed as a safe alternative to other tobacco products. The aim of this systematic review is to evaluate whether e-cigarette use in children and adolescents is associated with coughing. METHOD Studies were identified through systematic searches of Excerpta Medica Database, Medline, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, OVID Emcare, Health Management Information Consortium, PsycINFO, and Allied and Complementary Medicine. The Grey Literature was also searched. Selected studies either contained only children and adolescents as study participants or if adults were included, the data for adolescents and children must be presented separately. RESULTS Seven studies were selected from 104. Three studies compared e-cigarette users with nonusers; two studies found a significant association between coughing and e-cigarette use in adolescence. Two studies investigated whether adolescents attributed their symptoms to their e-cigarette use. One study reported that coughing was the most likely negative symptom reported by adolescents on initiation of e-cigarette use; the other study found that adolescents, on initiation of e-cigarette use, reported coughing. Two studies looked at the cases of children and adolescents who had presented to the hospital after e-cigarette use and found coughing was a common presenting symptom. CONCLUSION This systematic review shows that adolescent use of e-cigarettes is associated with increased coughing and e-cigarette users are more likely to report coughing compared to non-users.
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Affiliation(s)
- Michael Bourke
- Paediatric Respiratory, Royal Manchester Children's Hospital, Manchester, UK
| | - Naseem Sharif
- Paediatric Respiratory, Royal Manchester Children's Hospital, Manchester, UK
| | - Omendra Narayan
- Paediatric Respiratory, Royal Manchester Children's Hospital, Manchester, UK
- Department of Medical Education, University of Manchester, Manchester, UK
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12
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Extracorporeal Life Support for Respiratory Failure in Patients With Electronic Cigarette or Vaping Product Use-Associated Lung Injury. Crit Care Med 2021; 50:e173-e182. [PMID: 34524154 DOI: 10.1097/ccm.0000000000005299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electronic cigarette or vaping product use-associated lung injury is a clinical entity that can lead to respiratory failure and death. Despite the severity of electronic cigarette or vaping product use-associated lung injury, the role of extracorporeal life support in its management remains unclear. Our objective was to describe the clinical characteristics and outcomes of patients with electronic cigarette or vaping product use-associated lung injury who received extracorporeal life support. DESIGN We performed a retrospective review of records of electronic cigarette or vaping product use-associated lung injury patients who received extracorporeal life support. Standardized data were collected via direct contact with extracorporeal life support centers. Data regarding presentation, ventilatory management, extracorporeal life support details, and outcome were analyzed. SETTING This was a multi-institutional, international case series with patients from 10 different institutions in three different countries. PATIENTS Patients who met criteria for confirmed electronic cigarette or vaping product use-associated lung injury (based on previously reported diagnostic criteria) and were placed on extracorporeal life support were included. Patients were identified via literature review and by direct contact with extracorporeal life support centers. MEASUREMENTS AND MAIN RESULTS Data were collected for 14 patients ranging from 16 to 45 years old. All had confirmed vape use within 3 months of presentation. Nicotine was the most commonly used vaping product. All patients had respiratory symptoms and radiographic evidence of bilateral pulmonary opacities. IV antibiotics and corticosteroids were universally initiated. Patients were intubated for 1.9 days (range, 0-6) prior to extracorporeal life support initiation. Poor oxygenation and ventilation were the most common indications for extracorporeal life support. Five patients showed evidence of ventricular dysfunction on echocardiography. Thirteen patients (93%) were placed on venovenous extracorporeal life support, and one patient required multiple rounds of extracorporeal life support. Total extracorporeal life support duration ranged from 2 to 37 days. Thirteen patients survived to hospital discharge; one patient died of septic shock. CONCLUSIONS Electronic cigarette or vaping product use-associated lung injury can cause refractory respiratory failure and hypoxemia. These data suggest that venovenous extracorporeal life support can be an effective treatment option for profound, refractory respiratory failure secondary to electronic cigarette or vaping product use-associated lung injury.
