Vaping-Associated Lung Injury: A Review

A Comprehensive Review of the Harmful Compounds in Electronic Cigarettes

Electronic cigarettes (e-cigarettes) are devices designed to vaporize a liquid solution, offering an alternative to traditional tobacco consumption. The identification, detection, and analysis of the compounds present in these devices are crucial for understanding their impacts on health and the environment. Numerous studies have identified a diverse range of compounds emitted by e-cigarettes, including well-known substances such as nicotine, thermal degradation products, and other toxicants that may be harmful or carcinogenic. Although e-cigarettes are often considered an alternative to conventional smoking, they are not without risks. Recent research has increasingly focused on assessing the health impacts of e-cigarettes, integrating findings from various scientific disciplines. Two primary analytical approaches are used for the sample preparation, identification, and quantification of these compounds. The first approach focuses on aerosol analysis, utilizing techniques such as headspace static extraction and gas chromatography coupled with mass spectrometry (GC-MS). The second approach is directed towards liquid analysis, employing liquid-liquid extraction techniques and liquid chromatography (LC) systems. Given the constant publication of new research in this area, a comprehensive review that consolidates information on identified compounds, sample preparation methods, and extraction and analysis techniques is necessary to integrate current knowledge and address emerging findings.

Exploring the Practice of Dual Vaping: Health Risks and Behavioral Patterns in Nicotine and Cannabis E-Cigarette Users

BACKGROUND

E-cigarettes, initially designed for nicotine consumption, are now increasingly being used to smoke cannabis, resulting in a growing trend known as "dual vaping". This term describes individuals, referred to as "dual users", who use e-cigarettes for both substances. This study aims to review and analyze existing research on dual vaping, with a focus on the associated health risks and behavioral patterns.

METHODS

A narrative review of the literature was conducted using PubMed. Studies focusing on individuals who use electronic cigarettes for vaping tobacco and cannabis, either chronically or episodically, were examined. Relevant articles were identified and thematically synthesized to provide a comprehensive overview of the topic.

RESULTS

Dual vaping was found to be prevalent among younger men, White and Hispanic populations, and individuals with higher economic status and educational level. The use of one substance was shown to predispose individuals to the use of the other, often leading to concurrent use of both substances. Peer influence and positive expectations regarding e-cigarettes were identified as significant predictors of dual use. Dual vapers exhibited a higher susceptibility to respiratory and systemic symptoms compared to those who exclusively vaped nicotine or cannabis. Moreover, a notable prevalence of psychiatric disorders, such as substance use disorders, anxiety, and depression, was observed in this group. Fruit-flavored e-cigarettes were the most preferred option among dual vapers when using both nicotine and cannabis.

CONCLUSIONS

Current evidence is insufficient to fully elucidate the long-term impacts of dual vaping on physical and mental health, particularly when compared to individuals who have never vaped. Further studies are needed to gain a more comprehensive understanding of this behavior.

Socioeconomics of e-cigarette use in Colombia: 2019 National Substance Use Survey

Background

E-cigarettes have been extensively marketed and popularized worldwide despite their harmful effects. To effectively plan and implement preventive measures, comprehensive analyses are needed to understand the influence of individual and contextual factors on their use.

Objective

This study aimed to analyze the influence of poverty and demographic and socioeconomic patterns on e-cigarette use in Colombia.

Methods

This study is based on a secondary analysis of the 2019 Colombian Survey on Psychoactive Substance Use, which included 49,756 individuals aged between 12 and 68. State-level multidimensional poverty and individual health-related, socioeconomic, and demographic characteristics were analyzed. Two-level regression models adjusted for the individual and contextual effects.

Results

The prevalence of vaping was 4.4% (95% CI: 4.2%-4.6%), with substantial variation across departments, ranging from 0.0% to 9.6%. In the multilevel models, younger age, male sex, technical or higher education, middle-income stratum, not contributing economically to the household, affiliation with the subsidized health scheme, history of tobacco smoking, alcohol consumption, and self-reported use of other drugs were all significantly associated with vaping. The estimated median odds ratio for multidimensional poverty was 1.23 (95% CI: 1.14-1.33; p= 0.012).

Conclusions

E-cigarette use in Colombia is a health risk and an indicator of social vulnerability that is influenced by structural determinants. Urgent action from health authorities, the education system, regulatory bodies, and civil society is needed to prevent the normalization of vaping among youth. If left unaddressed, vaping could worsen health inequalities and lead to chronic addiction-related disorders in underserved communities.

