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Callahan SJ, Beck E, Blagev D, Harris D, Lanspa M, Brown S, Reilly CA, Paine R, Warren KJ. Vitamin E Acetate Is Associated with Select Proinflammatory Cytokines: An Analysis of a 2020-2022 Cohort of EVALI Patients. Am J Respir Crit Care Med 2024; 209:1404-1407. [PMID: 38530102 PMCID: PMC11146565 DOI: 10.1164/rccm.202311-2155le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Sean J. Callahan
- Pulmonary Division, Department of Internal Medicine
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
| | - Emily Beck
- Pulmonary Division, Department of Internal Medicine
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
| | | | | | | | | | - Christopher A. Reilly
- Department of Pharmacology and Toxicology, College of Pharmacy, and
- Center for Human Toxicology, University of Utah, Salt Lake City, Utah
| | - Robert Paine
- Pulmonary Division, Department of Internal Medicine
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
| | - Kristi J. Warren
- Pulmonary Division, Department of Internal Medicine
- Department of Pharmacology and Toxicology, College of Pharmacy, and
- Center for Human Toxicology, University of Utah, Salt Lake City, Utah
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
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Barker CK, Ghera P, Hsu B. The Evolution of a Pediatric Public Health Crisis: E-cigarette or Vaping-Associated Lung Injury. Pediatrics 2024; 153:e2023063484. [PMID: 38629169 DOI: 10.1542/peds.2023-063484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 05/02/2024] Open
Abstract
E-cigarettes and vaping products were first introduced in the United States around 2007, and quickly grew in popularity. By 2014, e-cigarettes had become the most commonly used tobacco product among youth in the United States. An e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak was identified by the Centers for Disease Control and Prevention (CDC) in 2019, with many cases in the adolescent population. The CDC opened a national database of cases and launched a multistate investigation; reported cases reached a peak in September 2019. The CDC investigation found that a vaping liquid additive, vitamin E acetate, was strongly linked to the EVALI outbreak but determined that the decline in cases was likely multifactorial. Due to decreased cases and the identification of a potential cause of the outbreak, the CDC stopped collecting data on EVALI cases as of February 2020. However, e-cigarettes and vaping products have continued to be the most popular tobacco product among youth, though state and national regulations on these products have increased since 2016. While pediatric case series and studies have shown differences in clinical presentation and medical histories between pediatric and adult EVALI cases, the fact that cases are no longer tracked at a national level limits necessary information for pediatric clinicians and researchers. We describe the available literature on the diagnosis, pathophysiology, treatment, and outcomes of EVALI in the pediatric population, and provide clinical and public health recommendations to facilitate prevention and management of EVALI specific to pediatrics.
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Affiliation(s)
| | - Princy Ghera
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benson Hsu
- University of South Dakota, Sioux Falls, South Dakota
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3
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Jiménez-Ruiz CA, Rábade-Castedo C, de Granda-Orive JI. Electronic Cigarettes are Neither Effective Nor Safe for Quitting Smoking: A Critical View of the Most Recent Meta-Analyses. Arch Bronconeumol 2024; 60:195-196. [PMID: 38160162 DOI: 10.1016/j.arbres.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | - Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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4
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Hinckley J, Bhatia D, Ellingson J, Molinero K, Hopfer C. The impact of recreational cannabis legalization on youth: the Colorado experience. Eur Child Adolesc Psychiatry 2024; 33:637-650. [PMID: 35428897 PMCID: PMC10097013 DOI: 10.1007/s00787-022-01981-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Abstract
Over the past two decades, cannabis policies have liberalized in the United States, culminating in the legalization of recreational cannabis in Colorado and Washington state in 2012. This review will focus on the impact of recreational cannabis legalization in Colorado. While the prevalence of past-year and past-month cannabis use has remained relatively steady among adolescents post-legalization, the prevalence of young adult use has continued to rise. Cannabis products with increased potency have become more prevalent and widely used. There are concerns that the use of products with increased potency will increase risk for cannabis use and comorbid mental health disorders, particularly cannabis-induced psychosis and suicidal behavior, although more research is needed to fully understand the impact of high-potency products. Since the legalization of recreational cannabis, numerous additional public health concerns have emerged: unintentional overdoses requiring acute care visits, electronic vaping-associated lung injury, increased motor vehicle collisions related to cannabis consumption, and higher rates of cannabis use during pregnancy. Lessons learned from the first decade of cannabis legalization emphasize the need for research efforts to provide evidence-based guidelines, inform prevention strategies, and implement selective interventions for at-risk populations including youth, individuals with comorbid mental health disorders, and individuals who are pregnant.
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Affiliation(s)
- Jesse Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Devika Bhatia
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jarrod Ellingson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karla Molinero
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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5
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Vaziri S, McGarry ME, Huang CY, Cuneo AA, Willen SM, Iwanaga K, Neemuchwala F, Gibb ER, Chan M, Ly NP. Time to be blunt: Substance use in cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 38251844 DOI: 10.1002/ppul.26880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND As the population of people with cystic fibrosis (pwCF) continues to age, attention is shifting towards addressing the unique challenges teenagers and adults face, including substance use. Changing attitudes and legality regarding marijuana and cannabidiol (CBD) may influence their use among pwCF, but data on the rate of use, reasons for use, and administration methods are lacking. OBJECTIVE Investigate marijuana, CBD, e-cigarette, and cigarette usage among pwCF and explore differences in demographics, disease severity, and cystic fibrosis transmembrane receptor (CFTR) modulator use between recent users and nonusers. METHODS This cross-sectional study used a one-time electronic survey to assess marijuana, CBD, e-cigarette, and cigarette use in pwCF aged >13 years. Demographic and clinical characteristics were compared between recent users and nonusers. The association between recent substance use and CFTR modulator use was analyzed using logistic regressions. RESULTS Among 226 participants, 29% used marijuana, 22% used CBD, 27% used e-cigarettes, and 22% used cigarettes in the last 12 months. Users of all substances were more likely to be college-educated or aged 29-39 years than nonusers. E-cigarette users were 2.9 times more likely to use CFTR modulators (95% confidence interval [95% CI]: 0.98-11.00, p = .08) and marijuana users were 2.5 times more likely to use CFTR modulators compared to nonusers, adjusted for confounders. CBD, e-cigarettes, and cigarettes users were more likely to have an abnormal mental health screen compared to nonusers. A high proportion of never-users of marijuana and CBD expressed interest in using. CONCLUSION Substance use is more prevalent among pwCF than previously reported and needs to be addressed by healthcare providers.
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Affiliation(s)
- Sanaz Vaziri
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Shaina M Willen
- Department of Pediatrics, University of California Davis, Davis, California, USA
| | - Kensho Iwanaga
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Fatima Neemuchwala
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth R Gibb
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Marilynn Chan
- Department of Pediatrics, Kaiser Permanente, Oakland, California, USA
| | - Ngoc P Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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Alqahtani MM, Alenezi FK, Almeshari MA, Alanazi AM, Taleb ZB, Kalan MEE, Martinasek MP, McNab RJ, Culbreth R, Alotaibi M, Aljohani H, Goodfellow LT, Ismaeil TT, Algarni SS, Alotaibi TF, Alqahtani MK, Al-Ajel H, Alwadeai KS, Almutairi NS, Ford E. E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis. Tob Induc Dis 2023; 21:168. [PMID: 38098748 PMCID: PMC10720266 DOI: 10.18332/tid/174660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. METHODS Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). RESULTS The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. CONCLUSIONS Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use.
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Affiliation(s)
- Mohammed M. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Population Science, American Cancer Society, Atlanta, United States
| | - Faraj K. Alenezi
- Department of Anaesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Birmingham Acute Care Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mohammed A. Almeshari
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M. Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ziyad Ben Taleb
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, United States
| | | | - Mary P. Martinasek
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, United States
| | - Rheese J. McNab
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, United States
| | - Rachel Culbreth
- Department of Respiratory Therapy, Georgia State University, Atlanta, United States
| | - Mansour Alotaibi
- Department of Physical Therapy, Northern Border University, Arar, Saudi Arabia
| | - Hassan Aljohani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Lynda T. Goodfellow
- Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, United States
| | - Taha T. Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saleh S. Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tareq F. Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mobarak K. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamoud Al-Ajel
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, AlRiyadh, Saudi Arabia
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, United States
| | - Khalid S. Alwadeai
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nafea S. Almutairi
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eric Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, United States
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Osman A, Petrescu GS, Tuculină MJ, Dascălu IT, Popescu C, Enescu AȘ, Dăguci C, Cucu AP, Nistor C, Carsote M. Metabolic and Other Endocrine Elements with Regard to Lifestyle Choices: Focus on E-Cigarettes. Metabolites 2023; 13:1192. [PMID: 38132874 PMCID: PMC10745117 DOI: 10.3390/metabo13121192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Our objective was to overview recent data on metabolic/endocrine disorders with respect to e-cigarette (e-cig) use. This is a narrative review; we researched English, full-length, original articles on PubMed (between January 2020 and August 2023) by using different keywords in the area of metabolic/endocrine issues. We only included original clinical studies (n = 22) and excluded case reports and experimental studies. 3 studies (N1 = 22,385; N2 = 600,046; N3 = 5101) addressed prediabetes risk; N1 showed a 1.57-fold increased risk of dual vs. never smokers, a higher risk that was not confirmed in N2 (based on self-reported assessments). Current non-smokers (N1) who were dual smokers still have an increased odd of prediabetes (a 1.27-fold risk increase). N3 and another 2 studies addressed type 2 diabetes mellitus (DM): a lower prevalence of DM among dual users (3.3%) vs. cigarette smoking (5.9%) was identified. 6 studies investigated obesity profile (4 of them found positive correlations with e-cig use). One study (N4 = 373,781) showed that e-cig use was associated with obesity in the general population (OR = 1.6, 95%CI: 1.3-2.1, p < 0.05); another (N5 = 7505, 0.82% were e-cig-only) showed that obesity had a higher prevalence in dual smokers (51%) vs. cig-only (41.2%, p < 0.05), while another (N6 = 3055) found that female (not male) e-cig smokers had higher body mass index vs. non-smokers. Data on metabolic syndrome (MS) are provided for dual smokers (n = 2): one case-control study found that female dual smokers had higher odds of MS than non-smokers. The need for awareness with respect to potential e-cig--associated medical issues should be part of modern medicine, including daily anamnesis. Whether the metabolic/endocrine frame is part of the general picture is yet to be determined. Surveillance protocols should help clinicians to easily access the medical background of one subject, including this specific matter of e-cig with/without conventional cigarettes smoking and other habits/lifestyle elements, especially when taking into consideration metabolism anomalies.
