Severe respiratory failure risk elevated in older e-cigarette users in rural Appalachia
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Patients hospitalized with e-cigarette and vaping-associated lung injury living in rural areas are more commonly older and develop more severe respiratory failure compared with those living in urban areas, researchers reported.
“Rural populations, such as states in the Midwest and Appalachian region of the U.S., are of particular concern since adult and youth tobacco use remains among the highest in the [United States], and there is evidence that West Virginia youth vaping rates are rising faster compared to any other states in the U.S.,” Rahul Sangani, MD, assistant professor division of pulmonary, critical care and sleep medicine at West Virginia University School of Medicine, and colleagues wrote in Hospital Practice. “Despite such concerns, the reported prevalence of hospitalized [e-cigarette and vaping-associated lung injury] cases or death in Appalachian region remains low.”
Researchers conducted a consecutive case series of 17 patients (mean age, 37 years; 59% men) with e-cigarette and vaping-associated lung injury (EVALI) admitted to West Virginia University Hospital from August 2019 to March 2020. Researchers collected demographics, baseline characteristics, comorbidities, vaping behavior and hospital course data. Patient-volunteered e-liquid materials and vapors were analyzed and bronchoalveolar lavage specimens were assessed for lipid-laden macrophages staining for oil red O (n = 15) and hemosiderin-laden macrophages staining for Prussian blue (n = 14).
Researchers followed up with all patients at 6 to 12 weeks.
The most common CT scan finding was bilateral ground-glass opacities with a predilection for lower lung zones in 14 patients (82%). Of the 15 patients who underwent bronchoalveolar lavage, 13 (87%) were positive for lipid-laden macrophages and four (27%) were positive for hemosiderin-laden macrophages. Of these patients, nine were consuming THC and seven (78%) required critical care.
Concomitant infection occurred in four patients (24%), with the presence of a virus in two patients, presence of bacteria in one patient and presence of both in one patient.
Mechanical or noninvasive ventilation was required in 10 patients and two underwent venovenous extracorporeal membrane oxygenation therapy. The most common substances between e-cigarette and vaping devices identified in the six voluntarily provided samples were formaldehyde, acetaldehyde, acetone, propylene glycol, cyclohexane and nicotine.
Complete cessation of vaping or smoking after discharge and resolution of respiratory symptoms were reported by 12 patients at follow-up. Of these patients, four who reported vaping cessation continued having residual symptoms that included persistent cough, dyspnea and wheezing, and two were on home oxygen.
There were no deaths in the cohort during the study period.
Although ad campaigns have warned youths of health risks related to e-cigarettes and vaping and the FDA banned enticing e-liquid flavors and e-cigarette advertisements targeted toward this population, the results of this study suggest targeting messages regarding to dangers of vaping to older populations in rural areas, according to a related press release.
“As per the recent CDC guidelines, the increased risk of readmission and death, patients with EVALI should be followed within 48 hours and strongly counseled on vaping cessation,” the researchers wrote. “Given the recent data showing that youth using e-cigarettes are at increased risk for COVID-19, it is imperative that to improve public awareness and education on the risks of vaping.”