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Abstract
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Battery operated electronic cigarettes or e-cigarettes are used to inhale nicotine and additive agents. There has been no large-scale study identifying such exposure till 2019, when several journals and health departments reporting such cases as a public health concern. Potentially toxic chemicals such as nicotine, carbonyls, benzene, toluene are shown as key ingredients in vaping.
According to the Center of Disease Control (CDC), VALI is defined as the use of e-cigarette or vaping in the 90 days before symptom onset, pulmonary infiltrate (opacities on chest X-ray or ground glass opacities on computed tomography), absence of infection after workup and no evidence of an alternative cause (cardiac, rheumatologic, or neoplastic)...
Vaping devices in the form of easy-to-carry pens and USB flash drives have been aggressively marketed. It was first introduced in the US in 2006. Literature highlighted the short and long term health effects of vaping and its comparison with traditional cigarettes. CDC reported VALI with worsening symptoms including shortness of breath, fever, cough, vomiting, diarrhea, headache, dizziness and chest pain. Range of symptoms and imaging were correlated with chemical pneumonitis. Patients required ICU care with mechanical ventilation due to severe respiratory failure.
As of early September 2019, approximately 450 cases in the United States were reported with mortality in five cases.5,6 The largest case number (150-199) was reported from Texas and Ilinois of United States with 47 deaths.2
The pathogenesis of VALI is yet to be discovered; however, multiple compounds were identified as potential risk factors such as diacetyl, nickel, tin, and lead; no specific liquid or device has been identified as the causative agent. VALI has been reported with nicotine, tetrahydrocannabinol and cannabidiol products. Laboratory and imaging findings are non-specific. Bronchoscopy samples showed neutrophilia and lipid laden macrophages.
The patterns of lung injury reported with VALI include acute eosinophilic pneumonia, lipoid pneumonia, acute lung injury and acute respiratory distress syndrome, acute and subacute hypersensitivity pneumonitis, organizing pneumonia, acute eosinophilic pneumonia, diffuse alveolar hemorrhage, and respiratory bronchiolitis-associated pneumonitis.3,6
Emergency physicians should inquire specifically about e-cigarette use in any patient presenting with acute lung disease. VALI is changing into an epidemic with under-reported numbers. In anticipation of rise of respiratory illnesses during influenza season, the CDC updated its guidance for VALI to...
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