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Affiliation(s)
- Andrei Osman
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Department ENT & Clinical Emergency County Hospital of Craiova, 200349 Craiova, Romania; (A.O.); (C.P.); (A.-Ș.E.)
| | - Gabriel Sebastian Petrescu
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela Jana Tuculină
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ionela Teodora Dascălu
- Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cristina Popescu
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Department ENT & Clinical Emergency County Hospital of Craiova, 200349 Craiova, Romania; (A.O.); (C.P.); (A.-Ș.E.)
| | - Anca-Ștefania Enescu
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Department ENT & Clinical Emergency County Hospital of Craiova, 200349 Craiova, Romania; (A.O.); (C.P.); (A.-Ș.E.)
| | - Constantin Dăguci
- Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca-Pati Cucu
- PhD Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest & Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Claudiu Nistor
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy & Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania;
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania;
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Kulak JA, Voit HE, Balfour CA, Homish GG. College health providers' knowledge and confidence in addressing students' vaping: Evidence from a pilot study in New York State. PEC INNOVATION 2023; 2:100123. [PMID: 37214494 PMCID: PMC10194164 DOI: 10.1016/j.pecinn.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 05/24/2023]
Abstract
Objective This study examines the knowledge and confidence of college healthcare providers in discussing vaping with their college student populations. Methods This is a mixed-methods descriptive study using a sequential-explanatory approach, consisting of a cross-sectional, online survey followed by qualitative interviews. Survey data was collected from 50 college health providers located at 26 colleges in the 64-campus State University of New York system. Targeted semi-structured interviews (N = 11) were conducted by telephone with providers who completed the survey. Results Despite high reported levels of knowledge and confidence, few providers had participated in educational activities relative to vaping. There was evidence of misinformation about e-cigarettes, and they did not know what product (nicotine/cannabis) students typically vape. Conclusions Findings indicate a potential disconnect between providers' perceived and actual knowledge of college student vaping and demonstrate areas of opportunity to assist college health providers in comprehensively addressing vaping with their college student populations. Innovation College health providers played a key role in lowering rates of combustible cigarette smoking, but little is known about how they are now are communicating with college students about e-cigarette and cannabis vaping. This paper examines college health providers' knowledge, confidence, and training needs relative to vaping communications.
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Affiliation(s)
- Jessica A. Kulak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Hannah E. Voit
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Cierra A. Balfour
- Department of Health, Nutrition, and Dietetics, Buffalo State College, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Henn SL, Martinasek MP, Lange M. Vaping Behavior in Young Adults During the COVID-19 Pandemic. Respir Care 2023; 68:1493-1501. [PMID: 37024281 PMCID: PMC10589117 DOI: 10.4187/respcare.10629] [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: 10/07/2022] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS) continue to be popular among young adults. These devices are often advertised as a healthy alternative to quitting tobacco cigarettes. However, young adults represent a population who view it as a novel behavior that provides a sense of popularity, social acceptance, and desired physiologic properties. The objective of this study was to examine characteristics of vaping behavior among college students and explore possible associations between groups of vaping behavior (stopped, initiated, increased, decreased, stayed the same). METHODS In a multi-center cross-sectional study, 656 students from University of Tampa in the United States and University of Applied Sciences in Germany (IST) were recruited to answer a 31-item online questionnaire. A chi-square test was used to evaluate associations between the groups. RESULTS Prevalence rates indicated approximately 31% of all students were currently using ENDS. Even though more negative than positive experiences with ENDS were reported, most students stated their vaping increased during COVID-19 lockdowns. Addiction and stress relief emerged to be predictors (P < .001) of an increase in vaping, whereas social motives were not statistically significant. Living situation (P = .63) and depression (P = .10) were not significantly associated with vaping behavior. CONCLUSIONS ENDS products continue to yield very high levels of nicotine creating addiction in young adults. Addiction counseling and evidenced-based practices should be employed at every level (individual, community, and school). Additionally, mental health counseling for students in pandemic and high-stress environments may help to combat stress in a more proactive manner than self-medicating.
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Affiliation(s)
- Stella L Henn
- Department of Fitness and Health, IST University of Applied Sciences, Düsseldorf, Germany
| | - Mary P Martinasek
- Department of Health Science and Human Performance, The University of Tampa, Tampa, Florida
| | - Martin Lange
- Department of Fitness and Health, IST University of Applied Sciences, Düsseldorf, Germany.
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10
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Llanes KD, Ling PM, Guillory J, Vogel EA. Young Adults' Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study. J Med Internet Res 2023; 25:e46153. [PMID: 37552552 PMCID: PMC10540020 DOI: 10.2196/46153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Inhaling aerosolized nicotine and cannabis (colloquially called "vaping") is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging the use of both products received national media attention during the 2019 outbreak of e-cigarette or vaping-associated lung injury (EVALI). OBJECTIVE This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults' perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. METHODS Participants (N=1229) aged 18-25 (mean 21.40, SD 2.22) years were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (618/1229, 50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) × 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive and aesthetically pleasing selfies. The positive text was supportive and uplifting regarding quitting the use of vaporized products. Negative images and text were graphic and fear inducing. After viewing 3 posts, participants reported the perceived harmfulness of nicotine and cannabis products, the perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses were adjusted for product use history. RESULTS Compared to viewing positive images, viewing negative images resulted in significantly greater perceived harm of nicotine (P=.02 for disposable pod-based vaporizers and P=.04 for other e-cigarette "mods" devices) and cannabis vaporized products (P=.01), greater perceived risk of nicotine vaporizers (P<.01), and lower odds of intentions to use nicotine (P=.02) but not cannabis (P=.43) vaporizers in the future. There were no significant main effects of text valence on perceived harm, perceived risk, and intentions to use nicotine and cannabis vaporized products. No significant interaction effects of image and text valence were found. CONCLUSIONS Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post's text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI.
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Affiliation(s)
- Karla D Llanes
- Center for Tobacco Control Research & Education, University of California San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, University of California San Francisco, San Francisco, CA, United States
| | | | - Erin A Vogel
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Rose JJ, Krishnan-Sarin S, Exil VJ, Hamburg NM, Fetterman JL, Ichinose F, Perez-Pinzon MA, Rezk-Hanna M, Williamson E. Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products: A Scientific Statement From the American Heart Association. Circulation 2023; 148:703-728. [PMID: 37458106 DOI: 10.1161/cir.0000000000001160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Vaping and electronic cigarette (e-cigarette) use have grown exponentially in the past decade, particularly among youth and young adults. Cigarette smoking is a risk factor for both cardiovascular and pulmonary disease. Because of their more limited ingredients and the absence of combustion, e-cigarettes and vaping products are often touted as safer alternative and potential tobacco-cessation products. The outbreak of e-cigarette or vaping product use-associated lung injury in the United States in 2019, which led to >2800 hospitalizations, highlighted the risks of e-cigarettes and vaping products. Currently, all e-cigarettes are regulated as tobacco products and thus do not undergo the premarket animal and human safety studies required of a drug product or medical device. Because youth prevalence of e-cigarette and vaping product use was as high as 27.5% in high school students in 2019 in the United States, it is critical to assess the short-term and long-term health effects of these products, as well as the development of interventional and public health efforts to reduce youth use. The objectives of this scientific statement are (1) to describe and discuss e-cigarettes and vaping products use patterns among youth and adults; (2) to identify harmful and potentially harmful constituents in vaping aerosols; (3) to critically assess the molecular, animal, and clinical evidence on the acute and chronic cardiovascular and pulmonary risks of e-cigarette and vaping products use; (4) to describe the current evidence of e-cigarettes and vaping products as potential tobacco-cessation products; and (5) to summarize current public health and regulatory efforts of e-cigarettes and vaping products. It is timely, therefore, to review the short-term and especially the long-term implications of e-cigarettes and vaping products on cardiopulmonary health. Early molecular and clinical evidence suggests various acute physiological effects from electronic nicotine delivery systems, particularly those containing nicotine. Additional clinical and animal-exposure model research is critically needed as the use of these products continues to grow.
