Dataset Information

E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI) with Acute Respiratory Failure in Three Adolescent Patients: a Clinical Timeline, Treatment, and Product Analysis.

ABSTRACT: INTRODUCTION:E-cigarette, or vaping, product use associated lung injury (EVALI) has become a recent concern among public health officials. Factors that contribute to the concern include an increasing number of cases over time, the severity of the illness, and an unknown understanding of the pathophysiology and etiology of the illness. CASE SERIES:We cared for three adolescent patients with acute respiratory failure secondary to EVALI. All three patients were treated with high-dose steroids in addition to antimicrobials, which resulted in clinical improvement and resolution of their respiratory failure. Pulmonary function testing was performed on these previously healthy patients both acutely and subacutely. Additionally, we report the results from the laboratory analysis of one vaping device fluid which revealed previously unpublished components within these products. DISCUSSION:EVALI is a recent public health concern without a known etiology which can cause life-threatening lung injury in patients without prior lung pathology. We hope these cases will highlight the importance of return precautions in adolescents with vague respiratory symptoms and provide a cautionary tale to providers while they counsel patients regarding the use of these products.

SUBMITTER: Billa R

PROVIDER: S-EPMC7095090 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI) with Acute Respiratory Failure in Three Adolescent Patients: a Clinical Timeline, Treatment, and Product Analysis.

Billa Ramya R Tigges Cody C Vijayakumar Niranjan N Radke Joshua J Pedati Caitlin C Weiner Rebecca R McCabe Daniel D

Journal of medical toxicology : official journal of the American College of Medical Toxicology 20200319 3

<h4>Introduction</h4>E-cigarette, or vaping, product use associated lung injury (EVALI) has become a recent concern among public health officials. Factors that contribute to the concern include an increasing number of cases over time, the severity of the illness, and an unknown understanding of the pathophysiology and etiology of the illness.<h4>Case series</h4>We cared for three adolescent patients with acute respiratory failure secondary to EVALI. All three patients were treated with high-dose ...[more]

PMID: 32193828

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Project description:"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.

Project description:IntroductionNews media can shape public perceptions about e-cigarettes, particularly in the context of ongoing uncertainty from the recent outbreak of e-cigarette or vaping product use-associated lung injury (EVALI). This study aimed to characterize news articles published about e-cigarettes in 2019, including before and during the EVALI outbreak.Aims and methodsUsing 24 e-cigarette-related search terms, we gathered all articles published in leading print and online U.S. news sources in 2019 from databases (i.e., Factiva, Access World News) and archival web sites (i.e., www.newspapers.com). We conducted a content analysis of e-cigarette themes and statements, identifying differences in themes between articles that did and did not mention EVALI.ResultsOf the 1643 e-cigarette news articles published in 2019, 62% mentioned EVALI. Frequency of e-cigarette articles peaked in September (n = 532) at the height of the EVALI outbreak. Among all articles discussing e-cigarettes, the most prevalent main topics were policy/regulation (45%) and health effects (35%). Articles that mentioned EVALI frequently discussed youth e-cigarette use (40%) and JUUL (33%). Compared to non-EVALI articles, EVALI articles were more likely to discuss health effects (p < .001) but less likely to discuss policies/regulations, except for flavor bans (47% of EVALI articles vs. 39% of non-EVALI articles, p = .002). EVALI articles were also less likely to discuss e-cigarettes being less risky than cigarettes (p = .005).ConclusionsE-cigarette news coverage was prevalent in 2019, and patterns in frequency and content reflected major events (i.e., EVALI). In turn, news media can shape public perceptions, and even policy, about e-cigarettes and must continue to be monitored.ImplicationsE-cigarette news coverage in 2019 was high, driven in large part by news coverage of the EVALI outbreak. Indeed, the peak in e-cigarette news articles in September directly coincided with the peak in EVALI cases in the United States. Of note, articles that mentioned EVALI frequently discussed youth e-cigarette use, JUUL, and flavor bans, which may have triggered national and state-level policy responses, and likely influenced public perceptions (including misperceptions) regarding the harms of e-cigarettes.

Dataset Information

E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI) with Acute Respiratory Failure in Three Adolescent Patients: a Clinical Timeline, Treatment, and Product Analysis.

Publications

E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI) with Acute Respiratory Failure in Three Adolescent Patients: a Clinical Timeline, Treatment, and Product Analysis.

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