vaping

Introduction: The association between e-cigarette use and chronic bronchitis, emphysema, and
chronic obstructive pulmonary disease has not been studied thoroughly, particularly in populations
defined by concomitant combustible smoking status.

Methods: Using pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System,
investigators studied 705,159 participants with complete self-reported information on e-cigarette use,
combustible cigarette use, key covariates, and chronic bronchitis, emphysema, or chronic obstructive
pulmonary disease. Current e-cigarette use was the main exposure, with current use further classified
as daily or occasional use. The main outcome was defined as reported ever having a diagnosis of

chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. For all the analyses, multi-
variable adjusted logistic regression was used, with the study population stratified by combustible ciga-
rette use status (never, former, or current). All the analyses were conducted in 2019.

Results: Of 705,159 participants, 25,175 (3.6%) were current e-cigarette users, 64,792 (9.2%) current
combustible cigarette smokers, 207,905 (29.5%) former combustible cigarette smokers, 432,462

(61.3%) never combustible cigarette smokers, and 14,036 (2.0%) dual users of e-cigarettes and combus-
tible cigarettes. A total of 53,702 (7.6%) participants self-reported chronic bronchitis, emphysema, or

chronic obstructive pulmonary disease. Among never combustible cigarette smokers, current e-ciga-
rette use was associated with 75% higher odds of chronic bronchitis, emphysema, or chronic obstruc-
tive pulmonary disease compared with never e-cigarette users (OR=1.75, 95% CI=1.25, 2.45), with

daily users of e-cigarettes having the highest odds (OR=2.64, 95% CI=1.43, 4.89). Similar associations
between e-cigarette use and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease
were noted among both former and current combustible cigarette smokers.
Conclusions: The results suggest possible e-cigarette−related pulmonary toxicity across all thecategories of combustible cigarette smoking status, including those who had never smoked combus-
tible cigarettes.

Author/s:

Osei , A.D., Mirbolouk, M., Orimoloye, O.A., Dzaye, O.

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

John Bayhi — Thu, 02 Jan 2020 20:08:03 +0000

Date Added:

January 2, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publisher:

Elsevier Inc.

Publication Date:

December 11, 2019

URL:

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2019.07.028

Keywords

e-cigarette or vaping product use-associated lung injury

PMID (1):

31859175

MeSH

Adult

electronic nicotine delivery systems

This longitudinal study documents an increase in respiratory problems associated with e-cigarette use and supports a mechanism distinct from those associated with respiratory problems associated with standard cigarettes. The combination of e-cigarettes and standard cigarettes appears to be particularly hazardous. James W. Mold, MD, MPH.

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INTRODUCTION:

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

METHODS:

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013-2016 and analyzed in 2018-2019.

RESULTS:

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

CONCLUSIONS:

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

Author/s:

Bhatta, DN, Glantz, SA

Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019

John Bayhi — Wed, 30 Oct 2019 18:22:21 +0000

Date Added:

October 30, 2019

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

October 28, 2019

Volume:

URL:

MMWR - Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6843e1

Keywords

e-cigarette or vaping product use-associated lung injury

This is a summary of information on cases and deaths in the U.S. due to e-cigarettes or vaping. The data is summarized in the table. James W. Mold, MD, MPH

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What is already known about this topic?

CDC and partners are investigating the ongoing outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) in the United States, the District of Columbia, and one U.S. territory.

What is added by this report?

As of October 22, 2019, a total of 1,604 cases of EVALI, including 34 deaths, were reported to CDC. Based on data collected as of October 15, 2019, use of tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset was reported by 86% of patients. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years.

What are the implications for public health practice?

Most EVALI patients report using THC-containing products before symptom onset. CDC recommends that persons should not use e-cigarette, or vaping, products containing THC. Because the specific compound or ingredient causing EVALI is not known, persons should consider refraining from use of all e-cigarette, or vaping, products.

TABLE. Characteristics of patients with electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) reported to CDC — United States, August–October 2019*
Characteristic	No. /Total No. (%^†)
Characteristic	EVALI patients who survived	EVALI–associated deaths	All EVALI patients
Sex
Male	947/1,349 (70)	17/29 (59)	964/1,378 (70)
Female	402/1,349 (30)	12/29 (41)	414/1,378 (30)
Age group (yrs)
13–17	735/1,335 (55)^§	2/29 (7)^§	196/1,364 (14)
18–24	735/1,335 (55)^§	2/29 (7)^§	541/1,364 (40)
25–34	339/1,335 (25)	5/29 (17)	344/1,364 (25)
35–44	165/1,335 (12)	7/29 (24)	172/1,364 (13)
45–64	79/1,335 (6)	8/29 (28)	87/1,364 (6)
65–75	17/1,335 (1)	7/29 (24)	24/1,364 (2)
Median age, yrs (range)
Overall	23 (13–72)	45 (17–75)	24 (13–75)
Male	23 (13–68)	55 (17–71)	23 (13–71)
Female	25 (13–72)	43 (27–75)	25 (13–75)
Race/Ethnicity^¶
White	283/365 (78)	15/18 (83)	298/383 (78)
Black or African American	22/365 (6)**	1/18 (6)**	9/383 (2)
American Indian or Alaska Native			4/383 (1)
Asian, Native Hawaiian, or other Pacific Islander			5/383 (1)
Other			5/383 (1)
Hispanic	60/365 (16)	2/18 (11)	62/383 (16)
Substances used in e-cigarette, or vaping, products^††,§§
THC-containing products, any use	733/848 (86)	16/19 (84)	749/867 (86)
Nicotine-containing products, any use	545/848 (64)	7/19 (37)	552/867 (64)
Both THC- and nicotine-containing products, any use	451/848 (53)	4/19 (21)	455/867 (52)
THC-containing products, exclusive use	282/848 (33)	12/19 (63)	294/867 (34)
Nicotine-containing products, exclusive use	94/848 (11)	3/19 (16)	97/867 (11)
No THC- or nicotine-containing products reported	21/848 (2)	0/19 (0)	21/867 (2)

