E cigarettes vaping and vaping induced lung injury EVALI
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Newer forms of Tobacco Better or Worse or unknown?
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E cigarettes vaping and vaping induced lung injury EVALI
- 1. Newer forms of Tobacco Better or Worse or unknown? Muhammed Aslam MD Specialist Pulmonologist International Modern Hospital Dubai , UAE
- 2. Introduction Despite all the efforts to reduce cigarette use, other forms of tobacco use such as vaping and waterpipe/hookah have been on the rise, especially among young adults. Dana El Hajj etal .Tob Use Insights. 2019; 12: 1179173X19874811.
- 5. What is Vape? Vaping is the act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device Many of these particles contain varying amounts of toxic chemicals
- 6. Electronic cigarettes Electronic nicotine delivery devices are known as electronic cigarettes Contains nicotine, propylene glycol, formaldehyde, nitrosamines , tetrahydrocannabinol (THC) , cannabinoid (CBD) oils, and other substances and additives.
- 9. What are the benefits of e-cigarettes? ● ? Less harmful than conventional ● ? Helps to quit smoking
- 10. ?Less harmful McNeil et al (2015) E-cigarettes: an evidence update. A report commissioned by Public Health England.
- 11. Are e-cigarettes safe? • Nicotine • Propylene Glycol • Glycerine • Flavourings • Contaminants (most significant concern)
- 13. © New York State Department of Health www.health.ny.gov EVALI (e-cigarette, or vaping, product use associated lung injury)
- 15. EVALI IMAGING This patient has e-cigarette, or vaping, product use associated lung injury, with diffuse bilateral ground glass opacities (green arrows) in a peribronchial distribution, with subpleural sparing (black arrows). E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach .Lancet Respir Med 2019
- 16. EVALI IMAGING A - diffuse bilateral ground-glass opacities with peripheral prominence, mimicking eosinophilic pneumonia. B - diffuse bilateral ground-glass opacities with areas of consolidation Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping): A Report of Eight Cases, American Journal of Clinical Pathology, , aqz182, https://doi.org/10.1093/ajcp/aqz182
- 17. C - bilateral basilar dependent consolidations with diffuse ground-glass opacities and mild smooth septal thickening. D - bilateral ground-glass opacities in a somewhat patchy distribution. EVALI IMAGING Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping): A Report of Eight Cases, American Journal of Clinical Pathology, , aqz182, https://doi.org/10.1093/ajcp/aqz182
- 18. EVALI HISTOPATHOLOGY The pathologic patterns observed were generally nonspecific patterns of acute lung injury, including organizing pneumonia, fibrinous organizing pneumonia, and diffuse alveolar damage.
- 19. EVALI HISTOPATHOLOGY Most cases showed airway-centered acute lung injury (Panel A), often with severe bronchiolitis accompanied by marked mucosal edema, sloughing of bronchiolar epithelium, and peribronchiolar organization (Panel B). All cases showed accumulation of foamy or vacuolated macrophages in peribronchiolar airspaces with pneumocyte vacuolization (Panel C). Four cases showed severe injury, with diffuse alveolar damage and hyaline membranes (Panel D). NEnglJMed2019;381:1780-1781
- 20. EVALI © New York State Department of Health www.health.ny.gov
- 21. EVALI (e-cigarette, or vaping, product use associated lung injury) ● As of November 20, 2019, 2,290 cases of EVALI have been reported to CDC (Centers for Disease Control and Prevention) ● Forty-seven deaths have been confirmed ● Most patients have reported a history of using products containing THC, the psychoactive compound in cannabis. Source : www.cdc.gov
- 22. EVALI (e-cigarette, or vaping, product use associated lung injury) ● Health researchers believe vitamin E acetate, a chemical added to some THC vaping liquids, could be behind the mystery illness. ● The substance was found in every bronchoalveolar lavage (BAL) fluid samples from afflicted patients tested by the CDC. Source : www.cdc.gov
- 23. Can e-cigarettes help people stop smoking? • The debate remains open and more randomized trials are needed with long-term data about the efficacy and safety of e-cigarettes. Sources: - McRobbie et al (2014) – Electronic cigarettes for smoking cessation and reduction (Cochrane Review). - Grana (2014) JAMA Internal Medicine – A longitudinal analysis of electronic cigarette use and smoking cessation - Lancet Respir Med. 2016 Feb;4(2):116-28. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis - Ann Intern Med. 2018 May 1;168(9):613-620. Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study.
