e-Cigarette or Vaping Product Use-Associated Lung Injury

MacMurdo, Maeve G.; Lin, Charlie; Saeedan, Mnahi Bin; Doxtader, Erika E.; Mukhopadhyay, Sanjay; Arrossi, Valeria; Reynolds, Jordan; Ghosh, Subha; Choi, Humberto

doi:10.1016/j.chest.2020.01.030

Cited by 12 publications

(12 citation statements)

References 6 publications

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“…This suggests that in the absence of risk factors for or symptoms of a specific infectious or other alternative diagnosis, bronchoscopy is not routinely necessary, as has been argued by other authors. 16 There were no complications of bronchoscopy in our patients, but a recent article reported a high rate of adverse events among younger patients, further arguing for limiting the use of bronchoscopy in typical cases of EVALI. 40 Our finding of 3 false-positive PCR results for Pneumocystis jirovecii may be surprising to some readers.…”

Section: Jama Network Open | Pulmonary Medicinementioning

confidence: 46%

“…The reason for the lower rate of ICU admission in our series is not readily apparent but may reflect a lower severity of illness or different thresholds for ICU utilization. Of note, the demographic characteristics of our cohort are comparable to other series 1,12,[14][15][16]20 in that they are comprised largely of young, White men who frequently use THC products, with substantial psychiatric comorbidity rates. This argues against underlying demographic dissimilarities as the cause of lower ICU admissions.…”

Section: Discussionmentioning

confidence: 66%

“…In the series by Blagev et al, 12 33 of 60 patients (55%) were admitted to an ICU, and 19 patients (32%) underwent bronchoscopy. More recent additions to the literature, including those by Zou et al, 20 Henzerling et al, 14 and MacMurdo et al, 16 demonstrated similar ICU admission rates (range, 46%-47%) and bronchoscopy rates (range, 19%-47%). By comparison, only 8 (26%) of our patients were treated in an ICU, and a much larger proportion of all patients (22 [77%]) underwent bronchoscopy.…”

Section: Discussionmentioning

confidence: 84%

“…All patients survived, and 20 patients (65%) were seen in follow-up. Median (IQR) time to follow-up after hospital discharge was 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)…”

Section: Follow-upmentioning

confidence: 99%

“…Most patients had the OP pattern as the exclusive finding, a feature witnessed to a high degree in other studies. 16 The prototypical OP pattern comprises multifocal, multilobar, ground glass opacities, often contiguous with uninvolved pulmonary lobules, and sometimes with sparing of the peripheral, subpleural lung. We caution that this very prevalent imaging pattern does not predict pathologic findings in the lung.…”

Section: Jama Network Open | Pulmonary Medicinementioning

confidence: 99%

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Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use–Associated Lung Injury Among Patients Treated at an Academic Medical Center

et al. 2020

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IMPORTANCE e-Cigarette, or vaping, product use-associated lung injury (EVALI) has caused more than 2800 illnesses and 68 deaths in the United States. Better characterization of this novel illness is needed to inform diagnosis and management. OBJECTIVE To describe the clinical features, bronchoscopic findings, imaging patterns, and outcomes of EVALI. DESIGN, SETTING, AND PARTICIPANTS This case series of 31 adult patients diagnosed with EVALI between June 24 and December 10, 2019, took place at an academic medical center in Salt Lake City, Utah. EXPOSURES e-Cigarette use, also known as vaping. MAIN OUTCOMES AND MEASURES Symptoms, laboratory findings, bronchoscopic results, imaging patterns, and clinical outcomes. RESULTS Data from 31 patients (median [interquartile range] age, 24 [21-31] years) were included in the study. Patients were primarily men (24 [77%]) and White individuals (27 [87%]) who used e-cigarette products containing tetrahydrocannabinol (THC) (29 [94%]). Patients presented with respiratory (30 [97%]), constitutional (28 [90%]), and gastrointestinal (28 [90%]) symptoms. Serum inflammatory markers were elevated in all patients. Bronchoscopy was performed in 23 of 28 inpatients (82%) and bronchoalveolar lavage (BAL) revealed the presence of lipid-laden macrophages (LLMs) in 22 of 24 cases (91%). BAL samples tested positive for Pneumocystis jirovecii (3 patients [13%]), rhinovirus (2 patients [8%]), human metapneumovirus and Aspergillus (1 patient each [4%]); all except human metapneumovirus were determined to be false-positives or clinically inconsequential. The exclusive or dominant computed tomography (CT) pattern was organizing pneumonia in 23 of 26 cases (89%). Patients received antibiotics (26 [84%]) and corticosteroids (24 [77%]), and all survived; 20 patients (65%) seen in follow-up showed marked improvement, but residual symptoms (13 [65%]), radiographic opacities (8 [40%]), and abnormal pulmonary function tests (8 of 18 [44%]) were common. CONCLUSIONS AND RELEVANCE In this case series, patients with EVALI characteristically presented with a flu-like illness with elevated inflammatory markers, LLMs on BAL samples, and an organizing pneumonia pattern on CT imaging. Bronchoscopic testing for infection had a high incidence of false-positive results. Patients had substantial residual abnormal results at early (continued) Key Points Question What are the typical clinical, radiographic, and bronchoscopic findings and clinical outcomes of e-cigarette, or vaping, product use-associated lung injury (EVALI)? Findings This case series of 31 patients found that EVALI typically presented as a flu-like illness with elevated inflammatory markers and an organizing pneumonia pattern on computed tomography imaging. Bronchoscopy showed lipid-laden macrophages and had a high rate of false-positive results for infection. Meaning The findings of this study suggest that EVALI has a characteristic clinical and radiographic presentation and that bronchoscopy has limited utility in its evaluation.

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Section: Jama Network Open | Pulmonary Medicinementioning

confidence: 46%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 84%

Section: Follow-upmentioning

confidence: 99%

Section: Jama Network Open | Pulmonary Medicinementioning

confidence: 99%

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Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use–Associated Lung Injury Among Patients Treated at an Academic Medical Center

et al. 2020

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E‐cigarette and vaping product use‐associated lung injury in the pediatric population: A critical review of the current literature

Kaslow

Rosas‐Salazar

Moore

2021

Pediatric Pulmonology

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Use of electronic nicotine delivery systems (ENDS), also known as e‐cigarettes, in the adolescent population has significantly increased over the past several years. This rise led to an outbreak of e‐cigarette or vaping product use‐associated lung injury (EVALI) in the summer of 2019. Since that time, numerous case reports and case series on vaping and EVALI have been published but the majority of literature highlights the adult population with few articles focusing on pediatric patients. Given the addictive nature of these products and the lack of full understanding of the human health effects, there is concern that use of ENDS may have lasting impacts on users, especially adolescents and young adults. The goal of this review is to critically assess published data on ENDS use in children, report our institutional experience, discuss the reasons why the use of ENDS have increased among young individuals, outline the current understanding of EVALI as it pertains to the pediatric population, and discuss future opportunities for health policy implementation.

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