The importance of anti‐vaping vigilance—EVALI in seven adolescent pediatric patients in Northeast Ohio

Abstract

As of 18 February 2020, the e‐cigarette or vaping product use‐associated lung injury (EVALI) epidemic has claimed the lives of 68 patients in the USA with the total number of reported cases standing at 2807 to date. We present the clinical and radiologic findings, course of illness, and treatment of EVALI in seven adolescent patients in Northeast Ohio. Five of our patients required supplemental oxygen with four requiring intensive care unit care for respiratory support during admission. Three patients were treated with systemic steroids while inpatient. Bilateral opacities were seen on radiographic imaging of all seven of our patients. All patients were discharged alive on room air. However, impaired diffusing capacity of the lungs for carbon monoxide (DLCO) with nonobstructive spirometry was seen in patients that were tested postdischarge. This suggests that although recovery from the acute illness process of EVALI is achieved, there may be long‐term impact on lung function in these patients. We recommend close follow‐up with a pediatric pulmonologist where spirometry and DLCO can be performed.

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

“…These symptoms are often accompanied by gastrointestinal symptoms (occurring in ∼77% of patients) and constitutional symptoms such as fever, chills, and weight loss (occurring in ∼85% of patients). The few published pediatric reports mirror similar presenting symptoms (Table 1), 57–62 although children appear to have a higher incidence of non‐respiratory symptoms than adults. In a large ( n = 2155), national, cross sectional study comparing hospitalized or deceased adolescents (aged 13–17 years), young adults (aged 18–24 years), and adults (aged 25–49 years), Adkins et al 63 showed that adolescents more frequently reported both gastrointestinal and constitutional symptoms compared to adults, although there was no difference when compared to young adults.…”

“…To date, most of the published research in pediatric EVALI has been limited to case reports and case series of single institutional experiences (Table 1). 57–62 Thus, there remains a lack of hypothesis‐driven pediatric focused literature in this field. Furthermore, the published series likely suffer from selection bias towards the more severe patients who either presented to a tertiary care center or required admission to the hospital, suggesting that the epidemiology of less severe disease may be significantly higher than what has been reported in the literature.…”

Treatment of electronic cigarette or vaping product use‐associated lung injury (EVALI) by corticosteroid and low‐dose pirfenidone: Report of a case

“…In the acute stage of EVALI, both obstructive and restrictive spirometry patterns have been reported, and often accompanied by a reduced DLCO 15–19 . Improvements in these parameters after corticosteroid treatment, however, varied widely between previous studies 15,16 .…”

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.…”