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Kotoulas SC, Katsaounou P, Riha R, Grigoriou I, Papakosta D, Spyratos D, Porpodis K, Domvri K, Pataka A. Electronic Cigarettes and Asthma: What Do We Know So Far? J Pers Med 2021; 11:jpm11080723. [PMID: 34442368 PMCID: PMC8399607 DOI: 10.3390/jpm11080723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 12/20/2022] Open
Abstract
Electronic cigarettes (EC) are a novel product, marketed as an alternative to tobacco cigarette. Its effects on human health have not been investigated widely yet, especially in specific populations such as patients with asthma. With this review, we use the existing literature in order to answer four crucial questions concerning: (1) ECs' role in the pathogenesis of asthma; (2) ECs' effects on lung function and airway inflammation in patients with asthma; (3) ECs' effects on asthma clinical characteristics in asthmatics who use it regularly; and (4) ECs' effectiveness as a smoking cessation tool in these patients. Evidence suggests that many EC compounds might contribute to the pathogenesis of asthma. Lung function seems to deteriorate by the use of EC in this population, while airway inflammation alters, with the aggravation of T-helper-type-2 (Th2) inflammation being the most prominent but not the exclusive effect. EC also seems to worsen asthma symptoms and the rate and severity of exacerbations in asthmatics who are current vapers, whilst evidence suggests that its effectiveness as a smoking cessation tool might be limited. Asthmatic patients should avoid using EC.
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Affiliation(s)
- Serafeim-Chrysovalantis Kotoulas
- Clinic of Respiratory Failure, General Hospital of Thessaloniki Georgios Papanikolaou, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (I.G.); (A.P.)
- Correspondence: ; Tel.: +30-6977-705450
| | - Paraskevi Katsaounou
- 1st ICU “Evangelismos Hospital”, School of Medicine, National and Kapodistrian University of Athens, Ypsilantou 45-47, 10676 Athens, Greece;
| | - Renata Riha
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK;
| | - Ioanna Grigoriou
- Clinic of Respiratory Failure, General Hospital of Thessaloniki Georgios Papanikolaou, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (I.G.); (A.P.)
| | - Despoina Papakosta
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Dionysios Spyratos
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Konstantinos Porpodis
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Kalliopi Domvri
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Athanasia Pataka
- Clinic of Respiratory Failure, General Hospital of Thessaloniki Georgios Papanikolaou, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (I.G.); (A.P.)
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14
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Bush A, Ferkol T, Valiulis A, Mazur A, Chkhaidze I, Maglakelidze T, Sargsyan S, Boyajyan G, Cirstea O, Doan S, Katilov O, Pokhylko V, Dubey L, Poluziorovienė E, Prokopčiuk N, Taminskienė V, Valiulis A. Unfriendly Fire: How the Tobacco Industry is Destroying the Future of Our Children. Acta Med Litu 2021; 28:6-18. [PMID: 34393624 PMCID: PMC8311841 DOI: 10.15388/amed.2020.28.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022] Open
Abstract
Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned by European Union legislation. Accelerating numbers of young people are vaping, and this does not reflect an exchange of vapes for cigarettes. The acute toxicity of e-cigarettes is greater than that of tobacco, and includes acute lung injury, pulmonary haemorrhage and eosinophilic and lipoid pneumonia. Given the worse acute toxicity, it should be impossible to be complacent about medium and long term effects of vaping. Laboratory studies have demonstrated changes in lung proteomics and the innate immune system with vaping, some but not all of which overlap with tobacco. It would be wrong to consider vapes as a weaker form of tobacco, they have their own toxicity. Children and young people are being targeted by the vaping industry (which is largely the same as the tobacco industry), including on-line, and unless an efficient legislative program is put in place, a whole new generation of nicotine addicts will result.