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12
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Zhao M, Han Y, Yang Q, Yue Q, Zhang S, Zhao C, Sun X, Xu J, Jiang X, Li K, Li B, Zhao L, Su L. Evaluation of the Effects of e-Cigarette Aerosol Extracts and Tobacco Cigarette Smoke Extracts on RAW264.7 Cells. ACS OMEGA 2023; 8:29336-29345. [PMID: 37599962 PMCID: PMC10433514 DOI: 10.1021/acsomega.3c02758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
With the advancement of society, electronic cigarettes (e-cigarettes) have gained popularity among a growing number of individuals. While numerous toxicological studies have suggested that e-cigarettes are a safer alternative to traditional cigarettes, there is also a body of literature presenting contrasting findings. This in vitro study aimed to compare the effects of e-cigarettes and tobacco cigarettes (t-cigarettes) on RAW264.7 cells by using four e-cigarette aerosol extracts (ECA) and cigarette smoking extracts (CS) containing different nicotine concentrations. The results revealed that low concentration of nicotine in CS as well as in ECA with grape, watermelon, and cola flavors could promote cell viability. Conversely, high nicotine concentration in CS and ECA with four flavors decreased cell viability. Furthermore, our study demonstrated that CS significantly reduced the phagocytic capability of RAW264.7 cells and increased the levels of inflammatory cytokines (IL-6, TNF-α, and IL-1β) and reactive oxygen species (ROS) compared to ECA. Overall, our findings indicate all four e-cigarettes induced less cytotoxicity to RAW264.7 cells and might be safer than t-cigarettes.
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Affiliation(s)
- Minghan Zhao
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
| | - Yuting Han
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
| | - Qi Yang
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
| | - Qiulin Yue
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
- Shengshengxiangrong
(Shandong) Biotechnology Co., Ltd., Jinan 250000, P. R. China
| | - Song Zhang
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
| | - Chen Zhao
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
| | - Xin Sun
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
| | - Jing Xu
- Shenzhen
RELX Tech. Co., Ltd., Shenzhen 518000, P. R. China
| | - Xingtao Jiang
- Shenzhen
RELX Tech. Co., Ltd., Shenzhen 518000, P. R. China
| | - Kunlun Li
- Shandong
Zhuoran Biotechnology Co., Ltd., Jinan 250000, P. R. China
| | - Baojun Li
- Shandong
Zhuoran Biotechnology Co., Ltd., Jinan 250000, P. R. China
| | - Lin Zhao
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
- Shandong
Chenzhang Biotechnology Co., Ltd., Jinan 250353, P. R. China
| | - Le Su
- State
Key Laboratory of Biobased Material and Green Papermaking, School
of Bioengineering, Qilu University of Technology,
Shandong Academy of Sciences, Jinan 250353, P. R. China
- Shengshengxiangrong
(Shandong) Biotechnology Co., Ltd., Jinan 250000, P. R. China
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13
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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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14
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Warren KJ, Beck EM, Callahan SJ, Helms MN, Middleton E, Maddock S, Carr JR, Harris D, Blagev DP, Lanspa MJ, Brown SM, Paine R. Alveolar macrophages from EVALI patients and e-cigarette users: a story of shifting phenotype. Respir Res 2023; 24:162. [PMID: 37330506 PMCID: PMC10276465 DOI: 10.1186/s12931-023-02455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/19/2023] [Indexed: 06/19/2023] Open
Abstract
Exposure to e-cigarette vapors alters important biologic processes including phagocytosis, lipid metabolism, and cytokine activity in the airways and alveolar spaces. Little is known about the biologic mechanisms underpinning the conversion to e-cigarette, or vaping, product use-associated lung injury (EVALI) from normal e-cigarette use in otherwise healthy individuals. We compared cell populations and inflammatory immune populations from bronchoalveolar lavage fluid in individuals with EVALI to e-cigarette users without respiratory disease and healthy controls and found that e-cigarette users with EVALI demonstrate a neutrophilic inflammation with alveolar macrophages skewed towards inflammatory (M1) phenotype and cytokine profile. Comparatively, e-cigarette users without EVALI demonstrate lower inflammatory cytokine production and express features associated with a reparative (M2) phenotype. These data indicate macrophage-specific changes are occurring in e-cigarette users who develop EVALI.
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Affiliation(s)
- Kristi J Warren
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA.
- George E. Wahlen VA Medical Center, 500 Foothill Dr, Salt Lake City, UT, 84148, USA.
| | - Emily M Beck
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA
- George E. Wahlen VA Medical Center, 500 Foothill Dr, Salt Lake City, UT, 84148, USA
| | - Sean J Callahan
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA
- George E. Wahlen VA Medical Center, 500 Foothill Dr, Salt Lake City, UT, 84148, USA
| | - My N Helms
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA
| | - Elizabeth Middleton
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA
| | - Sean Maddock
- George E. Wahlen VA Medical Center, 500 Foothill Dr, Salt Lake City, UT, 84148, USA
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Jason R Carr
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA
- Intermountain Healthcare, Department of Pulmonary & Critical Care Medicine, Murray, UT, 84107, USA
| | - Dixie Harris
- Intermountain Healthcare, Department of Pulmonary & Critical Care Medicine, Murray, UT, 84107, USA
| | - Denitza P Blagev
- Intermountain Healthcare, Department of Pulmonary & Critical Care Medicine, Murray, UT, 84107, USA
| | - Michael J Lanspa
- Intermountain Healthcare, Department of Pulmonary & Critical Care Medicine, Murray, UT, 84107, USA
| | - Samuel M Brown
- Intermountain Healthcare, Department of Pulmonary & Critical Care Medicine, Murray, UT, 84107, USA
| | - Robert Paine
- Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, 84132, USA
- George E. Wahlen VA Medical Center, 500 Foothill Dr, Salt Lake City, UT, 84148, USA
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15
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Baiden P, Cavazos-Rehg P, Szlyk HS, Onyeaka HK, Peoples JE, Kasson E, Muoghalu C. Association between Sexual Violence Victimization and Electronic Vaping Product Use among Adolescents: Findings from a Population-based Study. Subst Use Misuse 2023; 58:637-648. [PMID: 36803403 DOI: 10.1080/10826084.2023.2177963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Although studies have investigated the association between sexual violence (SV) victimization and substance use, few studies have examined the association between SV victimization and electronic vaping product (EVP) use among adolescents in the United States. The objective of this study was to examine the cross-sectional association between SV victimization and EVP use among adolescents. METHODS Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The outcome variable investigated was EVP use, and the main explanatory variable was SV victimization. RESULTS Of the 28,135 adolescents, the prevalence of past 30-day EVP use and SV victimization was 22.7% and 10.8%, respectively. Controlling for other factors, adolescents who experienced SV had 1.52 times higher odds of being EVP users when compared to their counterparts who did not experience SV (AOR = 1.52, p < .001, 95% CI = 1.27-1.82). Other factors associated with EVP use included cyberbullying victimization, symptoms of depression, and current use of cigarettes, alcohol, and marijuana. CONCLUSIONS Experiencing SV was associated with EVP use. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying the association between SV victimization and EVP use. In addition, school-based interventions that focus on sexual violence prevention and reducing substance use among adolescents are warranted.
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Affiliation(s)
- Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Henry K Onyeaka
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, McLean Hospital, Boston, Massachusetts, USA
| | - JaNiene E Peoples
- The Brown School at Washington University in St. Louis, Missouri, USA
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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16
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Winburn C, Ofei-Dodoo S. Nicotine Dependence from Electronic Cigarettes Use and Depressive Symptoms Among Adolescents. Kans J Med 2023; 16:1-4. [PMID: 36703951 PMCID: PMC9872498 DOI: 10.17161/kjm.vol16.18723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction The use of electronic cigarettes (e-cigarettes) has been increasing among adolescents in the United States since they were first introduced to the U.S. market in 2007. With depression as a major risk factor for suicide in adolescents, this study examined nicotine dependence from the use of e-cigarettes and depressive symptoms among adolescents. Methods The authors conducted a retrospective patient chart review at a pediatric clinic in the Midwestern United States, from May 2021 to September 2021. As a standard practice, the clinic uses the adapted Penn State Nicotine Dependency Index to evaluate its patients' nicotine dependence from the use of e-cigarettes, and the PHQ-9 modified for teens to screen for depressive symptoms of its patients. Data on 69 patients were included in the study. The authors used standard descriptive statistics and an adjusted odds ratio (aOR) to analyze the data on the 69 adolescents. Results The mean age of the adolescents was 17.6 (SD = 2.3), 46.4% (n = 32) were female, and 53.6% (n = 37) were male. More than 88% (n = 61) of the adolescents met criteria for high nicotine dependence from e-cigarette use and 30.4% (21 of 69) of them screened positive for depression. Findings of the analyses indicated that there was not a statistically significant association between nicotine dependence from e-cigarette use and depressive symptoms (aOR = 1.07; 95% confidence interval, 0.93-1.23; p = 0.297). Conclusions The results showed that while a third of the adolescents screened positive for depression and the majority (88%) depended on nicotine from e-cigarettes, there was no association between the outcomes. Future larger multicenter studies are needed to better understand the association between nicotine dependence from e-cigarettes and depressive symptoms as reported in the literature.
