E-Cigarettes and Vaping-Related Disease

• • Original Article Deaths Due to E-Cigarette– or Vaping-Associated Lung Injury A.K. Werner and Others

    This study from the CDC compared the characteristics of 60 patients who died from EVALI with those of 2558 patients who were hospitalized for the condition but survived. The deaths were reported from 27 states and the District of Columbia, and most were associated with vaping THC-containing products before symptom onset.

    Apr 23

    Special Report Syndromic Surveillance for E-Cigarette, or Vaping, Product Use–Associated Lung Injury
    Editorial Vaping-Induced Lung Disease — A Look Forward by Looking Back

• • Original Article Vaping-Induced Lung Injury J.E. Layden and Others

    Vaping use has rapidly increased. In this final report from the Wisconsin and Illinois departments of public health, a severe respiratory illness in otherwise healthy young people is described. Of the 98 case patients identified in this investigation, 95% were hospitalized, 26% were intubated, and 2 persons died.

    Mar 05

    Correspondence Imaging of Vaping-Associated Lung Disease
    Correspondence Pulmonary Lipid-Laden Macrophages and Vaping
    Correspondence Trends in Adolescent Vaping, 2017–2019
    Correspondence Pulmonary Illness Related to E-Cigarette Use
    Editorial Vaping-Induced Acute Lung Injury

  • Perspective Regulating Vaping J.L. Sindelar

    Federal and state governments have implemented numerous policies to combat the growth of vaping. But policies should protect young people without diminishing adult smokers’ ability to use e-cigarettes to transition away from more harmful combustible cigarettes.

    Mar 25

Additional Articles on E-Cigarettes and Vaping-Related Disease

• Correspondence Mar 19, 2020 An Animal Model of EVALI
  T.A. Bhat and Others N Engl J Med 2020; 382:1175-1177

  In this study, investigators developed a mouse model of e-cigarette, or vaping, product use–associated lung injury. They showed that in these mice, vitamin E acetate induced lung injury that had many similarities to what has been seen in human cases.

• Original Article Feb 20, 2020 Role of Vitamin E Acetate in EVALI
  B.C. Blount and Others N Engl J Med 2020; 382:697-705

  In a study involving 51 patients with electronic-cigarette, or vaping, product use–associated lung injury in 16 states across the United States, vitamin E acetate was detected in samples of bronchoalveolar-lavage fluid from 94% of the patients but not in samples from a healthy comparator group.

  Editorial Cornering the Suspects in Vaping-Associated EVALI

• Perspective Feb 20, 2020 The EVALI and Youth Vaping Epidemics
  B.A. King and Others N Engl J Med 2020; 382:689-691

  Interventions aimed at curbing two related U.S. epidemics connected with vaping — an outbreak of lung injuries and a continued surge in use by young people — should take into consideration their underlying drivers.

• Special Report Feb 20, 2020 Vaping Syndromic Surveillance
  K.P. Hartnett and Others N Engl J Med 2020; 382:766-772

  Increases in EVALI were identified in 2019. Using the National Syndromic Surveillance Program, which includes about 70% of U.S. EDs, researchers found a gradual increase in ED visits associated with shortness of breath and e-cigarette use from January 2017 through early June 2019. A sharp increase was identified in June, peaking in September. A subsequent decrease was observed.

• Correspondence Jan 23, 2020 More on the Pathology of Vaping-Associated Lung Injury
  N Engl J Med 2020; 382:387-390

  This description of untreated vaping-associated lung injury examined at autopsy provides a look at the pathology of the process independent of medical intervention.

• Correspondence Jan 23, 2020 Pulmonary Illness Related to E-Cigarette Use
  N Engl J Med 2020; 382:384-386

  In these letters, Diaz et al. highlight the potential for severe airway reactivity and perioperative challenges when performing bronchoscopy and BAL in patients with e-cigarette, or vaping, product use–associated lung injury, and Russell and Cevik stress the importance of ruling out infectious causes in these patients. Layden et al. respond.

• Correspondence Oct 31, 2019 Real-Time Surveillance of Vaping-Induced Pulmonary Disease
  Y. Hswen and J.S. Brownstein N Engl J Med 2019; 381:1778-1780

  This report documents the ongoing surge in cases of severe pulmonary disease associated with e-cigarettes, collecting online information from news aggregators, eyewitness reports, and official alerts.

• Correspondence Oct 31, 2019 Pathology of Vaping-Associated Lung Injury
  Y.M. Butt and Others N Engl J Med 2019; 381:1780-1781

  This letter describes findings in 17 patients with a history of vaping who had lung biopsies after presenting with symptoms and bilateral pulmonary opacities that led to a clinical diagnosis of vaping-associated lung injury. The lung histopathology is described, along with some preliminary insights into the pathogenesis of acute lung injury.

• Correspondence Oct 10, 2019 Imaging of Vaping-Associated Lung Disease
  T.S. Henry, J.P. Kanne, and S.J. Kligerman N Engl J Med 2019; 381:1486-1487

  A sampling of imaging findings in patients with lung disease associated with electronic cigarette use is provided.

  Editorial Vaping-Induced Lung InjuryOriginal Article Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

• Correspondence Oct 10, 2019 Vaping Trends among Adolescents, 2017–2019
  R. Miech and Others N Engl J Med 2019; 381:1490-1491

  Vaping by adolescents is a concern because of the risks of nicotine addiction and because of reports of an association between vaping and acute lung injury. This nationally representative survey finds sharp increases in the frequency of vaping among 8th-, 10th-, and 12th-grade students.

