#e-cigs

Harms of Vaping Hang in the Air

With the increasing popularity of e-cigarettes or vaping, there has been a concurrent rise in “e-cigarette or vaping product use-associate lung injury,” dubbed EVALI. In 2019, according to published data, more than half of patients diagnosed with EVALI in the United States required hospitalization.  

In a paper published March 30, 2022 in the journal CHEST, a multi-institution team of researchers, including Laura E. Crotty Alexander, MD, associate professor of medicine in the UC San Diego School of Medicine and a pulmonary specialist, outline best health care practices for treating EVALI patients.

“Not long ago, there was tremendous interest in vaping-related lung injuries. But I think, especially in light of the COVID-19 pandemic, many people believe this problem has gone away,” said first author Don Hays, MD, a pulmonologist at Cincinnati Children’s Hospital.

“The truth is that it hasn’t. These injuries are still being seen, though we’re not positive on the frequency because the CDC has ceased collecting data since the pandemic began. The goal of this study is twofold: to provide information and guidance on treating EVALI patients, and also to put forth a reminder that this is still a problem.”

EVALI is characterized by respiratory symptoms, such as cough, shortness of breath and chest pain, combined with gastrointestinal symptoms, such as nausea, vomiting and diarrhea. The new study reviewed CDC data regarding 2,708 confirmed or probable EVALI patients requiring hospital admission between August 2019 and January 2020. The study reported that 93 percent of the patients survived to discharge, but 88.5 percent required respiratory support.

Given that EVALI symptoms can be similar to common respiratory infections, such as influenza and COVID-19, the authors said it is important to determine whether a patient has a history of e-cigarette use, particularly within the last three months.

Alexander said the EVALI epidemic in 2019 was primarily due to the addition on Vitamin E acetate to e-cigarettes already containing THC, the psychoactive compound in marijuana, but also noted that e-cigarettes containing nicotine were linked to EVALI before and after 2019.

“We need to continue to warn both THC and nicotine e-cigarette vapers about the potential for acute lung injury,” said Alexander, who noted that UC San Diego Health averages two EVALI hospitalizations monthly.

“In health care, it is critical to be aware of, and understand, what’s going on in the public domain, in order to be suspicious of what might be happening with an individual patient. This is why public health is so important,” said Hayes. “The fact is, the average doctor may only see one or two EVALI cases, so by utilizing this panel of experts, who see EVALI cases more frequently, we’re able to provide guidance to questions like, ‘What should we be doing, how do we manage this, and should we be doing certain types of diagnostic tests?’”

Alexander agreed: “As clinicians become more aware of the health effects of e-cigarettes, we are hopeful that more accurate inhalation histories will be taken and documented, allowing us to accurately quantify e-cigarette driven diseases and outcomes.”

— Scott LaFee