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Affiliation(s)
| | - Samuel Ofei-Dodoo
- University of Kansas School of Medicine-Wichita, Wichita, KS,Department of Family and Community Medicine
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17
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[Inhalative toxic lung failure-E-cigarette or vaping product use-associated lung injury]. DIE ANAESTHESIOLOGIE 2023; 72:261-265. [PMID: 36648508 PMCID: PMC9843653 DOI: 10.1007/s00101-022-01246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023]
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18
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Kwack TJ, Kim C, Hwang SH, Yong HS, Oh YW, Kang EY. Electronic Cigarette or Vaping-Associated Lung Injury Manifested as Acute Eosinophilic Pneumonia: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:298-303. [PMID: 36818711 PMCID: PMC9935969 DOI: 10.3348/jksr.2022.0002] [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: 01/03/2022] [Revised: 05/19/2022] [Accepted: 06/18/2022] [Indexed: 06/18/2023]
Abstract
Electronic cigarette or vaping-associated lung injury (EVALI) is a disease defined by lung injuries caused by e-cigarette use. It predominantly manifests in forms of organized pneumonia or diffuse alveolar damage but rarely as acute eosinophilic pneumonia (AEP). This report describes a 34-year-old male with acute respiratory symptoms and a vaping history of only nicotine. Chest CT revealed peripheral distributing multiple patchy consolidations and ground-glass opacities dominant in both lower lobes, bilateral diffuse interlobular septal thickening, and bilateral pleural effusion without cardiomegaly. Bronchoalveolar lavage fluids showed increased eosinophilia levels, while infectious laboratory results were all negative, enabling the diagnosis of both AEP and EVALI. Herein, we report a rare case of only-nicotine vaping EVALI manifested as AEP.
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19
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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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20
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Clausen M, Romm KF, Berg CJ, Ciceron AC, Fuss C, Bennett B, Le D. Exploring young adults' e-cigarette use behavior during COVID-19. Tob Prev Cessat 2022; 8:45. [PMID: 36568488 PMCID: PMC9753572 DOI: 10.18332/tpc/155332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Changes in daily life related to COVID-19 have impacted e-cigarette use, particularly in young adults. This cross-sectional mixed-methods study explored young adults' perceptions regarding how COVID-19 influenced their e-cigarette use. METHODS We analyzed Fall 2020 survey data from 726 past 6-month e-cigarette users (mean age=24.15 years, 51.1% female, 35.5% sexual minority, 4.4% Black, 10.2% Asian, 12.1% Hispanic) and Spring 2021 semi-structured interview data among a subset of 40 participants (mean age=26.30 years, 35.0% female, 45.0% sexual minority, 5.0% Black, 22.5% Asian, 12.5% Hispanic). Participants were drawn from 6 metropolitan statistical areas with varied tobacco and cannabis legislative contexts. RESULTS Among survey participants, 44.4% also smoked cigarettes, 54.0% other tobacco products, and 60.1% used cannabis. They reported various changes in their daily lives, including changes in the nature and/or status of employment (e.g. 15.3% were laid off, 72.8% experienced household income loss). Regarding changes in e-cigarette use since COVID-19, 22.6% tried to cut down and 16.0% tried to quit. Interview participants commonly indicated that they increased their use due to stress, boredom, changes in accessibility, and/or changes to daily environment that made e-cigarette use more feasible. CONCLUSIONS Results highlight the importance of promoting opportunities for young adults to build relationships to decrease stress, foster a sense of belonging, and increase quality of life (e.g. increasing the accessibility to mental health and social support services, intentionally engaging young adults in pandemic-appropriate community-building and extracurricular activities). This research may help to inform future e-cigarette cessation interventions that consider the unique challenges of societal stressors, such as pandemics.
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Affiliation(s)
- Michelle Clausen
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington, United States
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, United States
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, United States
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
| | - Annie C. Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington, United States
| | - Caroline Fuss
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Breesa Bennett
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Daisy Le
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, Washington, United States
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
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21
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Kathuria H. Electronic Cigarette Use, Misuse, and Harm. Med Clin North Am 2022; 106:1081-1092. [PMID: 36280334 DOI: 10.1016/j.mcna.2022.07.009] [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: 11/21/2022]
Abstract
Electronic cigarettes (e-cigarettes) are battery-powered devices that use heat to aerosolize a liquid containing a variety of substances (usually nicotine and/or cannabinoids, flavorings, and glycerol or propylene glycol base) that is then inhaled. E-cigarettes are rapidly evolving over time, so the true health effects of e-cigarettes are difficult to study and remain largely unknown. We review the effects of e-cigarettes on nicotine addiction and on pulmonary disease including the effects of dual use and switching from combustible cigarettes to e-cigarettes. Studies show that e-cigarette use can increase the risk to nicotine dependence and combustible tobacco use. Studies show an association between e-cigarette use and pulmonary disease. Some studies suggest reduced harm from e-cigarette use compared with smoking, but this requires further study. Most adults who use e-cigarettes also smoke cigarettes; epidemiologic studies suggest that the combination of e-cigarettes and cigarettes is more harmful than using either product alone.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, 72 East Concord Street R304, Boston, MA 02118, USA.
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22
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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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Zheng Y, Zhao Y, Bai M, Gu H, Li X. Metal-organic frameworks as a therapeutic strategy for lung diseases. J Mater Chem B 2022; 10:5666-5695. [PMID: 35848605 DOI: 10.1039/d2tb00690a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lung diseases remain a global burden today. Lower respiratory tract infections alone cause more than 3 million deaths worldwide each year and are on the rise every year. In particular, with coronavirus disease raging worldwide since 2019, we urgently require a treatment for lung disease. Metal organic frameworks (MOFs) have a broad application prospect in the biomedical field due to their remarkable properties. The unique properties of MOFs allow them to be applied as delivery materials for different drugs; diversified structural design endows MOFs with diverse functions; and they can be designed as various MOF-drug synergistic systems. This review concentrates on the synthesis design and applications of MOF based drugs against lung diseases, and discusses the possibility of preparing MOF-based inhalable formulations. Finally, we discuss the chances and challenges of using MOFs for targeting lung diseases in clinical practice.
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Affiliation(s)
- Yu Zheng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Yuxin Zhao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Mengting Bai
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Huang Gu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
| | - Xiaofang Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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Khan T, Huda AB, Al-Jibury M, Tin Z. A case of acute lung injury due to an e-cigarette. Clin Med (Lond) 2022; 22 Suppl 4:16-17. [PMID: 38614564 PMCID: PMC9600810 DOI: 10.7861/clinmed.22-4-s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tasaduksultan Khan
- University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe, UK
| | | | - Maithem Al-Jibury
- University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe, UK
| | - Zeyarmyo Tin
- University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe, UK
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Matsumoto S, Traber MG, Leonard SW, Choi J, Fang X, Maishan M, Wick KD, Jones KD, Calfee CS, Gotts JE, Matthay MA. Aerosolized vitamin E acetate causes oxidative injury in mice and in alveolar macrophages. Am J Physiol Lung Cell Mol Physiol 2022; 322:L771-L783. [PMID: 35318859 PMCID: PMC9109788 DOI: 10.1152/ajplung.00482.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
Although vitamin E acetate (VEA) is suspected to play a causal role in the development of electronic-cigarette, or vaping, product use-associated lung injury (EVALI), the underlying biological mechanisms of pulmonary injury are yet to be determined. In addition, no study has replicated the systemic inflammation observed in humans in a murine EVALI model, nor investigated potential additive toxicity of viral infection in the setting of exposure to vaping products. To identify the mechanisms driving VEA-related lung injury and test the hypothesis that viral infection causes additive lung injury in the presence of aerosolized VEA, we exposed mice to aerosolized VEA for extended times, followed by influenza infection in some experiments. We used mass spectrometry to evaluate the composition of aerosolized VEA condensate and the VEA deposition in murine or human alveolar macrophages. Extended vaping for 28 days versus 15 days did not worsen lung injury but caused systemic inflammation in the murine EVALI model. Vaping plus influenza increased lung water compared with virus alone. Murine alveolar macrophages exposed to vaped VEA hydrolyzed the VEA to vitamin E with evidence of oxidative stress in the alveolar space and systemic circulation. Aerosolized VEA also induced cell death and chemokine release and reduced efferocytotic function in human alveolar macrophages in vitro. These findings provide new insights into the biological mechanisms of VEA toxicity.