  Original Article Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

• Correspondence Oct 10, 2019 Pulmonary Lipid-Laden Macrophages and Vaping
  S.D. Maddock and Others N Engl J Med 2019; 381:1488-1489

  The use of electronic cigarettes has been associated with pulmonary injury, one feature of which has been lipid-laden macrophages in pulmonary-lavage fluid. Six cases in Utah are reported.

  Editorial Vaping-Induced Lung InjuryOriginal Article Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

• Editorial Mar 05, 2020 Vaping-Induced Lung Injury
  D.C. Christiani N Engl J Med 2020; 382:960-962

  Until the investigation into the cause of this epidemic of vaping-induced respiratory injury is complete, no conclusions can be drawn as to which compound or compounds are the causes of injury. In light of these cases, however, efforts should be made to increase public awareness of the harmful effect of vaping, and physicians should discourage their patients from vaping.

  Original Article Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary ReportCorrespondence Pulmonary Lipid-Laden Macrophages and VapingCorrespondence Imaging of Vaping-Associated Lung Disease

• Images in Clinical Medicine Jun 20, 2019 Injury from E-Cigarette Explosion
  M.G. Katz and K.W. Russell N Engl J Med 2019; 380:2460

  A 17-year-old boy presented to the ED with pain and swelling in his jaw 2 hours after an e-cigarette exploded during use. He had extensive lacerations in his mouth, multiple disrupted lower incisors, and bony incongruity of his left mandible.

• Original Article Feb 14, 2019 E-Cigarettes vs. Nicotine-Replacement Therapy
  P. Hajek and Others N Engl J Med 2019; 380:629-637

  In a randomized trial involving 886 smokers, e-cigarettes were more effective than nicotine-replacement therapy with respect to the 1-year abstinence rate (18% vs. 10%). Throat or mouth irritation was more common in the e-cigarette group, and nausea was more common in the nicotine-replacement group.

  Editorial The Dangerous Flavors of E-CigarettesEditorial E-Cigarettes to Assist with Smoking CessationCorrespondence E-Cigarettes versus Nicotine-Replacement Therapy for Smoking Cessation

• Correspondence Feb 14, 2019 Youth Vaping in Colorado
  T.S. Ghosh and Others N Engl J Med 2019; 380:689-690

  In a 2017 survey of Colorado high-school students, 27% reported current use of electronic cigarettes (vaping). These students were also more likely to report risky behaviors (including binge drinking and the use of opioid pain medications without a prescription) than nonusers.

• Correspondence Jan 10, 2019 Adolescent Vaping and Nicotine Use in 2017–2018
  R. Miech and Others N Engl J Med 2019; 380:192-193

  A national survey revealed a large increase in nicotine vaping among high school students; more than 20% of 12th-graders reported that they vaped nicotine in 2018. The increase in adolescent nicotine use from 2017 to 2018 was explained by an increase in vaping; the use of other nicotine products declined.

• Perspective Sep 20, 2018 Adolescents’ Use of “Pod Mod” E-Cigarettes
  J.L. Barrington-Trimis and A.M. Leventhal N Engl J Med 2018; 379:1099-1102

  Use of a new e-cigarette product class called “pod mods” is rampant among young people. There is reason to be concerned that adolescents’ use of these products could bring a host of adverse health consequences to the current generation of adolescents and young adults.

• Special Article Jun 14, 2018 Approaches to Smoking Cessation
  S.D. Halpern and Others N Engl J Med 2018; 378:2302-2310

  In a pragmatic trial involving smokers, financial incentives were more effective than free cessation aids; free cessation aids or e-cigarettes were no more effective than usual care. Cessation rates among smokers assigned to financial incentives were less than 3%.

  Correspondence E-Cigarettes, Incentives, and Drugs for Smoking Cessation

• Perspective Jan 18, 2018 E-Cigarettes and the Harm-Reduction Continuum
  A.L. Fairchild and Others N Engl J Med 2018; 378:216-219

  In recent years, there has been a trend of acknowledging the importance of a harm-reduction approach in policy discussions about e-cigarettes. But some proposed strategies might well limit, if not entirely undermine, the population benefits associated with e-cigarettes.

• Review Article Oct 06, 2016 The Health Effects of Electronic Cigarettes
  C. Dinakar and G.T. O’Connor N Engl J Med 2016; 375:1372-1381

  The use of electronic cigarettes is growing, and some hope that they will replace what is felt to be the more dangerous nicotine-delivery system — cigarettes. However, data on the long-term safety of e-cigarettes are still being gathered.

  Correspondence The Health Effects of Electronic Cigarettes

• Correspondence Oct 06, 2016 Explosion Injuries from E-Cigarettes
  E.G. Brownson and Others N Engl J Med 2016; 375:1400-1402

  This report from a single center describes 15 patients with injuries caused by explosions of e-cigarettes that occurred over a period of less than a year. Patients had a combination of flame burns, chemical burns, and blast injuries.

• Perspective Jul 21, 2011 E-Cigarette or Drug-Delivery Device? Regulating Novel Nicotine Products
  N.K. Cobb and D.B. Abrams N Engl J Med 2011; 365:193-195

  The FDA intends to regulate e-cigarettes as tobacco products, since the courts blocked it from treating them as drug-delivery devices. Until the FDA asserts its new authority over tobacco, concentrated nicotine products may be sold to consumers, raising safety concerns.