Impaired lung function following e‐cigarette or vaping product use associated lung injury in the first cohort of hospitalized adolescents

Abstract

Background Beginning June 2019, Children's Wisconsin was the first hospital to identify a cohort of adolescent patients hospitalized with symptoms likely associated with e‐cigarette use. Our report adds to the growing literature describing the radiographic, gross and cytopathologic bronchoscopic findings, and short‐term lung function outcomes in this cohort of adolescents with e‐cigarette or vaping product use associated lung injury (EVALI). Methods We present 15 adolescents hospitalized from June to September, 2019 with confirmed EVALI. We abstracted data from inpatient hospitalization and first outpatient pulmonary clinic visit. Results There were 15 patients (11 male, 12 White) with a mean age of 17.1 years. All patients presented with subacute pulmonary, gastrointestinal and constitutional complaints. Diagnostic workup was guided by the Centers for Disease Control criteria for confirmed EVALI case surveillance. Flexible bronchoscopy was performed in 13/15 patients with 10/13 demonstrating gross pathologic abnormalities. Seven of 15 patients required intensive care and 2 met criteria for pediatric Acute Respiratory Distress Syndrome. Patients had dramatic improvement with systemic glucocorticoid therapy and 14/15 were discharged on room air. Eleven patients were seen as outpatients. Despite 11/11 patients reporting resolved or improved symptoms, 7/11 had abnormalities on pulmonary function testing. We initiated inhaled corticosteroids for 5/11 patients and 4/11 patients remained on their corticosteroid wean. Conclusions and Relevance We report short‐term outcomes of the first cohort of adolescent patients hospitalized with EVALI. An association is observed between clinical improvement and treatment with systemic corticosteroids. However, residual airway reactivity or diffusion abnormalities persisted when patients were re‐evaluated in the short‐term period (mean 4.5 weeks).

Improvement in Pulmonary Function Following Discontinuation of Vaping or E-cigarette Use in Adolescents with EVALI

“…In comparing to previous reports characterizing the symptoms and clinical course of patients affected by EVALI, our patients experienced similar clinical resolution (4,5,15,16). A majority of patients affected by EVALI show significant improvement by clinical (4,5,15), radiologic (8) and spirometric assessment (17).…”

Deadly combination of Vaping-lnduced lung injury and Influenza: case report

“…Influenza is one of the consistent causes of death attributed to viral pneumonias every year [14]. EVALI due to vaping has been recently recognized as a concern in young patients who use vaping 168 devices [1][2][3][4][5][6][7][8]. Our patient had a complex of influenza-related severe lung injury and rhabdomyolysis further complicated by vaping of a mixture of Vitamin-E and THC.…”

“…The use of vaping devices is especially prevalent in the age group of 11 to 34-year-olds [1]. While the mechanism of lung injury in patients who vape is under investigation at the state and federal levels, vitamin E acetate, a chemical used to dilute tetrahydrocannabinol (THC) oil in vape cartridges, has emerged as one of the likely causes of EVALI [3][4][5][6][7]. In January 2020, the FDA finalized a policy that will prioritize enforcement against certain e-cigarette flavors and manufacturers of products that are targeted to minors or have failed to take adequate measures to prevent minors' access [8].…”

Vaping-related lung injury

“…Clinical and imaging follow-up will be critical to ensure resolution of the pathologic process. Case reports have suggested that there may be residual lung dysfunction, mainly diffusion abnormalities, present for at least up to 2 months after discharge [ 35 , 36 ]. However, follow-up studies must be conducted to determine whether these abnormalities persist long term.…”