Acute Eosinophilic Pneumonia Associated with Non-Cigarette Smoking Products: A Systematic Review

Abstract

Acute eosinophilic pneumonia (AEP) is characterized by an acute onset respiratory illness with bilateral chest infiltrates and evidence of pulmonary eosinophilia. Cigarette smoking is the main risk factor, but drugs and other inhalational exposures have also been reported. Herein, the association between AEP and smoking devices other than cigarettes is reviewed The PubMed database was searched using terms such as ”smoking”, ”vaping”, ”e-cigarette”, ”waterpipe”, and ”marijuana”, along with other commonly used synonyms for these terms. In addition, eosinophilic lung diseases were also searched for using the same database. All cases of AEP were identified using the modified Philit criteria in association with the use of marijuana, waterpipe, e-cigarettes or heat-not-burn cigarettes. Cases associated with illicit drug use were excluded. Twelve cases were included with amedian age of 20 (15–60). 75% of patients studied were male. Exposures included marijuana smoking (n = 5), waterpipe usage (n = 2), heat-not-burn cigarette use (n = 2), e-cigarette use (n = 2) and synthetic cannabinoid use (n = 1). Arecent change in smoking habits was reported in 50% of patients. Presenting symptoms were dyspnea (91.6%), cough (66.6%), fever (66.6%) and chest pain (25%). 90% of patients had leukocytosis on presentation, but only 16.6% had peri-pheral eosinophilia. The median eosinophil percentage in bronchoalveolar lavage was 67.5% (0 to 78). Two patients had alung biopsy performed. Bilateral involvement on chest imaging was reported in all patients. Five patients (41.6%) required invasive mechanical ventilation and ten patients (83.3%) were treated in an intensive care unit. All patients responded to corticosteroid therapy with no relapses reported. Acute eosinophilic pneumonia is reported with smoking that does not include traditional cigarette smoking such as waterpipes, e-cigarettes, heat-not-burn cigarettes, and marijuana and can have asimilar presentation and clinical course.

Unfriendly Fire: How the Tobacco Industry is Destroying the Future of Our Children

“…Different lung pathologies have been described in people with EVALI, including acute eosinophilic pneumonia, organising pneumonia, lipoid pneumonia, and alveolar haemorrhage [57][58][59][60][61]. Eosinophilic pneumonia may be an early complication of vaping with an acute onset mandating ventilator support.…”

Diagnostic index for acute eosinophilic pneumonia without bronchoscopy in military smokers

“…First, a detailed history regarding heat-not-burn and electronic cigarettes was not included in our study. Although both smoking products can be possible causes for AEP [36], they were excluded because it was not possible to assess the relative importance of each agent. In addition, the standardized quantification of electronic cigarettes is impossible, considering the diverse ingredients in the devices [37].…”

Vaping Associated Pulmonary Injury

“…Lipoid pneumonia is an inflammatory response to the presence of lipids within the alveolar space and results from aspiration of hydrocarbons or oil-based products (such as THC oil). CT findings usually show fat attenuation in the lungs in lipoid pneumonia, and this was not seen in VAPI [3].…”

“…Findings from chest x-rays vary in severity and include findings of bilateral infiltrates, although those findings may be absent early in the disease course [3]. Computed tomography (CT) of the chest can show bilateral ground glass opacities with pleural effusions and pneumomediastinum.…”