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Affiliation(s)
- Andrew Bush
- Imperial College Centre for Paediatrics and Child Health, London, UK
National Heart and Lung Institute, London, UK
Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Thomas Ferkol
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Algirdas Valiulis
- Vilnius University Medical Faculty Institute of Health Sciences, Vilnius, Lithuania
| | - Artur Mazur
- Medical College of Rzeszow University, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Rzeszow, Poland
| | - Ivane Chkhaidze
- Tbilisi State Medical University, Department of Paediatrics, Tbilisi, Georgia
Iashvili Central Children’s Hospital, Tbilisi, Georgia
| | - Tamaz Maglakelidze
- Ivane Javakhishvili Tbilisi State University, Department of Pulmonology, Tbilisi, Georgia
Chapidze Emergency Cardiology Center, Tbilisi, Georgia Planning Committee of Global Initiative Against Chronic Respiratory Diseases (WHO GARD), Geneva, Switzerland
| | - Sergey Sargsyan
- Arabkir Medical Centre, Instutute of Child and Adolescent Health, Yerevan, Armenia
| | - Gevorg Boyajyan
- Arabkir Medical Centre, Instutute of Child and Adolescent Health, Yerevan, Armenia
| | - Olga Cirstea
- University of Medicine and Pharmacy “Nicolae Testemitanu”, Department of Paediatrics, Chisinau, Republic of Moldova
| | - Svitlana Doan
- Kyiv Medical University, Department of Public Health and Microbiology, Kyiv, Ukraine
| | | | - Valeriy Pokhylko
- Ukrainian Medical Stomatological Academy, Department of Paediatrics, Poltava, Ukraine
| | - Leonid Dubey
- Lviv National Medical University by Danylo Galytsky, Lviv, Ukraine
| | - Edita Poluziorovienė
- Vilnius University Medical Faculty Institute of Clinical Medicine, Vilnius, Lithuania
| | - Nina Prokopčiuk
- Vilnius University Medical Faculty Institute of Clinical Medicine, Vilnius, Lithuania
| | - Vaida Taminskienė
- Vilnius University Medical Faculty Institute of Health Sciences, Vilnius, Lithuania
| | - Arūnas Valiulis
- Vilnius University Medical Faculty Institute of Health Sciences, Vilnius, Lithuania
Vilnius University Medical Faculty Institute of Clinical Medicine, Vilnius, Lithuania
Planning Committee of Global Initiative Against Chronic Respiratory Diseases (WHO GARD), Geneva, Switzerland
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15
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Marlière C, De Greef J, Gohy S, Hoton D, Wallemacq P, Jacquet LM, Belkhir L. Fatal e-cigarette or vaping associated lung injury (EVALI): a first case report in Europe. Eur Respir J 2020; 56:13993003.00077-2020. [PMID: 32217651 DOI: 10.1183/13993003.00077-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Camille Marlière
- Dept of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint Luc, Brussels, Belgium.,These authors have contributed equally to this work
| | - Julien De Greef
- Dept of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint Luc, Brussels, Belgium .,Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium.,These authors have contributed equally to this work
| | - Sophie Gohy
- Pneumology Dept, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Delphine Hoton
- Pathology Dept, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Pierre Wallemacq
- Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium.,Clinical Chemistry Dept, Cliniques universitaires St Luc, Brussels, Belgium
| | - Luc-Marie Jacquet
- Cardiac ICU Dept, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Leïla Belkhir
- Dept of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint Luc, Brussels, Belgium.,Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium
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16
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Isakov KMM, Legasto AC, Hossain R, Verzosa Weisman S, Toy D, Groner LK, Feibusch A, Escalon JG. A Case-Based Review of Vaping-Induced Injury-Pulmonary Toxicity and Beyond. Curr Probl Diagn Radiol 2020; 50:401-409. [PMID: 32703539 DOI: 10.1067/j.cpradiol.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
The last 10 years has seen a steady rise in the use of electronic cigarettes ("e-cigarettes" or ECIGs) or "vape pens." Though initially developed to assist with smoking cessation, use among adolescents has been particularly high. A concomitant rise in ECIG-related injuries disproportionately affecting young patients has been recognized. This unique case series highlights both pulmonary and extra-pulmonary ECIG-induced injuries including vape tip ingestion, maxillofacial fractures after vape pen explosion, myocarditis, and several different manifestations of vaping-associated lung injury. Becoming familiar with expected imaging findings in the wide array of ECIG-induced complications will help radiologists recognize these findings, recommend further imaging as needed, facilitate early diagnosis by help referring clinicians elicit the relevant history from patients, and expedite appropriate treatment.
