Lung Disease from E-cigarette Use should be carefully monitored for better treatment and prevention
One NEJM General Medicine Journal Watch Review article, “E-Cigarette or Vaping-Associated Lung Injury”, notes: “Evaluation of (e-cigarette lung injuries) with broncho-alveolar lavage (BAL) is uncommon, but when it is performed, lipid-laden macrophages are consistent findings (NEJM JW Gen Med Oct 15 and N Engl J Med Sep 6; [epub]; NEJM JW Gen Med Jan 1 2020 and Lancet Nov 8; [e-pub]). The CDC has reported that BAL fluid from 29 patients with EVALI (across 10 states) revealed vitamin E acetate in all samples and did not demonstrate other concerning substances (e.g., oils, petroleum products). Vitamin E might be added by some illicit manufacturers to dilute THC or to thicken vaping liquids. Whether vitamin E acetate is the causative agent is not yet established (NEJM JW Gen Med Dec 15 and MMWR Morb Mortal Wkly Rep Nov 15; 68:1040).
In the reported case series, nearly all patients were treated with antibiotics and glucocorticoids. Because improvement often was noted in conjunction with steroid treatment, the CDC recommends considering steroids along with supportive care for patients with suspected EVALI. Although deaths have occurred, most patients improve with supportive care. In a report of short-term follow-up, chest imaging and pulmonary function tests were persistently abnormal 2 weeks after hospital discharge (NEJM JW Gen Med Jan 1 2020 and Lancet Nov 8; [e-pub]). Continued heightened awareness of EVALI is essential, as is further investigation into causative agents.” Patricia Kritek, MD
Clearly, case finds continue to reveal information important to physician understanding and treatment, and should be followed in news from the US CDC.
by Dr.Stephen Hamann
