EVALI

Q: 24 years old male is admitted to ICU with severe respiratory distress. History corelates with starting E-cigarette one week ago. Presumed diagnosis of E-cigarette or vaping product use-associated lung injury (EVALI) is made. Which of the following is the most dominant feature of EVALI? (select one)

A) fever

B) tachycardia 

C) tachypnea 

D) hemoptysis 

Answer: B

EVALI patients generally present with many constitutional, respiratory, and gastrointestinal (GI) symptoms. EVALI is an umbrella term for various disease pathologies that occur in association with the use of E-Cigarettes or vaping. It includes acute eosinophilic pneumonia, diffuse alveolar hemorrhage, lipoid pneumonia, and respiratory-bronchiolitis interstitial lung disease. Interestingly, it is rarely an infectious process. The usual underlying culprit products are THC, vitamin E acetate, nicotine, CBD or other plant oils, medium-chain triglycerides, petroleum distillates, and terpenes.

Although patients may report subjective feelings of warmth, fever is present only in one-third of the patients. Tachycardia is extremely common. Only less than half have tachypnea, though all of them have some level of shortness of breath (SOB) and cough. Remember: Tachypnea and SOB are two different entities.  Pleuritic chest pain may be present. 

Hemoptysis is rare unless the underlying pathology is diffuse alveolar hemorrhage.

#toxicity

#pulmonary

References:

1. Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. N Engl J Med 2020; 382:903.

2. Kalininskiy A, Bach CT, Nacca NE, Ginsberg G, Marraffa J, Navarette KA, McGraw MD, Croft DP. E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med. 2019 Dec;7(12):1017-1026. doi: 10.1016/S2213-2600(19)30415-1. Epub 2019 Nov 8. PMID: 31711871.

3. Winnicka L, Shenoy MA. EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review. J Gen Intern Med. 2020 Jul;35(7):2130-2135. doi: 10.1007/s11606-020-05813-2. Epub 2020 Apr 3. PMID: 32246394; PMCID: PMC7351931.