What lung diseases are associated with electronic cigarette (e-cigarette) use?

From the Guidelines

Vaping and e-cigarette use are associated with several serious lung conditions, most notably E-cigarette or Vaping product use-Associated Lung Injury (EVALI), and the safest approach is to avoid all vaping products. EVALI can cause symptoms like shortness of breath, cough, chest pain, fever, and gastrointestinal issues, potentially leading to respiratory failure requiring hospitalization 1. Other lung conditions linked to vaping include lipoid pneumonia (from inhaling oil-based substances), chemical pneumonitis (lung inflammation from inhaled chemicals), bronchiolitis obliterans (also called "popcorn lung," involving scarring of small airways), and exacerbation of existing conditions like asthma and COPD. The primary culprit in many EVALI cases has been vitamin E acetate, particularly in THC-containing products, though other chemicals in vaping liquids may also contribute to lung damage.

Key Considerations

• Treatment typically involves corticosteroids like prednisone (40-60mg daily, tapered over weeks), supportive care, and complete cessation of vaping 1.
• The long-term effects of vaping remain largely unknown, and many harmful chemicals have been identified in e-cigarette aerosols, including formaldehyde, acrolein, and heavy metals.
• Evaluating and managing patients with suspected EVALI requires a thorough initial clinical assessment, including vital signs, pulse oximetry, focused history and physical exam, and ruling out other possible etiologies (e.g., influenza, community-acquired pneumonia) 1.

Management Approach

• Determine if the patient is a candidate for outpatient EVALI management based on factors such as O2 saturation, respiratory distress, comorbidities, and access to care/social support systems 1.
• Patients with suspected EVALI should be closely monitored and managed as clinically indicated, with a focus on reducing the risk for rehospitalization and death following hospital discharge 1.

From the Research

Lung Diseases Associated with Vaping or E-Cigarette Use

• Electronic cigarettes (e-cigarettes) are electronic devices designed to vaporize chemical compounds, and their use may pose health risks in the form of cardiovascular and respiratory diseases 2.
• Acute lung injury may also be associated with the use of e-cigarettes, but the underlying cause remains unknown 2.
• E-cigarette use is associated with reduced toxicant exposure and reduced short-term respiratory symptoms compared to traditional cigarettes, but long-term health effects are unknown 3.
• E-cigarettes pose several potential health risks, including exposure to heavy metals and toxicants, and nicotine poisoning 3.

Respiratory Diseases and Vaping

• Chronic obstructive pulmonary disease (COPD) is a respiratory disease that can be exacerbated by vaping or e-cigarette use 4, 5, 6.
• Acute exacerbation of COPD (AECOPD) tends to be critical and debilitating events leading to poorer outcomes in relation to COPD treatment modalities 5.
• Noninvasive ventilation (NIV) is recommended as the treatment of choice for AECOPD with acute respiratory failure, as it is thought to be most effective in reducing intubation risk 5.
• High-flow nasal cannula oxygen therapy is another supportive strategy that serves to improve the symptoms of hypoxic respiratory failure 5.

Health Risks and Vaping

• E-cigarette use is associated with increased risk of subsequent cigarette and marijuana use in youth 3.
• Youth e-cigarette use is a concern, with rates of e-cigarette use surpassing those of cigarette use in this population 3.
• Screening for e-cigarette use in youth and adults, including pregnant women, in conjunction with screening for tobacco use, is advised 3.
• Education and interventions to prevent e-cigarette use should be provided to all youth, and pregnant women should be counseled to abstain from using all nicotine/tobacco products 3.