E-cigarette use-associated lung injury (EVALI)

 

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Abstract

The prevalence of vaping has overtaken conventional cigarettes as the most frequent form of nicotine consumption among 15–24-year olds. There are currently a large number of both legitimate and illegitimate products and suppliers offering more than 8000 different flavors of vape on the market, whose additives are not tested, studied or regulated and whose safety and toxicity profile remains unknown. In vitro studies have demonstrated a dose-dependent decrease in the viability of normal human bronchial epithelial cells after exposure to vapor from electronic vape devices.

Short- and medium-term studies to date indicate that vapor-induced pulmonary lesions are the most serious and commonly reported side effect; such lesions include bilateral ground glass opacities in lung bases with subpleural preservation, bilateral infiltrates, pleural effusion, pneumomediastinum and nodular opacities. Cases of EVALI have been described in patients with daily exposure, as well as in users who reported having been exposed to these substances at least once a month. The most frequently inhaled substances are THC, flavored liquids of unknown content, and nicotine.

The clinical manifestations of dyspnea and cough are the most frequent respiratory symptomatology, in addition to constitutional manifestations such as fever and chills, and gastrointestinal manifestations such as vomiting, nausea, abdominal pain and diarrhea. To these can be added the presence of tachypnea, tachycardia, elevated blood pressure, hypoxia, leukocytosis with neutrophilia and elevated ESR.

Zusammenfassung

Das Dampfen hat die herkömmlichen Zigaretten als häufigste Form des Nikotinkonsums bei den 15- bis 24-Jährigen überholt. Derzeit gibt es auf dem Markt eine Vielzahl von legalen und illegalen Produkten und Anbietern, die mehr als 8000 verschiedene Geschmacksrichtungen anbieten, deren Zusatzstoffe nicht getestet, untersucht oder reguliert werden und deren Sicherheits- und Toxizitätsprofil unbekannt bleibt. In-vitro-Studien haben eine dosisabhängige Abnahme der Lebensfähigkeit normaler menschlicher Bronchialepithelzellen nach Exposition gegenüber Dampf aus elektronischen Verdampfungsgeräten gezeigt.

Bisherige kurz- und mittelfristige Studien deuten darauf hin, dass dampfinduzierte Lungenläsionen die schwerwiegendste und am häufigsten gemeldete Nebenwirkung sind. Zu diesen Läsionen gehören: bilaterale Mattigkeit in der Lungenbasis mit subpleuralem Erhalt, bilaterale Infiltrate, Pleuraerguss, Pneumomediastinum und knotige Trübungen. Fälle von EVALI wurden sowohl bei Patienten mit täglicher Exposition als auch bei Anwendern beschrieben, die angaben, diesen Substanzen mindestens einmal im Monat ausgesetzt gewesen zu sein. Die am häufigsten inhalierten Substanzen sind THC, aromatisierte Flüssigkeiten mit unbekanntem Inhalt und Nikotin.

Die klinischen Manifestationen von Dyspnoe und Husten sind die häufigsten respiratorischen Symptome, zusätzlich zu anderen konstitutionellen Manifestationen wie Fieber und Schüttelfrost und anderen gastrointestinalen Manifestationen wie Erbrechen, Übelkeit, Bauchschmerzen und Durchfall; hinzu kommt das Vorhandensein von Tachypnoe, Tachykardie, erhöhtem Blutdruck, Hypoxie, Leukozytose mit Neutrophilie und erhöhter ESR.

Publication History

Received: 26 May 2023

Accepted after revision: 13 July 2023

Article published online:
19 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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