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E-cigarette, or Vaping, Product Use-Associated Lung Injury: Looking Back, Moving Forward.

ABSTRACT: Implications In this commentary, we describe the evidence-based approach used to identify the primary cause of EVALI and to curb the 2019 outbreak. We also discuss future research opportunities and public health practice considerations to prevent a resurgence of EVALI.

SUBMITTER: King BA

PROVIDER: S-EPMC7792918 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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E-cigarette, or Vaping, Product Use-Associated Lung Injury: Looking Back, Moving Forward.

King Brian A BA Jones Christopher M CM Baldwin Grant T GT Briss Peter A PA

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 20201201 Suppl 1

Implications In this commentary, we describe the evidence-based approach used to identify the primary cause of EVALI and to curb the 2019 outbreak. We also discuss future research opportunities and public health practice considerations to prevent a resurgence of EVALI. ...[more]

PMID: 33320257

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Project description:Inhalation of aerosolized products generated by different electronic devices is called vaping. E-cigarettes or Vaping product use Associated Lung Injury (EVALI) outbreak peaked in August-September 2019 and gradually declined. EVALI remains a diagnosis of exclusion which presents as an acute lung injury in the vaping population. Vitamin E acetate and its products are implicated as one of the cytotoxic agents causing airway centered pneumonitis. Lipid laden macrophages are found in samples of BAL fluid but their role in cytopathology of the disease remains unclear. We present a 57 years old man who came to the emergency department at Monmouth Medical Center, New Jersey in fall, 2019. Reportedly he has been vaping THC about 100g every day for past three days. At initial presentation, he had fever, shortness of breath and hypoxia requiring supplemental oxygen. He was empirically treated with levofloxacin 500 mg for five days without a significant improvement in his symptoms. Non-contrast chest CT scan showed bilateral ground-glass opacities, indicative of diffuse alveolar damage. He underwent flexible bronchoscopy to rule out infective pneumonia followed by auto-immune work-up that was non-conclusive. He was given 1 mg/kg methylprednisolone with a quick taper of oral steroids leading to the resolution of symptoms. At six months follow-up, imaging showed near resolution of ground-glass opacities.

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Patient Characteristics and Product Use Behaviors Among Persons with E-cigarette, or Vaping, Product Use-Associated Lung Injury - Indiana, June October 2019.

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Project description:The NHLBI convened a working group on October 23, 2019, to identify the most relevant and urgent research priorities and prevailing challenges in e-cigarette or vaping product use-associated lung injury (EVALI). Experts across multiple disciplines discussed the complexities of the EVALI outbreak, identified research priorities, and recommended strategies to address most effectively its causal factors and improve diagnosis, treatment, and prevention of this disease. Many research priorities were identified, including the need to create national and international registries of patients with EVALI, to track accurately those affected and assess outcomes. The group concluded that biospecimens from subjects with EVALI are urgently needed to help define EVALI pathogenesis and that vaping has disease risks that are disparate from smoking, with the occurrence of EVALI highlighting the importance of broadening e-cigarette research beyond comparators to smoking-related diseases.

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Confirmed E-cigarette or vaping product use associated lung injury (EVALI) with lung biopsy; A case report and literature review.

Project description:BackgroundE-cigarette or vaping has become an increasingly popular alternative to smoking tobacco. In September 2019 multiple cases of confirmed E-cigarette or vaping product use associated lung injury were published. However, there is limited knowledge regarding the pathologic mechanism of this condition.MethodsWe performed a systematic literature review in PubMed and EMBASE aiming to obtain additional clinical data on confirmed E-cigarette or vaping product use associated lung injury cases with lung biopsy results. With this information we hope to determine whether this condition is related to a histopathological pattern of acute lung injury instead of lipid deposits.ResultsSeven articles were reviewed and a total of 27 cases were included. Imaging findings predominantly showed presence of diffuse bilateral ground glass opacities. A majority of patients had complete resolution of the disease. The most common histopathological pattern was organizing pneumonia present in almost half of the patients. Other frequently occurring patterns included diffuse alveolar damage and acute fibrinous pneumonitis; lipoid pneumonia was found in one case.ConclusionThe underlying pathophysiological mechanism in E-cigarette or vaping product use associated lung injury is most likely acute lung injury related to direct inhalant-mediated parenchymal inflammation.

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