E-cigarette, or vaping, product use-associated lung injury: a review
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Belok et al. Pneumonia (2020) 12:12 https://doi.org/10.1186/s41479-020-00075-2
REVIEW
Open Access
E-cigarette, or vaping, product useassociated lung injury: a review Samuel H. Belok*†, Raj Parikh†, John Bernardo and Hasmeena Kathuria
Abstract Background: E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) is a disease entity related to the use of battery-operated or superheating devices that create an aerosolized form of nicotine and tetrahydrocannabinol (THC) and/or other substances for inhalation. Methods: We performed a literature review to document epidemiology, pathogenesis and risk factors, diagnosis, clinical presentation, evaluation and management of EVALI. Results: In the summer of 2019, an outbreak of EVALI cases brought this disease entity into the national spotlight. Since being recognized as a serious pulmonary disease with public health implications, more than 2600 cases have been reported to CDC with 68 deaths as of February 2020. The pathophysiology of EVALI remains unknown. Substances such as Vitamin E acetate have been implicated as a possible causes of lung injury. The CDC has established case definitions of “confirmed EVALI” cases to help guide identification of the disease and assist in surveillance. While clinical judgement by healthcare providers is imperative in the identification of EVALI cases, the heterogeneous presentations of EVALI make this difficult as well. Ultimately most investigative studies should be aimed at ruling out other disease processes that can present similarly. Treatment is centered around removing the offending substance and providing supportive care. Conclusions: EVALI is a serious pulmonary disease with public health implications. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. It may be beneficial to involve a pulmonary specialist early in the management of this disease which is generally supportive care. Keywords: EVALI, Vaping, Inhalational injury, E-cigarettes
Background Electronic cigarettes (e-cigarettes) are known by many different names, including e-cigs, mods, vapes, and electronic nicotine delivery systems [1]. E-cigarettes are battery-operated devices that produce an aerosol by heating substances typically containing nicotine and/or other materials or flavorings on an internal metal coil until the material is aerosolized and can be inhaled [2, 3]. “Vaping” is a broad term which denotes inhaling the aerosol produced by an e-cigarette or other vaporizing device. E-cigarettes began to appear in US markets in * Correspondence: [email protected] † Samuel H. Belok and Raj Parikh contributed equally to this work. Section of Pulmonary and Critical Care Medicine, Boston University School of Medicine, 72 E Concord St., R-304, Boston, MA 02118, USA
2006, and enjoyed a growing demand among youth and adults, culminating with the US Surgeon General naming e-cigarette use a growing public health “epidemic” [4]. Since entering the US marketplace, several generations of e-cigarette
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