Vaping

Among adolescents, vaping is more common than cigarette smoking (1). Vaping can result in the adverse outcome of nicotine addiction in people who might otherwise be nonsmokers, rather than the intended benefit of e-cigarettes decreasing risks in habitual cigarette smokers.

Commercially produced vaping liquids usually contain other ingredients in addition to water and the active ingredient. While there is no combustion involved in using e-cigarettes, the aerosol emitted from the device contains ultra-fine particles, which can be inhaled deeply into the lungs; flavoring such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds; cancer-causing chemicals; and heavy metals (eg, nickel, tin, and lead), though all at lower levels than in cigarettes, which are combusted tobacco smoke.

E-cigarette and vaping product use-associated lung injury (EVALI) is a term used by the Centers for Disease Control and Prevention (CDC) to describe a severe lung illness associated with using e-cigarette and vaping products that was first identified in 2019. As of 2020, < 2800 hospitalized cases and 68 deaths had been reported in the United States (2). Most cases involved THC or cannabidiol-containing products. Vitamin E acetate was the most strongly associated agent. This is an example of the toxicity of adulterants.

The clinical presentation of EVALI includes respiratory symptoms (eg, cough, chest pain, shortness of breath), gastrointestinal symptoms (eg, abdominal pain, nausea, vomiting, diarrhea), nonspecific constitutional symptoms (eg, fever, chills, weight loss), reduced blood oxygen levels, elevated white blood cell count, and injuries resembling those caused by exposures to toxic chemical fumes, poisonous gases, and toxic agents. In some patients with EVALI, respiratory distress progresses to acute respiratory distress syndrome.

The EVALI diagnosis is made by a history of recent e-cigarette or vapor use and exclusion of other causes of lung pathology (eg, infection). Laboratory tests may show leukocytosis with eosinophilia, although this finding is neither sensitive nor specific. Imaging studies of the lungs show bilateral lung opacities, most clearly seen with computed tomography.

Treatment may require intubation, mechanical ventilation, and extracorporeal membrane oxygenation. There is no evidence to support the administration of glucocorticoids.