| Title: | Electronic Cigarettes and Vaping-Associated Lung Injury (EVALI): A Rural Appalachian Experience |
| Author(s): | Sangani R; Rojas E; Forte M; Zulfikar R; Prince N; Tasoglou A; Goldsmith T; Casuccio G; Boyd J; Olfert IM; Flanagan M; Sharma S; |
| Address: | "Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA. C. Eugene Bennett Department of Chemistry, West Virginia University, Morgantown, WV, USA. Department of Orthopedics, West Virginia University School of Medicine, Morgantown, WV, USA. RJ Lee Group, Inc., Monroeville, PA, USA. Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA. Occupational and Environmental Health, West Virginia University School of Public Health, Morgantown, WV, USA. Center of Inhalation Toxicology (Itox, WVU Robert C. Byrd Health Science Center, Morgantown, USA. Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, USA. Department of Pathology, Anatomy, and Laboratory Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA" |
| DOI: | 10.1080/21548331.2020.1843282 |
| ISSN/ISBN: | 2154-8331 (Print) 2154-8331 (Linking) |
| Abstract: | "Background: Electronic cigarette use has increased dramatically since their introduction in 2007. Respiratory complications, particularly lipoid pneumonia, have been reported as early as 2012. An outbreak of pulmonary injury in 2019 has been reported in patients using vaping products.Research Question: To describe a rural Appalachian tertiary center's experience of EVALI and to identify novel mechanisms of pulmonary injury patterns.Study Design and Methods: We present a consecutive case series of 17 patients admitted to our rural, academic, tertiary care institution with EVALI from August 2019 to March 2020. Demographics, baseline characteristics, co-morbidities, vaping behavior, and hospital course were recorded. Broncho-alveolar lavage specimens were assessed for lipid-laden macrophages and hemosiderin-laden macrophages with stains for Oil-Red-O (n = 15) and Prussian Blue (n = 14) respectively.The patient volunteered e-liquid materials (n = 6), and vapors were analyzed using a proton transfer reaction time-of-flight mass spectrometer (PTR-TOF-MS) to describe the chemical profile. Post-discharge interviews were conducted.Results: The most common CT finding was bilateral ground-glass opacities with a predilection for lower lung zones. The most frequent pulmonary injury pattern was lipoid pneumonia. The majority of EVALI patients were critically ill requiring ventilation or ECMO. The most severely ill patients were noted to be positive for iron stains in macrophages and showed higher volatile organic compound (VOC) levels in chemical analysis.Interpretation: Based on our experience, EVALI in rural Appalachia presented with relatively severe respiratory failure. Worse outcomes appear to be correlated to high levels of VOCs, iron deposition in lungs, and concomitant infection" |
| Keywords: | Adolescent Adult Aged Appalachian Region *Electronic Nicotine Delivery Systems Female Humans Lung Injury/*chemically induced Male Middle Aged Pneumonia/chemically induced *Rural Population Vaping/*adverse effects Young Adult Electronic Cigarettes and Vapi; |
| Notes: | "MedlineSangani, Rahul Rojas, Edward Forte, Michael Zulfikar, Rafia Prince, Nicole Tasoglou, Antonios Goldsmith, Travis Casuccio, Gary Boyd, Jonathan Olfert, I Mark Flanagan, Melina Sharma, Sunil eng U54 GM104942/GM/NIGMS NIH HHS/ England 2020/11/03 Hosp Pract (1995). 2021 Apr; 49(2):79-87. doi: 10.1080/21548331.2020.1843282. Epub 2021 Jan 21" |
