A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Abstract

Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016–2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

Acute Eosinophilic Pneumonia Induced by Switching from Conventional Cigarette Smoking to Heated Tobacco Product Smoking

“…A recent randomized clinical trial of e-cigarettes versus nicotine-replacement therapy showed no serious adverse events related to product use in either group ( 15 ). However, a recent review ( 16 ) described 58 cases of e-cigarette-related respiratory disease, including acute lung injury, organizing pneumonia, eosinophilic pneumonia, and acute respiratory distress syndrome. Among these 58 patients, 1 presented with acute lung injury after switching from conventional cigarettes to e-cigarettes ( 17 ).…”

“…Among these 58 patients, 1 presented with acute lung injury after switching from conventional cigarettes to e-cigarettes ( 17 ). While no single ingredient in e-cigarettes has yet been identified as responsible for respiratory diseases, cannabinoids, nicotine, and the e-liquid constituents are potential causes ( 16 ).…”

Severe neurological nicotine intoxication by e‐cigarette liquids: Systematic literature review

“…We performed an advanced search using ‘nicotine’ as the ‘meSH major term’ AND ‘toxicity’ as ‘all field’, with the filters: ‘10 years’ (publication data) and ‘abstract available’ (text availability). In addition, references of all relevant articles, including case reports and retrospective studies, were also evaluated, 8,15,16 as well as those from a prospective observational study of the Oregon Poison Centre, 17 through Google Scholar and CrossRef. We evaluated English and non‐English articles (using Google Translator) including case reports, adults, voluntary ingestion or injection, oral or intravenous intoxication with an e‐liquid.…”

“…Poisonings were all caused by the intentional intake of e-liquid, since evidence from the literature about accidental intake was exclusively reported in paediatric cases. 16 Of…”

Electronic cigarettes and vaping: toxicological awareness is increasing

“…In first instance, the design of e-cigarettes as electronic nicotine delivery systems has focused the interest of toxicologists on nicotine and on local effects on the respiratory system, but other endpoints of toxicity are also being discussed (Tzortzi et al 2020); current examples are atherosclerosis (Knura et al 2018) and neuroinflammation (Heldt et al 2020). The presence of a considerable number of toxic substances apart from nicotine in the liquid cartridges and in emissions of e-cigarettes has increasingly raised concern (Rehan et al 2018).…”