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Outcomes of Lung Injury Associated With E-Cigarettes or Vaping
Study Questions:
What are the potential causes, diagnostic methods, and management for lung injury associated with e-cigarettes or vaping?
Methods:
This was a prospective observational cohort study, in which data on all patients with lung injury associated with e-cigarettes or vaping seen at Intermountain Healthcare, Salt Lake City, UT, between June 27 and October 4, 2019 were included. Telecritical care was used as the central repository for case validation, public reporting, and system-wide dissemination of expertise, which included a proposed diagnosis and treatment guideline for lung injury associated with e-cigarettes or vaping. Vaping exposure history, signs and symptoms at presentation, laboratory and microbiological tests, bronchoscopy results, imaging findings, treatment, clinical course, and follow-up data were obtained via chart review in a standardized fashion.
Results:
A total of 60 patients presented with lung injury associated with e-cigarettes or vaping at 13 hospitals or outpatient clinics in the integrated health system. Of these patients, 33 (55%) were admitted to an intensive care unit (ICU). Symptoms reported included constitutional (n = 53 [88%]), respiratory (n = 59 [98%]), and gastrointestinal (n = 54 [90%]). Treatment included antibiotics (n = 54 [90%]) and steroids (n = 57 [95%]). Six (10%) of 60 patients were readmitted to an ICU or hospital within 2 weeks, three (50%) of whom had relapsed with vaping or e-cigarette use. Of 26 patients who were followed up within 2 weeks, despite clinical and radiographic improvement in all, many had residual abnormalities on chest radiographs (10 [67%] of 15) and pulmonary function tests (6 [67%] of 9). Two patients died and lung injury associated with e-cigarettes or vaping was thought to be a contributing factor, but not the cause of death, for both.
Conclusions:
The investigators concluded that lung injury associated with e-cigarettes or vaping is an emerging illness associated with severe lung injury and constitutional and gastrointestinal symptoms. Increased awareness has led to identification of a broad spectrum of severity of illness in patients who were treated with antibiotics and steroids. Despite improvement, at short-term follow-up many patients had residual abnormalities. Lung injury associated with e-cigarettes or vaping remains a clinical diagnosis with symptoms that overlap infectious and other lung diseases. Maintaining a high index of suspicion for this disease is important, as work continues in understanding the cause or causes, optimal therapy, and long-term outcomes of these patients.
Perspective:
These data from one healthcare system provide information on potential common characteristics of lung disease associated with e-cigarettes or vaping. Although limitations of this observational study design exist, it is an important initial step to providing ongoing cohort development, which allows for the information from multiple sources with the goal to improve current understanding related to predictors of such injuries in addition to effective management.
Keywords: Anti-Bacterial Agents, Bronchoscopy, Electronic Nicotine Delivery Systems, Gastrointestinal Tract, Intensive Care Units, Lung Injury, Primary Prevention, Radiographic Image Interpretation, Computer-Assisted, Respiratory Function Tests, Smoking, Smoke Inhalation Injury
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