Abbreviation: THC = tetrahydrocannabinol.
* Reported as of October 15, 2019.
^† Percentages might not add up to 100% because of rounding.
^§ Data for the 13–17 and 18–24 age groups were combined to protect patient identity.
^¶ Whites; blacks or African Americans; American Indians or Alaska Natives; Asians, Native Hawaiians and other Pacific Islanders; and Others were non-Hispanic. Hispanic persons could be of any race.
** Data for persons in the following race/ethnicity groups were combined to protect patient identity: black or African American; American Indian or Alaska Native, Asian, Native Hawaiian, or other Pacific Islander, and Other.
^†† In the 3 months preceding symptom onset; categories not mutually exclusive.
^§§ Data on both THC- and nicotine-containing product use required to be included.

Author/s:

Moritz, E.D., Zapata, L.B., Lekiachvili, A, Glidden, E, Annor, F.B., Werner, A., Ussery, E, Hughes, M.M., Kimball, A, DeSisto, C.L., Kenemer, E.H., Shamout, M, Garcia, M.C., Reagan-Steiner, S, Petersen, E.E., Koumans, E.H., Ritchey, M.D., King, BA, Jones, CM, Briss, PA, Delaney, L, Patel, A, Polen, KD, Sives, K, Meaney-Delman, D, Chatham-Stephens, K, Lung Injury Response Epidemiology/Surveillance Group

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

John Bayhi — Fri, 13 Sep 2019 12:52:13 +0000

Date Added:

September 13, 2019

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

U.S. Department of Health & Human Services / Centers for Disease Control and Prevention

Publication Date:

September 13, 2019

Issue:

Volume:

Pages:

787-790

URL:

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6836e2

Keywords

PMID (1):

31513561

MeSH

electronic nicotine delivery systems

volatile organic compounds

Neoplasms

Lung Diseases

centers for disease control and prevention (U.S.)

The latest information from the CDC on lung disease associated with vaping. James W. Mold, MD, MPH

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On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

Author/s:

Schier, JG, Meiman, JG, Layden, J, Mikosz, CA, VanFrank, B, King, BA, Salvatore, PP, Weissman, DN, Thomas, J, Melstrom, PC, Baldwin, GT, Parker, EM, Courtney-Long, EA, Krishnasamy, VP, Pickens, CM, Evans, ME, Tsay, SV, Powell, KM, Kiernan, EA, Marynak, KL, Adjemian, J, Holton, K, Armour, BS, England, LJ, Briss, PA, Houry, D, Hacker, KA, Reagan-Steiner, S, Zaki, S, Meaney-Delman, D, CDC 2019 Lung Injury Response Group

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

Brian Desmarais — Wed, 11 Sep 2019 20:35:44 +0000

Date Added:

September 18, 2019

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 6, 2019

URL:

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

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1911614

Keywords

vaping

caution

PMID (1):

31491072

MeSH

sentinel surveillance

Respiration

Artificial

Dronabinol

electronic nicotine delivery systems

Vaping

Patients should be cautioned not to vape until further information is available regarding the cause of this problem.

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BACKGROUND:

E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation.

METHODS:

We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools.

RESULTS:

There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.

CONCLUSIONS:

Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

Author/s:

Layden, J.E., Ghinai, I, Pray, I, Kimball, A, Layer, M, Tenforde, M, Navon, L, Hoots, B, Salvatore, PP, Elderbrook, M, Haupt, T, Kanne, J, Patel, MT, Saathoff-Huber, L, King, BA, Schier, JG, Mikosz, CA, Meiman, J

Electronic Nicotine Delivery Systems (ENDS)

Brian Desmarais — Sat, 18 May 2019 05:00:00 +0000

Date Added:

May 18, 2019

Publisher:

AAFP

Publication Date:

April 1, 2019

URL:

Electronic Nicotine Delivery Systems (ENDS)

Type:

Public Health Announcements

Format:

Web Page

Keywords

MeSH

electronic nicotine delivery systems

Antineoplastic Combined Chemotherapy Protocols

AAFP statement regarding e-cigarettes.

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Electronic nicotine delivery systems (ENDS), also called electronic cigarettes, e-cigarettes, vaping devices, or vape pens, are battery-powered devices used to smoke or “vape” a flavored solution which usually contains nicotine. The American Academy of Family Physicians (AAFP) recognizes the alarmingly increased use of ENDS, especially among youth and young adults, as well as its use by those attempting to quit smoking tobacco.

The AAFP calls for further research to assess ENDS’ safety, quality, and efficacy as a potential cessation device. The AAFP also recommends that the marketing and advertising of ENDS to children and youth cease immediately. The AAFP encourages members to screen for ENDS use starting with school-age children, to discuss the potential harms of ENDS, and to recommend cessation interventions with e-cigarette users. The AAFP encourages members to inform patients who use ENDS, especially children, that the majority of these products contain nicotine and are addictive. (2014 COD) (April 2019 BOD)

vaping

What Are E-Cigarettes?

Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019

TABLE. Characteristics of patients with electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) reported to CDC — United States, August–October 2019*

Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance

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

Electronic Nicotine Delivery Systems (ENDS)