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Affiliation(s)
- Shotaro Matsumoto
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Maret G Traber
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon
| | - Scott W Leonard
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon
| | - Jaewoo Choi
- Linus Pauling Institute, Oregon State University, Corvallis, Oregon
| | - Xiaohui Fang
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
| | - Mazharul Maishan
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
| | - Katherine D Wick
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
| | - Kirk D Jones
- Department of Pathology, University of California, San Francisco, California
| | - Carolyn S Calfee
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
| | - Jeffrey E Gotts
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
| | - Michael A Matthay
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
- Cardiovascular Research Institute, University of California, San Francisco, California
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Onyenwoke RU, Leung T, Huang X, Parker D, Shipman JG, Alhadyan SK, Sivaraman V. An assessment of vaping-induced inflammation and toxicity: A feasibility study using a 2-stage zebrafish and mouse platform. Food Chem Toxicol 2022; 163:112923. [PMID: 35318090 PMCID: PMC9018621 DOI: 10.1016/j.fct.2022.112923] [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: 12/22/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
It is currently understood that tobacco smoking is a major cause of pulmonary disease due to pulmonary/lung inflammation. However, due to a highly dynamic market place and an abundance of diverse products, less is known about the effects of e-cigarette (E-cig) use on the lung. In addition, varieties of E-cig liquids (e-liquids), which deliver nicotine and numerous flavor chemicals into the lungs, now number in the 1000s. Thus, a critical need exists for safety evaluations of these E-cig products. Herein, we employed a "2-stage in vivo screening platform" (zebrafish to mouse) to assess the safety profiles of e-liquids. Using the zebrafish, we collected embryo survival data after e-liquid exposure as well as neutrophil migration data, a key hallmark for a pro-inflammatory response. Our data indicate that certain e-liquids induce an inflammatory response in our zebrafish model and that e-liquid exposure alone results in pro-inflammatory lung responses in our C57BL/6J model, data collected from lung staining and ELISA analysis, respectively, in the mouse. Thus, our platform can be used as an initial assessment to ascertain the safety profiles of e-liquid using acute inflammatory responses (zebrafish, Stage 1) as our initial metric followed by chronic studies (C57BL/6J, Stage 2).
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Affiliation(s)
- Rob U Onyenwoke
- Biomanufacturing Research Institute and Technology Enterprise (BRITE), North Carolina Central University, Durham, NC, 27707, USA; Department of Pharmaceutical Sciences, North Carolina Central University, Durham, NC, 27707, USA
| | - TinChung Leung
- The Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, North Carolina Research Campus, Kannapolis, NC, 28081, USA; Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, 27707, USA
| | - Xiaoyan Huang
- The Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, North Carolina Research Campus, Kannapolis, NC, 28081, USA
| | - De'Jana Parker
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, 27707, USA
| | - Jeffrey G Shipman
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, 27707, USA
| | - Shatha K Alhadyan
- Department of Pharmaceutical Sciences, North Carolina Central University, Durham, NC, 27707, USA
| | - Vijay Sivaraman
- Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, 27707, USA.
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Benthien J, Meusel M, Cayo Talavera S, Eitel I, Drömann D, Franzen KF. JUUL™ing and Heating Lead to a Worsening of Arterial Stiffness. MEDICINES (BASEL, SWITZERLAND) 2022; 9:medicines9040028. [PMID: 35447876 PMCID: PMC9025913 DOI: 10.3390/medicines9040028] [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: 03/09/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
Background: The widespread use of the JUUL™ device ignited a discussion about the effects these products have on harm reduction. Therefore, we conducted a study directly comparing the JUUL™ device with a cigarette, a heated tobacco product, and a nicotine-free e-cigarette to examine the acute effects on arterial stiffness. Methods: This crossover-designed study examines 20 occasional smokers (age 25.2 ± 2.5 years). Study participants used each of the four smoking devices for a duration of 5 min following a protocol. Peripheral blood pressure and parameters of arterial stiffness and endothelial vasodilator function such as the reactive hyperemia index and the augmentation index were measured using the EndoPAT™2000 before and after. Results: In addition to significant peripheral hemodynamic changes after 5 and 10 min (p < 0.05), the reactive hyperemia index showed a significant decrease for all devices 15 min after consumption and remained significantly decreased after 60 min (p < 0.01). The augmentation index adjusted for a heart rate of 75 bpm increased significantly for all devices 15 and 60 min after consumption (p < 0.01). Conclusions: In conclusion, the increases in blood pressure and arterial stiffness are similar after smoking, JUUL™ing, heating, and vaping. These changes may be associated with an increase in cardiovascular risks; however, an evaluation of the long-term effects of JUUL™ing, vaping and heating is needed.
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Affiliation(s)
- Julia Benthien
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Moritz Meusel
- Medical Clinic II, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (M.M.); (I.E.)
| | - Silja Cayo Talavera
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Ingo Eitel
- Medical Clinic II, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (M.M.); (I.E.)
| | - Daniel Drömann
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Klaas F. Franzen
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany; (J.B.); (S.C.T.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
- Correspondence: ; Tel.: +49-(451)-500-45003
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Do family physicians perceive electronic cigarette use as a harm reduction strategy for smokers? A survey from Istanbul. Prim Health Care Res Dev 2022; 23:e15. [PMID: 35307043 PMCID: PMC8991075 DOI: 10.1017/s1463423622000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND E-cigarettes (ECs) are gaining popularity in Turkey among smokers. With the rapid increase of EC consumption, it is important to ascertain how family physicians (FPs) perceive ECs as they play a key role in providing smoking cessation services. AIM Our main objectives were to determine FPs' level of awareness and harm reduction perceptions of ECs and to delineate the factors associated with their counseling practices. METHODS This was a cross-sectional study with descriptive and analytical components. Data were collected through questionnaires. Questions mainly focused on demographic characteristics, knowledge and own use of ECs, general attitudes towards ECs, and daily practices while performing counseling on tobacco use. In order to control confounding factors, logistic regression analysis was performed. FINDINGS Among a total of 271 FPs, 49.1% (n = 133) were males and the median age (IQR) was 41 years (32-46). Almost one-fifth of the FPs (n = 52) reported that they did not provide counseling services to their smoking patients. Only 26.6% (n = 72) of the FPs stated that they felt confident enough to advise patients on smoking cessation. Of the FPs, 6.6% have stated that they have recommended ECs to their patients for smoking cessation with the strategy of harm reduction. Factors associated with providers' recommendation of ECs to their patients as a harm reduction strategy included 'believing that ECs help smokers to quit, ECs could be vaped in closed areas, and ECs were healthier than combustible tobacco products'. CONCLUSION In our study, FPs stated lack of confidence to advice patients on smoking cessation. Furthermore, they recommended ECs to their smoking patients as a harm reduction strategy. FPs' confidence should be increased with the trainings based on recent evidence on ECs.
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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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Narimani M, Adams J, da Silva G. Toxic Chemical Formation during Vaping of Ethyl Ester Flavor Additives: A Chemical Kinetic Modeling Study. Chem Res Toxicol 2022; 35:522-528. [PMID: 35258279 DOI: 10.1021/acs.chemrestox.1c00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ethyl ester flavor additives are used in e-liquids to produce a citrus flavor. Although these compounds are considered safe as flavor additives, this only applies to oral consumption and not vaping operations, where they can decompose into potentially harmful compounds including carboxylic acids. Further decomposition of these carboxylic acids is expected to produce ketene, which is a strong respiratory poison that can cause fatal lung damage at low concentrations. This study develops a kinetic model of the thermal decomposition of ethyl ester flavor additives and simulates the decomposition of these compounds under vaping conditions. These results show that under normal operating conditions, it is unlikely for any harmful compounds to be present in-lung. However, at higher operating temperatures, there is the potential for acetic and butanoic acid to be present in the lungs at concentrations that cause irritation, and where repeated exposure may lead to bronchitis. At more extreme operating conditions it is possible for harmful levels of ketene to be produced such that it could cause fatal or severely detrimental effects upon repeated exposure. These high temperatures can be reached under "dry" operating conditions that arise as a result of improper use, particularly in user-modified e-cigarettes.
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Affiliation(s)
- Milad Narimani
- Department of Chemical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Jamil Adams
- Department of Chemical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Gabriel da Silva
- Department of Chemical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
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Makki I, Zheng-Lin B, Kohli M. Medical marijuana knowledge and attitudes amongst internal medicine residents. BMC PRIMARY CARE 2022; 23:38. [PMID: 35240989 PMCID: PMC8895539 DOI: 10.1186/s12875-022-01651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mounting evidence suggests the safety and efficacy of medical marijuana (MM) in treating chronic ailments, including chronic pain, epilepsy, and anorexia. Despite incremental use of medical and recreational cannabinoids, current limited evidence shows generalized unpreparedness of medical providers to discuss or recommend these substances to their patients. Herein, the present study aims to examine internal medicine residents' knowledge of marijuana and their attitude towards its medical use. METHODS This is a descriptive cross-sectional study. A survey with 12 standardized queries was created and distributed among the internal medicine residents from Mount Sinai Morningside-West (MSMW) program from July 2020 to December 2020. Participants included preliminary and categorical residents from post-graduate years one to three. The survey consisted of self-assessment of residents' knowledge on the indication, contraindication, adverse effects of MM. RESULTS Eighty-six (59%) out of 145 residents completed the questionnaire. Despite most trainees (70%) having considered certifying the use of MM for their patients, over 90% reported none to little knowledge on its use. Approximately 80% of the surveyed residents expressed willingness to receive an appropriate educational curriculum. CONCLUSION To the best of our knowledge, this is the first study that indicated a critical lack of medical marijuana-related knowledge in surveyed internal medicine residents. In a population with growing cannabis consumption, physician training on the indication, toxicity, and drug interaction of cannabinoids is warranted.
