Vaping-Associated Pulmonary Injury

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction

Vaping-associated pulmonary injury (VAPI), is an acute or subacute respiratory illness distinguished by an array of clinical and pathologic findings. Vaping associated lung injury is a potentially fatal disease.

• Vaping (electronic cigarettes use) has become an increasing popular activity over the past decade, partly propelled by innovations in vape pen design and nicotine flavoring.
• The biggest use of vapes has been in the teen and younger adult population.
• Vaping is harmful to health, in particular for non-smokers and children, adolescents, and young adults. Their effects are as yet an unknown on many important health systems including the the potential effects of chronic vaping on the respiratory system. Improved quality evidence is needed on the health impact of vaping, its safety and efficacy.

Clinical Presentation

An array of clinical and pathological finding may be present including:

• Respiratory symptoms: Shortness of breath; Cough; Chest pain
• Constitutional symptoms: Subjective fever and chills; Fatigue; Gastrointestinal symptoms; Nausea and vomiting; Diarrhoea

Note: A study reported in 2019 that 64% of patient with vaping-associated illness presented with respiratory symptoms but an almost equal number, 57%, presented with gastrointestinal symptoms

These symptoms happen prior to hospitalisation (by days or weeks), hospitalisation is usually prompted by hypoxaemia and, in some cases, progression to respiratory failure and acute respiratory distress syndrome.

Vaping and potential lung tissue injury

Potential for electronic cigarettes (EC) to enhance lung tissue injury. Alcohol negatively impacts the lung via direct and indirect mechanisms. As with cigarette smoking, EC generate compounds known to enhance alcohol-mediated lung injury leading to both increased risk for infections and pneumonia as well as the exacerbation of existing chronic inflammatory lung diseases such as bronchitis, emphysema, and COPD.

Diagnostic Imaging

Diagnostic imaging shows a variety of radiographic presentations.

• Plain chest radiographs commonly show hazy bilateral opacities with central and peripheral sparing.
• On CT commonly found is diffuse bilateral ground-glass opacities, with a basilar predominance and sometimes subpleural or lobular sparing.

Treatment

Patients should be advised to stop vaping immediately and consulting an intensivist (a physician who specializes in providing care to critically ill patients, especially those in an intensive care) should be considered, due to possibility of sudden rapid and dramatic clinical deterioration within one or two days, needing high flow oxygen therapy, (non)-invasive ventilation, or even extracorporeal membrane oxygenation (ECMO.

Treatment is mainly supportive care, usually including:

1. Supplemental oxygen, maintaining oxygen saturation of 88 to 92% via nasal cannula or high-flow oxygen or high-flow nasal cannula (HFNC).
2. Symptoms severity guides treatment as to if the patient can be managed out of hospital or needs a hospital.
3. Pharmacological treatment is currently not supported by systematic clinical studies: Most patients however improve on high doses of systemic corticosteroid treatment. CDC guidance encourages consideration of systemic corticosteroids for those admitted to hospital, or if they present with risk factors for suggestive of adverse outcomes, including age over 50, immunosuppressed status, or underlying cardiopulmonary disease.; Initial antibiotic treatment should be dependent on the local or national antibiotic guidelines, in the current medical literature only empiric treatments have been mentioned.
4. Respiratory distress, comorbidities that compromise pulmonary reserve, or decreased oxygen saturation less than 95% (breathing room air) are indications that the patient needs hospital admission.
5. Mechanical ventilation may be needed in the case of hypoxemia.

Physiotherapy

The role of the physiotherapist will be the respiratory management as outlined above. See also

• Respiratory Physiotherapy
• Respiratory Physiotherapy for ICU Patients

Physiotherapists may also play a role in assisting with education re vaping cessation and supportive care.

Prognosis

• Vaping associated lung injury is a potentially fatal disease, with latest studies revealing 68 deaths reported. Large numbers of patients require non-invasive or invasive mechanical ventilation.
• A poor prognis is linked to patient age (more than 35 years), comorbidities that compromise pulmonary reserve, and patients presenting with resting oxygen saturation of less than 95%. These patients can deteriorate quickly, leading to acute respiratory distress syndrome.