- 24. Will e-cigarettes encourage children and teen to start smoking? EC use among youth is prospectively associated with progression toward greater cigarette use Nicotine & Tobacco Research, Volume 21, Issue 10, October 2019, Pages 1414–1422
- 25. ● A ban on e-cigarettes alone would likely increase the choice of cigarettes in smokers, arguably the more harmful way of obtaining nicotine ● More legalization to control illegal trading of vaping products is the ultimate solution Should Vaping Be Banned? Buckell J, Marti J, Sindelar JL. Tob Control 2019;28:168–175.
- 26. What should we tell patients? ● E-cigarettes are not harm-free ● The best thing you can do for your health is stop smoking: if e-cigarettes can help you do this, use only licensed products. ● But there are other better ways to stop smoking
- 27. Newer forms of Tobacco. Better or Worse or unknown? • Non smoker - don't try vaping • Smokers – to follow established smoking cessation programmes first • Vapers - to use licenced products only . Avoid illicit contaminated vaping products.
- 28. THANK YOU
Editor's Notes
- Tobacco use remains the number one cause of mortality and morbidity among adults globally. Despite all the efforts to reduce cigarette use, other forms of tobacco use such as vaping and waterpipe/hookah have been on the rise, especially among young adults. Waterpipe use is emerging as a global epidemic that needs immediate action and attention, particularly among college students and young adults alternative forms of tobacco use may be a gateway drug to cigarette use
- Vaping is the act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device Many of these particles contain varying amounts of toxic chemicals, which have been linked to cancer, as well as respiratory and heart disease
- The use of the electronic cigarettes is on the rise, especially among youths and young adults
- A recent report by Public Health England reported the harm from e-cigarettes to be expected to be 95% less than that of smoking tobacco cigarettes. This received widespread press coverage. A similar figure was stated in a report for the UK Parliament.
- 5 The authors also pay special attention to the term exogenous lipoid pneumonia and note that none of the cases reviewed fulfilled histologic criteria for that diagnosis.
- Updated data 79% of patients are under 35 years old. By age group category: 14% of patients are under 18 years old; 40% of patients are 18 to 24 years old; 25% of patients are 25 to 34 years old; and 21% of patients are 35 years or older.
- An outbreak of vaping-related deaths in the US has been described as a public health crisis. At least 39 people have died and more than 2,000 have suffered lung injuries from vaping-related illnesses, according to the Centers for Disease Control and Prevention (CDC). Currently 46 states and one US territory have reported cases of the illness. Two thirds of those with the illness are 18-34-years-old, while 16 per cent are under 18. Around 69 per cent of the patients are male. Most patients have reported a history of using products containing THC, the psychoactive compound in cannabis. But one patient who died in Georgia last month reported only “heavy nicotine vaping”. Health researchers believe vitamin E acetate, an chemical added to some THC vaping liquids, could be behind the mystery illness. The substance was found in every lung fluid sample from afflicted patients tested by the CDC. CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. Vitamin E acetate might be used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products. About 86% reported using THC-containing products; 34% reported exclusive use of THC-containing products. About 64% reported using nicotine-containing products; 11% reported exclusive use of nicotine-containing products.
- Vaping has emerged as the fastest growing epidemic among teens in schools, who would have never taken up smoking yet are now new users of e-cigarettes. According to the National Youth Tobacco Study, more than 3.6 million middle and high schoolers used e-cigarettes in 2018, which is up more than double from 1.5 million in 2017. Unfortunately, many kids believe that e-cigarettes are harmless compared to smoking, which contributes to this massive epidemic.