EVALI, the acronym for e-cigarette and vaping associated lung injury, triggers an inflammatory response with symptoms similar to those of COVID-19, making the condition difficult to diagnose in already overburdened Emergency Departments.
Globally, as of this writing, there have been 55 million cases reported since the SARS-CoV-2 virus outbreak. The death rate has exceeded 1.3 million recently. To date, there are no specific evidence-based therapeutic interventions against COVID-19. The main therapeutic strategies are limited to symptomatic treatment and organ support for severe patients. Expedited global vaccine development efforts are continuing under challenging circumstances.
Research into all potential COVID-19 mitigation strategies and appropriate timely diagnosis efforts obviously are essential and would be invaluable for in-patient care. But these tireless efforts would have the added benefit of informing ongoing respiratory tract disease prevention strategies in busy ED settings.
According to a new study based on a large sample of 13- to 24-year-olds, e-cigarette users are five times more likely to be infected with COVID-19. Meanwhile, dual users (those using both e-cigarettes and cigarettes) in the past 30 days are almost seven times more likely to be infected. Young people may be even more likely to use e-cigarettes during the pandemic because of heightened anxiety while spending time home alone and unsupervised. The research highly recommends that healthcare and school communities prioritize asking young patients and students about e-cigarette use.
There is a dire need to educate our children about the adverse outcomes of e-cigarettes. Our healthcare systems already are overburdened with critical and deadly respiratory tract disease, thus we must prevent the spread of other potential fatal lung injuries. EVALI was recognized as an epidemic in 2019 when it led to the deaths of 68 people. The most recent Canadian case study is outlined in the October issue of the B.C. Medical Journal.
When e-cigarettes first appeared in Canada a decade ago, many – including the Canadian Medical Association – warned of their potential harm, called for tight regulation of their sale and marketing and appealed for investment in research to ensure product safety. Unfortunately, this never happened. Sadly, e-cigarettes are continually promoted and perceived as a safer alternative to cigarette smoking.
Minnesota’s department of health in August sent an alert to healthcare providers statewide about suspected EVALI cases but advised that since EVALI symptoms are similar to those of COVID-19, anyone seeking care should first be tested for the virus.
E-cigarettes and their modifiable nature are harmful since the lungs are not designed for the chronic inhalation of the vapor. Therefore, we need to urge Health Canada and the U.S. Food and Drug Administration to more effectively regulate e-cigarette use during this pandemic.
It is also of the utmost importance to provide our fullest support to young people in their e-cigarette cessation efforts. The most recent U.S. Surgeon General’s report identified low-cost interventions that are effective in helping people to quit smoking. These low-cost interventions can be easily implemented in both outpatient and inpatient clinical settings. Further the report indicated that the benefits of quitting for health and well-being are substantial.
For the moment, diagnosis of EVALI should be suspected on the basis of vaping history and clinical presentation.
“Rapid clinical and/or radiologic recognition of EVALI allows clinicians to treat patients expeditiously and provide supportive care,” said Seth Kligerman, associate professor at UC San Diego School of Medicine and division chief of cardiothoracic radiology at UC San Diego Health in San Diego, California. “Making the correct diagnosis may prevent unnecessary therapies and procedures, which themselves can lead to complications.”
According to a recent study, e-cigarette use is associated with significantly increased risk of major respiratory diseases, independent of cigarette smoking and other tobacco product use. These findings add important evidence on the risk profile of e-cigarette.
Insufficient resources, limited clinician time and lack of clinician education are frequently cited reasons that prevent the delivery of interventions.
These are obstacles we must overcome.
The authors thank Kaumadi Kulathilaka for her contributions to this article.