Summary:

E-cigarettes and vaping are a growing health concern, especially during the COVID-19 pandemic. EVALI, a lung injury associated with e-cigarette use, has symptoms similar to COVID-19, making it difficult to diagnose. Research shows that e-cigarette use increases the risk of COVID-19 infection, and young people are more likely to use e-cigarettes due to increased anxiety during the pandemic. It is crucial for healthcare providers to ask patients about e-cigarette use. The adverse outcomes of e-cigarettes, including EVALI, need to be addressed and preventive measures should be taken. Unfortunately, there has been a lack of action to regulate e-cigarettes, and their perception as a safer alternative to smoking is a misconception. Timely diagnosis and cessation support for e-cigarette users are essential. Overcoming obstacles such as limited resources and clinician education is necessary to deliver interventions effectively.

Takeaways:

• 📚 Research shows that e-cigarette use increases the risk of COVID-19 infection.
• 👥 Healthcare providers should prioritize asking young patients about e-cigarette use.
• ❗️ Adverse outcomes of e-cigarettes, such as EVALI, need to be addressed and preventive measures implemented.
• ⚙️ Regulatory actions by Health Canada and the FDA should be taken to effectively regulate e-cigarette use.
• 💪 Support young people in their efforts to quit e-cigarette use.
• 💼 Overcome obstacles such as limited resources and clinician education to deliver interventions effectively.

EVALI: A Condition Difficult to Diagnose

Introduction

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.

The Global Context

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 and Diagnosis Efforts

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.

The Link between E-Cigarettes and COVID-19

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.

The Urgency to Educate

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 diseases, 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.

Lack of Regulation

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.

Diagnosis Challenges

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.

The Harmful Nature of E-Cigarettes

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.

Support for Cessation Efforts

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.

Diagnosis and Prevention

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](https://scitechdaily.com/what-in-known-about-evali-diagnosis-of-the-acute-lung-injury-associated-with-vaping/#:~:text=Credit%3A Radiological Society of North America Pulmonary imaging,review article published in the journal Radiology .).”

Added Risk of Respiratory Diseases

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-cigarettes.

Overcoming Obstacles

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.