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Affiliation(s)
- Iman Makki
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Binbin Zheng-Lin
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maanit Kohli
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Division of Hospital Medicine, Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, 1000 10th Ave, New York, NY, 10019, USA.
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Chatziparasidis G, Kantar A. Vaping in Asthmatic Adolescents: Time to Deal with the Elephant in the Room. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030311. [PMID: 35327682 PMCID: PMC8947668 DOI: 10.3390/children9030311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
Adolescence is a period characterized by developmental, psychological, and psychosocial alterations, with a major impact on youths’ attitudes and perceptions. Adolescents with asthma may not comply with treatment and may develop risky behaviors, including smoking, vaping, and other substance use, leading to unanticipated exacerbations and consequences. Vaping has become extremely popular in this age group, and studies have suggested that it has potential adverse effects on asthmatic airways. More well-designed studies are needed to confirm the initial worrying data, and action must be taken by both medical officers and health authorities to deal with the elephant in the room and curb the vaping pandemic. The aim of this paper is to provide a review of the current knowledge regarding the effect of vaping on adolescents with asthma and to propose actions to restrain this fast-growing trend.
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Affiliation(s)
- Grigorios Chatziparasidis
- Primary Cilia Dyskinesia Unit, School of Medicine, University of Thessaly, 41110 Thessaly, Greece
- Correspondence:
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Gruppo Ospedaliero San Donato, Bergamo and University Vita Salute San Raffaele, 24046 Milano, Italy;
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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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Kopsombut G, Ajjegowda A, Livingston F, Epelman M, Brown B, Werk L, Brogan R. Clinical Findings in Adolescents Hospitalized With EVALI; Novel Report on Coagulopathy. Hosp Pediatr 2022; 12:229-240. [PMID: 35098298 DOI: 10.1542/hpeds.2021-006059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Describe clinical characteristics of adolescents hospitalized with e-cigarette or vaping product use-associated lung injury (EVALI) and to investigate association between EVALI and coagulopathy. METHODS We conducted a retrospective cohort study of adolescents admitted to the general inpatient or ICUs at 2 major tertiary children's hospitals from January 2019 to June 2021. We included analysis of demographics, clinical findings, laboratory and imaging results, and outcomes. RESULTS Forty-four hospitalizations met diagnostic criteria for inclusion per Centers for Disease Control and Prevention guidelines, with 55% of patients admitted after April 2020. Compared with adults, pediatric patients were less likely to present with pulmonary symptoms. Significant laboratory work included elevated white blood cell count of 14.3 k/uL (confidence interval [CI], 13.7-15.0) with neutrophilic predominance, C-reactive protein of 25.2 mg/dL (CI, 22.1-28.2), and erythrocyte sedimentation rate of 66.7 mm/hour (CI, 26.9-76.4). Chest radiographs were poor predictors of disease in 53% of our patients but computed tomography was 100% sensitive. Significant coagulation abnormalities included prothrombin time of 17.7 seconds (CI, 16.4-19.1) and international normalized ratio of 1.54 (CI, 1.43-1.66). Coagulation studies improved with vitamin K and steroid administration. Nine of 16 patients (56%) had abnormal diffusing capacity of the lung for carbon monoxide divided by alveolar volume <80% predicted, suggesting evidence of pulmonary vascular disease, or >100%, suggesting pulmonary hemorrhage. CONCLUSIONS EVALI continues to be an important differential diagnosis in the adolescent population. EVALI is likely a result of systemic inflammation with consequences beyond the pulmonary system. The novel report of coagulopathy among adolescents with EVALI in this cohort reveals an opportunity to detect coagulopathy and initiate early therapy.
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Affiliation(s)
| | | | | | | | | | - Lloyd Werk
- General Academic Pediatrics, Nemours Children's Hospital, Orlando, Florida
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Brosius C, Caron KT, Sosnoff CS, Blount BC, Wang L. Rapid Development and Validation of a Liquid Chromatography-Tandem Mass Spectrometry Method to Measure Cannabinoids in Bronchoalveolar-Lavage Fluid of Patients with e-Cigarette, or Vaping, Product Use-Associated Lung Injury. ACS OMEGA 2022; 7:443-452. [PMID: 35036713 PMCID: PMC8756437 DOI: 10.1021/acsomega.1c04815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
In 2019, the Centers for Disease Control and Prevention responded to an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). Bronchoalveolar-lavage (BAL) fluid from EVALI patients was available for analysis to investigate a range of potential toxicants that might be present at the presumed site of lung injury. Our laboratory developed and validated a novel method to measure cannabinoids and their metabolites in BAL fluid to aid in the investigation of the toxicants that might be the cause of EVALI. In this paper, we describe a sensitive liquid chromatography-tandem mass spectrometry method to measure the following six cannabinoids: Δ9-tetrahydrocannabinol (THC), THC metabolites 11-nor-9-carboxy-THC and 11-hydroxy-THC, cannabinol, cannabidiol (CBD), and CBD metabolite 7-nor-7-carboxycannabidiol. Cannabinoids were extracted from BAL fluid using solid-phase extraction. Accuracy, precision, stability, and limits of detection were determined from replicate analyses of spiked BAL pools. The lower limits of detection ranged from 0.019 to 0.153 ng/mL for a sample volume of 150 μL. Overall accuracy ranged from 71.0 to 100.8%. Within-run imprecision (measured by the coefficient of variation) was below 8%, and between-run imprecision was below 21% for all analytes and concentrations tested. The method was applied to samples from 59 EVALI case patients. We identified THC, CBD, or their metabolites in 76% of EVALI patient samples. These findings support previous evidence that THC-containing products played a major role in the EVALI outbreak and help to inform public health recommendations.
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Abstract
Cannabis use in the United States is growing at an unprecedented pace. Most states in the United States have legalized medical cannabis use, and many have legalized nonmedical cannabis use. In this setting, health care professionals will increasingly see more patients who have questions about cannabis use, its utility for medical conditions, and the risks of its use. This narrative review provides an overview of the background, pharmacology, therapeutic use, and potential complications of cannabis.
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Affiliation(s)
- Deepika E Slawek
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Susanna A Curtis
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrSusieC2
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrArnsten
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. https://twitter.com/DrChinazo
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Ranpara A, Stefaniak AB, Williams K, Fernandez E, LeBouf RF. Modeled Respiratory Tract Deposition of Aerosolized Oil Diluents Used in Δ 9-THC-Based Electronic Cigarette Liquid Products. Front Public Health 2021; 9:744166. [PMID: 34805068 PMCID: PMC8599147 DOI: 10.3389/fpubh.2021.744166] [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: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022] Open
Abstract
Electronic cigarette, or vaping, products (EVP) heat liquids ("e-liquids") that contain substances (licit or illicit) and deliver aerosolized particles into the lungs. Commercially available oils such as Vitamin-E-acetate (VEA), Vitamin E oil, coconut, and medium chain triglycerides (MCT) were often the constituents of e-liquids associated with an e-cigarette, or vaping, product use-associated lung injury (EVALI). The objective of this study was to evaluate the mass-based physical characteristics of the aerosolized e-liquids prepared using these oil diluents. These characteristics were particle size distributions for modeling regional respiratory deposition and puff-based total aerosol mass for estimating the number of particles delivered to the respiratory tract. Four types of e-liquids were prepared by adding terpenes to oil diluents individually: VEA, Vitamin E oil, coconut oil, and MCT. A smoking machine was used to aerosolize each e-liquid at a predetermined puff topography (volume of 55 ml for 3 s with 30-s intervals between puffs). A cascade impactor was used to collect the size-segregated aerosol for calculating the mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD). The respiratory deposition of EVP aerosols on inhalation was estimated using the Multiple-Path Particle Dosimetry model. From these results, the exhaled fraction of EVP aerosols was calculated as a surrogate of secondhand exposure potential. The MMAD of VEA (0.61 μm) was statistically different compared to MCT (0.38 μm) and coconut oil (0.47 μm) but not to Vitamin E oil (0.58 μm); p < 0.05. Wider aerosol size distribution was observed for VEA (GSD 2.35) and MCT (GSD 2.08) compared with coconut oil (GSD 1.53) and Vitamin E oil (GSD 1.55). Irrespective of the statistical differences between MMADs, dosimetry modeling resulted in the similar regional and lobular deposition of particles for all e-liquids in the respiratory tract. The highest (~0.08 or more) fractional deposition was predicted in the pulmonary region, which is consistent as the site of injury among EVALI cases. Secondhand exposure calculations indicated that a substantial amount of EVP aerosols could be exhaled, which has potential implications for bystanders. The number of EVALI cases has declined with the removal of VEA; however, further research is required to investigate the commonly available commercial ingredients used in e-liquid preparations.
