Vaping-related lung injury outbreak spotlighted at CHEST
NEW ORLEANS — As the number of cases of lung injury associated with electronic cigarette use, or vaping, continues to grow, pulmonologists and public health officials are shining a spotlight on the disease, its presentation and ongoing efforts to target the cause.
As of Oct. 15, 1,479 probable and confirmed cases of e-cigarette- or vaping-associated lung injury — dubbed EVALI — have been reported in 49 states, the District of Columbia and one U.S. territory, and 33 deaths have been confirmed in 24 states, according to CDC. Alaska remains the only state unaffected by the outbreak, experts said at the CHEST Annual Meeting.
During a session, Jennifer E. Layden, MD, PhD, CMO and state epidemiologist at the Illinois Department of Public Health, provided a rundown of trends among the cases seen in Illinois and Wisconsin — two states that have been at the forefront of the investigation into the outbreak.
As Healio Pulmonology previously reported, most patients in Illinois and Wisconsin presented with respiratory, gastrointestinal and/or constitutional symptoms, such as fever. All had a history of e-cigarette use, with the majority reporting use of products containing tetrahydrocannabinol (THC), either alone or in addition to nicotine-containing products, and a smaller proportion of patients have also reported using nicotine-containing products only.
Notably, Layden said many patients have reported vaping multiple times a day and using a multitude of products and brands.
These trends are on par with those seen nationally, according to CDC reports.
Also during the session, Kevin Davidson, MD, from WakeMed Health and Hospitals in Raleigh, North Carolina, spoke about his experience treating patients with EVALI in North Carolina. Several of these patients were young, had respiratory failure and met the criteria for pneumonia.
“But there was something different about these patients,” he said. “Many were referred after failure of antibiotics. Early on, we performed a lot of bronchoalveolar lavage. The findings were nonspecific, with no signature that was the same for all, except for the cytology findings that showed the presence of lipid-laden macrophages.”
Davidson added that a number of groups from a variety of states have also described findings of lipid-laden macrophages in specimens as well, which points to lipoid pneumonia as a diagnosis. In light of this possibility, Davidson cautioned against paraffin processing of biopsied lung tissue in suspected patients, as the technique will wash all lipid oil out of the specimen, he said.
“We have known about lipoid pneumonia for 100 years, but it’s not described in young and healthy people,” he said. “We have a different entity here. We have patients who are heating and vaporizing small, atomized particles, so we might not see the same pattern macroscopically or microscopically.”
Overall, though, the cause of the outbreak and the culprit behind EVALI remain elusive, according to Layden. CDC, FDA and state and local health departments are collecting and testing samples of e-cigarette or vaping products, but the investigation is complicated.
“From an outbreak standpoint, we’re dealing with a novel, temporally related cluster of cases. It’s very complex, and we’re not as well versed and nimble in these types of noncommunicable disease outbreaks,” she said. “As far as vaping exposures, we don’t have one brand linked to all cases and whatever substance or substances are contributing to the outbreak is probably in a modicum of brands.” – by Melissa Foster
Davidson K, et al. Update on the 2019 Outbreak of Lung Disease Associated with E-Cigarette Product Use (Vaping). Presented at: CHEST Annual Meeting; Oct. 19-23, 2019; New Orleans.
Disclosures: Davidson and Layden report no relevant financial disclosures.