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Affiliation(s)
- Kimberly M M Isakov
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Alan C Legasto
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Rydhwana Hossain
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Stacey Verzosa Weisman
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Dennis Toy
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Lauren K Groner
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Amanda Feibusch
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Joanna G Escalon
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY.
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17
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Electronic cigarette vapour moderately stimulates pro-inflammatory signalling pathways and interleukin-6 production by human monocyte-derived dendritic cells. Arch Toxicol 2020; 94:2097-2112. [PMID: 32372213 PMCID: PMC7303083 DOI: 10.1007/s00204-020-02757-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
Dendritic cells (DCs) are professional antigen presenting cells that play a critical role in bridging innate and adaptive immunity. Numerous studies have shown that tobacco constituents present in conventional cigarettes affect the phenotype and function of DCs; however, no studies have examined the effects of vapour from E-cigarettes on human DCs. Here, the effects of E-cigarette vapour extract (ECVE) on the phenotype and function of DCs were investigated by creating an in vitro cell culture model using human monocyte-derived DCs (MoDCs). Immature DCs were generated from peripheral blood monocytes and mature DCs were then produced by treatment with LPS or Poly I:C for 24 h. For LPS-matured DCs, 3% ECVE treatment slightly suppressed HLA-DR and CD86 expression, whereas 1% ECVE treatment enhanced IL-6 production. The overall expression of 29 signalling molecules and other cytoplasmic proteins (mainly associated with DC activation) was significantly upregulated in immature DCs by 1% ECVE, and in LPS-treated DCs by 3% ECVE. In particular, the condition that induced IL-6 production also upregulated MAPK pathway activation. These findings indicate that E-cigarette vapour moderately affects human DCs, but the effects are less pronounced than those reported for tobacco smoke.
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18
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Bush A, Bhatt JM, Carroll W, Child F, Connett G, Doull I, Gilchrist F, Grigg J, Langton-Hewer S, Legg J, Lenney W, Paton J, Shields M, Sinha I. The ERS approach to e-cigarettes is entirely rational. Eur Respir J 2020; 55:2000413. [PMID: 32381632 DOI: 10.1183/13993003.00413-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew Bush
- Imperial College, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Will Carroll
- Paediatrics, Derby Hospitals NHS Trust, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Frances Child
- Dept of Respiratory Paediatrics, Central Manchester and Manchester Children, Manchester, UK
| | - Gary Connett
- University Hospital Southampton NHS Foundation Trust, University Hospital Southampton, Southampton, UK
| | - Iolo Doull
- Children's Hospital for Wales, Cardiff, UK
| | - Francis Gilchrist
- Paediatric Respiratory Services, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Queen Mary University London, London, UK
| | | | - Julian Legg
- Southampton University Hospitals NHS Trust, Southampton, UK
| | - Warren Lenney
- Academic Department of Child Health, University Hospital of North Staffordshire and Keele University, Stoke-on-Trent, UK
| | - James Paton
- Royal Hospital for Sick Children, Glasgow, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ian Sinha
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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19
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Eaton L. Severe allergic reaction to vaping prompts warning from doctors. BMJ 2019; 367:l6473. [PMID: 31719042 DOI: 10.1136/bmj.l6473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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