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Affiliation(s)
- Anand Ranpara
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Aleksandr B Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Kenneth Williams
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Elizabeth Fernandez
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
| | - Ryan F LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, United States
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38
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Ismail ALS, Imaduddeen T, Ibrahim WH. Electronic Cigarette or Vaping Product Use-Associated Lung Injury in a Previously Healthy Young Male. Cureus 2021; 13:e18269. [PMID: 34722048 PMCID: PMC8545557 DOI: 10.7759/cureus.18269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/05/2022] Open
Abstract
Vaping (i.e., the use of electronic cigarettes) has been gaining popularity among people for the past few years, perhaps due to the misconception that its use is less harmful than traditional cigarettes. Although the long-term effects of these products are still unknown, it has been shown that they can be implicated in acute lung injury in healthy people. In 2019, an epidemic of severe acute lung injury was reported in the United States, and it was linked to vaping or electronic cigarette use and was referred to as e-cigarette or vaping product use-associated lung injury (EVALI). Here, we present the first case of EVALI in the state of Qatar.
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Affiliation(s)
| | - Tahir Imaduddeen
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
| | - Wanis H Ibrahim
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
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Roman S, Millet C, Geris S, Manickam R, Mechineni A. Crazy vaping and crazy-paving, a case of E-Cigarette/Vaping-Associated Lung Injury (EVALI) with chest CT showing crazy-paving pattern. Radiol Case Rep 2021; 16:3208-3212. [PMID: 34484520 PMCID: PMC8405923 DOI: 10.1016/j.radcr.2021.07.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022] Open
Abstract
E-cigarettes are devices that generate an aerosol by heating a fluid containing multiple chemicals, such as nicotine, additives, and flavorings. They were developed to aid in smoking cessation and were promoted as socially acceptable, healthier, cheaper than conventional cigarettes. Multiple lung disorders related to e-cigarette use are reported, and they range from mild cases of pneumonitis to life-threatening lung disorders that may require intubation and mechanical ventilation. Most of the complications are due to the generation of various unknown and potentially harmful chemicals within the aerosol generated in the e-cigarette. These disorders are known collectively as e-cigarette/Vaping-associated lung injury (EVALI). E-cigarettes are marketed as safer alternatives to traditional cigarettes, with the highest rates of use are noted in young smokers. Given the significant prevalence of e-cigarettes use and their pulmonary complications, EVALI should be considered a potential etiology in the broad differential diagnosis of patients with pulmonary disease and a history of vaping. Herein, we present a case of cryptogenic organizing pneumonia with a chest C.T. showing a crazy-paving pattern in a patient with a history of vaping.
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Affiliation(s)
- Sherif Roman
- Department of Medicine, St. Joseph's University Medical Center, NJ, USA
| | | | - Shady Geris
- Department of Medicine, St. Joseph's University Medical Center, NJ, USA
| | - Rajapriya Manickam
- Department of Pulmonary/Critical Care, St. Joseph's University Medical Center, NJ, USA
| | - Ashesha Mechineni
- Department of Medicine, St. Joseph's University Medical Center, NJ, USA
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40
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Saulino PA, Greenwald BD, Gordon DJ. The changing landscape of the use of medical marijuana after traumatic brain injury: a narrative review. Brain Inj 2021; 35:1510-1520. [PMID: 34632896 DOI: 10.1080/02699052.2021.1978548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To summarize the potential therapeutic benefits of medical marijuana for patients with traumatic brain injury (TBI). METHODS A systematic search was conducted using PubMed and Cochran's library for information regard the safety and efficacy of medical marijuana as a therapeutic agent. We investigated, in depth, articles specifically evaluating medical marijuana's use in TBI, as well as articles that summarized the effects of marijuana in general. Articles from the year 2000-2020 were included. RESULTS A total of 37 articles met our inclusion criteria. An additional 3 articles were obtained from reference lists. CONCLUSION Studies have shown that medical marijuana can potentially aid the recovery from TBI by modulating the endocannabinoid system, reducing inflammation and secondary injury. Adverse cognitive and physiological effects have been observed in the acute setting as well as chronically, though more research is necessitated. There is also the concern of significant drug-drug interactions that have not been thoroughly studied. Thus, while there is evidence that medical marijuana can be beneficial in the treatment of TBI, more research is necessitated to fully explore the long-term efficacy and adverse effects.
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Affiliation(s)
- Patrick A Saulino
- Rutgers Robert Wood Johnson Medical School, Ringgold Standard Institution, Piscataway, New Jersey, USA
| | - Brian D Greenwald
- Center for Brain Injuries, JFK Johnson Rehabilitation Institute, Ringgold Standard Institution - Physical Medicine and Rehabilitation, Edison, New Jersey, USA.,Rutgers Robert Wood Johnson Medical School New Brunswick, - Physical Medicine and Rehabilitation, Edison, New Jersey, USA
| | - Dustin J Gordon
- Rehabilitation Specialists, Ringgold Standard Institution, Fairleigh Dickinson University, Fair Lawn, New Jersey, USA.,Fairleigh Dickinson University in Teaneck, New Jersey, USA
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41
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Wu C, Liao T, Chen Y, Kuo P. Treatment of electronic cigarette or vaping product use-associated lung injury (EVALI) by corticosteroid and low-dose pirfenidone: Report of a case. Respirol Case Rep 2021; 9:e0845. [PMID: 34584727 PMCID: PMC8453260 DOI: 10.1002/rcr2.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Electronic (e)-cigarette or vaping product use-associated lung injury (EVALI) is a novel and potentially lethal disease first reported in the United States. We report the case of a 56-year-old man who presented to our hospital with dyspnoea and cough lasting for 2 months after using an e-cigarette for approximately 50 puffs over 2 weeks. Physical examination revealed crackles in the left lower lung. High-resolution computed tomography (HRCT) showed consolidation and ground-glass opacities in both lungs. The baseline forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were 65.7% and 63.9% of the predicted, respectively. Lung biopsy revealed organizing pneumonia with focal fibrosis. In addition to prednisolone, he was treated with a low-dose pirfenidone (200 mg three times per day) due to the persistence of a mild cough, exertional dyspnoea and basal crackles after discharge. His symptoms and FVC significantly improved, but the recovery of the DLCO was slow. The follow-up HRCT demonstrated only minimal fibrotic changes. To our knowledge, this was the first reported case of EVALI successfully treated with a combination of corticosteroid and antifibrotic agents.
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Affiliation(s)
- Chia‐Hao Wu
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Ting‐Yu Liao
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Yung‐Hsuan Chen
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Ping‐Hung Kuo
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
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42
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Holder C, Adams A, Allison C, Cote O, Lippens R, Blount BC, Wang L. A Novel UHPLC-MS/MS Method for Measuring 8- iso-Prostaglandin F 2α in Bronchoalveolar Lavage Fluid. Front Chem 2021; 9:695940. [PMID: 34476231 PMCID: PMC8406638 DOI: 10.3389/fchem.2021.695940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
In August 2019, the Centers for Disease Control and Prevention (CDC) received the first reports of lung injuries that were eventually termed e-cigarette, or vaping, product use–associated lung injury (EVALI). As part of the investigation, CDC laboratories rapidly developed assays for analyzing substances in bronchoalveolar lavage (BAL) fluid collected from EVALI case patients. This report describes the development and validation of a high-throughput isotope dilution UHPLC-MS/MS method for measuring a major oxidative stress biomarker, 8-iso-prostaglandin F2α (8-isoprostane), in BAL fluid samples. The method showed good sensitivity, 17.6 pg/ml LOD, and requires only 50 μl of sample volume. The method had high throughput with an analytical run time of 11 min. The within-day and between-day coefficient of variation (CV) were below 2%. Accuracy, calculated from spiked recovery, at three spiking levels, ranged from 95.5–101.8%. This novel UHPLC-MS/MS method characterizes oxidative stress in lung epithelial tissue and thus helps to elucidate potential pathologic processes.