Plasmapheresis as therapeutic option in a 16-year-old with EVALI: A case report

Since 2019 when a cluster of cases with acute respiratory distress syndrome (ARDS) associated with e-cigarettes in the United States was reported, there have been increasing numbers of reports. Electronic-cigarette or Vaping Use-associated Lung Injury (EVALI) represents a recent entity of respiratory clinical syndromes, primarily in young adults. We report a previously healthy 16-year-old boy who developed severe ARDS following a brief nonspecific prodromal phase after excessive consumption of e-cigarettes. Despite maximum intensive care therapy, including several weeks of venovenous extracorporeal membrane oxygenation, plasmapheresis and repeated administration of immunoglobulins seemed the only way to achieve therapeutic success. Although many case reports have been published, to our knowledge, there are none to date on the therapeutic use of plasmaphoresis in severe EVALI. This case highlights the clinical features of EVALI and the diagnostic dilemma that can arise with EVALI occurring against the background of an expired SARS-CoV-2 infection, with a paediatric inflammatory syndrome (PIMS) as differential diagnosis. EVALI is a diagnosis of exclusion, and the medical history of vaping and e-cigarette use can provide valuable clues. Ethical approval for this case report (protocol number 23-145 RS) was provided by the Ethical Committee of the Department of Medicine, Philipps-Universität Marburg, Germany on 13 th of June 2023. Written informed consent to publish this case and the associated images was obtained from the patient and his mother.

Electronic cigarette, or vaping, product use-associated lung injury (EVALI) in a patient with testicular cancer: A case report

Electronic cigarette, or vaping, product use-associated lung injury (EVALI) is an increasingly recognized entity with the potential for severe pulmonary toxicity. We present the case of a young man first evaluated at a tertiary care center in the United States in 2019 with newly diagnosed testicular cancer with acute respiratory failure, which was initially attributed to possible metastatic disease but eventually determined to be related to EVALI. This case highlights the clinical features of EVALI, the potential diagnostic dilemma that can arise with EVALI when occurring in the setting of malignancy and the importance of inquiring about vaping use among patients with malignancy, especially in adolescents and young adults.

Autoxidation of glycols used in inhalable daily products: implications for the use of artificial fogs and e-cigarettes

The use of glycols is seen in various industries and occupations. In the past few decades, the health implications of inhalable glycols have gained public attention. Inhalable glycols may cause adverse health effects, especially for workers in occupations receiving frequent exposure and consumers of glycol-based daily products. Our previous work highlighted the rapid accumulation of formaldehyde and glycolaldehyde in fog juice, thus proposing the occurrence of glycol autoxidation. However, the fundamentals of glycol autoxidation remained unclear and unexplored. Our goal is to investigate the autoxidation of common glycols during indoor storage. Carbonyls were quantified using liquid chromatography-mass spectrometry (LC-MS), and peroxides from autoxidation were monitored via iodometry and UV-Vis spectrometry. The impact of certain factors such as the water mixing ratio and antioxidants (vitamin C) was also investigated. Formation of aldehydes in many glycols was weekly monitored, such as e-cigarette juice and triethylene glycol (TEG). Occurrence of autoxidation was confirmed by the increase in the total peroxide concentration. Additionally, we highlighted the dependence of the carbonyl formation rate on the TEG-water mixing ratio, demonstrating the complex role of water in glycol autoxidation. We have also tested the effectiveness of vitamin C and made suggestions for minimizing the formation of toxic carbonyls in consumer products.

Electronic Nicotine Delivery Systems (ENDS) use Among Members of a Community Engagement Program

Electronic nicotine delivery systems (ENDS) are relatively new and ENDS use data from community engagement programs may help us understand usage patterns and facilitate targeted longitudinal studies. Community members in Florida, USA, were asked about ENDS use, tobacco use, and health history/concerns by Community Health Workers. Among 7253 members recruited during 2014 to 2021 into our HealthStreet program, 1177 had ever used ENDS; the proportion increased from 12 to 27% from 2014 to 2021 (adjusted odds ratio (aOR) 2.5; 95% CI 1.7-3.5; Ever versus never used ENDS). Ever tobacco use was strongly associated with ENDS use; 69% of ever users were current tobacco users. Demographic determinants (sex, age, race) and food insecurity were strongest predictors of ENDS use. Most who had ever used ENDS were aged 18-25 (aOR 5.9; 95% CI 4.6-7.6; vs. aged 60 + years), White (aOR 3.7; 95% CI 3.2-4.3; vs. Black/African American), male (aOR 1.5; 95% CI 1.3-1.7; vs. female), and recently food insecure (aOR 1.8; 95% CI 1.5-2.0; vs. not recently food insecure). Those with respiratory issues were more likely to have used ENDS compared to those without (aOR 2.0; 95% CI 1.6-2.6; aOR 1.3; 95% CI 1.1-1.5). Members concerned about hypertension were less likely to have used ENDS (aOR 0.7; 95% CI 0.5-0.9). In this relatively rural, micropolitan sample, tobacco use, socio-economic determinants, and certain health history/concerns were strongly associated with ENDS use. Community outreach approaches are needed to further understand these factors and implement interventions.

Respiratory Immune Responses during Infection and Pollution Inhalation

The COVID-19 pandemic highlighted the importance of lung immune responses to pathogens and environmental factors [...].