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Affiliation(s)
- Cory Holder
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Aaron Adams
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Claire Allison
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Olivia Cote
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Rachel Lippens
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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43
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Prasad KN, Bondy SC. Electronic cigarette aerosol increases the risk of organ dysfunction by enhancing oxidative stress and inflammation. Drug Chem Toxicol 2021; 45:2561-2567. [PMID: 34474637 DOI: 10.1080/01480545.2021.1972680] [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] [Indexed: 10/20/2022]
Abstract
An electronic cigarette is a rechargeable device that produces an inhaled aerosol containing varying levels of nicotine, and inorganic and organic toxicants and carcinogenic compounds. The aerosol is generated by heating a solution of propylene glycol and glycerin with nicotine and flavoring ingredients at a high temperature. The e-cigarette was developed and marketed as a safer alternative to the regular cigarette which is known to be injurious to human health. However, published studies suggest that the aerosol of e-cigarette can also have adverse health effects. The main objective of this review is to briefly describe some consequences of e-cigarette smoking, and to present data showing that the resulting increased oxidative stress and inflammation are likely to be involved in effecting to lung damage. Other organs are also likely to be affected. The aerosol contains varying amounts of organic and inorganic toxicants as well as carcinogens, which might serve as the source of such deleterious events. In addition, the aerosol also contains nicotine, which is known to be addictive. E-cigarette smoking releases these toxicants into the air leading to inhalation by nonsmokers in residential or work place areas. Unlike regular tobacco smoke, the long-term consequences of direct and secondhand exposure to e-cigarette aerosol have not been extensively studied but based on available data, e-cigarette aerosol should be considered harmful to human health.
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Affiliation(s)
| | - Stephen C Bondy
- Center for Occupational and Environmental Health, University of California, Irvine, CA, USA
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44
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Yang JS, Sou A, Faruqui A, Mackey TK. A qualitative examination of e-cigarette use among California young adults during the EVALI outbreak. Prev Med Rep 2021; 24:101506. [PMID: 34401219 PMCID: PMC8351914 DOI: 10.1016/j.pmedr.2021.101506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Abstract
The 2019 outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) increased awareness of potential health risks associated with vaping among the general public. Little is known, however, about how unfolding information regarding EVALI affected knowledge, attitudes, and behaviors among e-cigarette users, particularly among young adults. This study describes attitudinal and behavioral responses to EVALI among young adult e-cigarette users. In October and November 2019, seven focus groups were held with college-going young adult tobacco users from two four-year public universities in California. Focus groups included questions regarding knowledge of and reaction to EVALI news, and how the news affected product use. Text from current e-cigarette users was extracted to develop individual phenomenological textural-structural descriptions of e-cigarette use for 38 individuals which were used to create a composite experience of e-cigarette use in light of EVALI. Experiences indicated that e-cigarette users were aware of information regarding EVALI and received information from numerous sources. Information was filtered for legitimacy of EVALI claims and causes of EVALI. Risk rationalizations were developed to assess potential harm of continued e-cigarette use and provided reasoning for behavioral responses to EVALI. The emerging harm associated with EVALI prompted e-cigarette users to engage in a cognitive process resulting in employment of a range of rationalities to justify continued use. These results suggest how environmental, cognitive, and behavioral factors may interact as young adults negotiate e-cigarette-related harms.
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Affiliation(s)
- Joshua S. Yang
- Department of Public Health, California State University, Fullerton, 800
N. State College Boulevard, KHS 161-A, Fullerton, CA 92831, USA
- Corresponding author.
| | - Angela Sou
- Department of Public Health, California State University, Fullerton, 800
N. State College Boulevard, KHS 161-A, Fullerton, CA 92831, USA
| | - Afsana Faruqui
- Department of Public Health, California State University, Fullerton, 800
N. State College Boulevard, KHS 161-A, Fullerton, CA 92831, USA
| | - Tim K. Mackey
- Global Health Program, Department of Anthropology, University of
California, San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA 92037,
USA
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45
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Kaslow JA, Rosas-Salazar C, Moore PE. E-cigarette and vaping product use-associated lung injury in the pediatric population: A critical review of the current literature. Pediatr Pulmonol 2021; 56:1857-1867. [PMID: 33821574 DOI: 10.1002/ppul.25384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Use of electronic nicotine delivery systems (ENDS), also known as e-cigarettes, in the adolescent population has significantly increased over the past several years. This rise led to an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the summer of 2019. Since that time, numerous case reports and case series on vaping and EVALI have been published but the majority of literature highlights the adult population with few articles focusing on pediatric patients. Given the addictive nature of these products and the lack of full understanding of the human health effects, there is concern that use of ENDS may have lasting impacts on users, especially adolescents and young adults. The goal of this review is to critically assess published data on ENDS use in children, report our institutional experience, discuss the reasons why the use of ENDS have increased among young individuals, outline the current understanding of EVALI as it pertains to the pediatric population, and discuss future opportunities for health policy implementation.
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Affiliation(s)
- Jacob A Kaslow
- Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian Rosas-Salazar
- Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul E Moore
- Division of Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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46
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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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47
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Regan AK, Bombard JM, O'Hegarty MM, Smith RA, Tong VT. Adverse Birth Outcomes Associated With Prepregnancy and Prenatal Electronic Cigarette Use. Obstet Gynecol 2021; 138:85-94. [PMID: 34259468 PMCID: PMC10896115 DOI: 10.1097/aog.0000000000004432] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the risk of adverse birth outcomes among adults who use electronic cigarettes (e-cigarettes) before and during pregnancy. METHODS Data from the 2016-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) were used to assess the association between e-cigarette use during the 3 months before and last 3 months of pregnancy among 79,176 individuals with a recent live birth and the following birth outcomes: preterm birth, small for gestational age, and low birth weight (LBW). Adjusted prevalence ratios were generated using average marginal predictions from multivariable logistic regression models. Models were stratified by prenatal combustible cigarette smoking and frequency of e-cigarette use (daily or less than daily use). RESULTS In the 3 months before pregnancy, 2.7% (95% CI 2.6-2.9%) of respondents used e-cigarettes; 1.1% (95% CI 1.0-1.2%) used e-cigarettes during the last 3 months of pregnancy. Electronic cigarette use before pregnancy was not associated with adverse birth outcomes. Electronic cigarette use during pregnancy was associated with increased prevalence of LBW compared with nonuse (8.1% vs 6.1%; adjusted prevalence ratio 1.33; 95% CI 1.06-1.66). Among respondents who did not also smoke combustible cigarettes during pregnancy (n=72,256), e-cigarette use was associated with higher prevalence of LBW (10.6%; adjusted prevalence ratio 1.88; 95% CI 1.38-2.57) and preterm birth (12.4%; adjusted prevalence ratio 1.69; 95% CI 1.20-2.39). When further stratified by frequency of e-cigarette use, associations were seen only for daily users. CONCLUSION E-cigarette use during pregnancy, particularly when used daily by individuals who do not also smoke combustible cigarettes, is associated with adverse birth outcomes.
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Affiliation(s)
- Annette K Regan
- School of Public Health, Texas A&M University, College Station, Texas; the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, and the School of Nursing and Health Professions, University of San Francisco, San Francisco, California; and the Division of Reproductive Health, the Office on Smoking and Health, and the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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48
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Regan AK, Pereira G. Patterns of combustible and electronic cigarette use during pregnancy and associated pregnancy outcomes. Sci Rep 2021; 11:13508. [PMID: 34188127 PMCID: PMC8241992 DOI: 10.1038/s41598-021-92930-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/08/2021] [Indexed: 11/15/2022] Open
Abstract
Although pregnant smokers may perceive electronic cigarettes (e-cigarettes) as safe alternatives to smoking combustible cigarettes, few studies have evaluated perinatal e-cigarette use and its associated health effects. We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS, 2016-2018) for 16,022 women who recently gave birth and reported smoking combustible cigarettes prior to pregnancy. Using average marginal predictive values from multivariable logistic regression to produce adjusted prevalence ratios (aPRs), we estimated the prevalence of combustible cigarette smoking during pregnancy and adverse birth outcomes associated with e-cigarette use. In total, 14.8% of smoking women reported using e-cigarettes prior to pregnancy. There was no association between e-cigarette use prior to pregnancy and combustible cigarette smoking during pregnancy (aPR 0.95; 95% CI 0.88, 1.02); however, e-cigarette use during pregnancy was associated with higher prevalence of combustible cigarette smoking during pregnancy (aPR 1.65; 95% CI 1.52, 1.80). In this sample, we did not observe evidence to support reduced risk of preterm birth, small-for-gestational age and low birthweight compared to combustible cigarette smoking during pregnancy. The prevalence of LBW was higher for those who used e-cigarettes, even exclusively, compared to women who quit smoking cigarettes entirely. These results suggest that e-cigarettes should not be considered a safe alternative to combustible cigarette smoking during pregnancy.
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Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA.
- UCLA Fielding School of Public Health, Los Angeles, CA, USA.
- School of Public Health, Curtin University, Perth, WA, Australia.
- Telethon Kids Institute, Perth, WA, Australia.
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
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49
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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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50
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Abstract
E-cigarette or vaping, product associated lung injury is a rampant public health issue with a total of 2807 reported hospitalized patients in the United States as of February 18, 2020. Limited data, non-specific symptoms, non-responsiveness to antibiotics, and the lack of a specific biomarker, make it a diagnosis of exclusion. Overlap of clinical and imaging findings with other ongoing respiratory illness (MERS, SARS and COVID-19) poses a challenge in accurate diagnosis. We compiled 3 cases of patients hospitalized with confirmed vaping-associated lung injury and analyzed their imaging patterns, which revealed bilateral consolidation, ground-glass opacities and pleural effusions. We also reviewed the available literature on pathophysiology, imaging findings of EVALI and other respiratory illness.
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