Thread by @GasBugZa

One of two morning sessions (this one themed 'Take a Breath') at CCSSA2022 - starting with a talk by Prof Charles Feldman on 'E-cigarettes, vaping and lung injury'
#CCSSA2022 #critcare #FOAMcc

Prof starts by saying that vaping is not the panacea that it was hoped.
Electronic cigarettes (e-cigarettes or vapes) work by heating a liquid to produce an aerosol that users inhale into their lungs. The liquid can contain nicotine, THC, CBD, flavourants etc...
#CCSSA2022

Interesting that many of the THC-containing preparation contain Vitamin E - which when injected or ingested is safe, but when inhaled as an aerosol may have a deleterious effect
doi.org/10.1016/j.amjm…
#CCSSA2022

Vitamin E is degraded by enzymes in the GIT, but this is not the case in the lung, where instead lung injury occurs. This is one of the proposed mechanisms by which vaping may cause ALI.
doi.org/10.1146/annure…
#CCSSA2022

Furthermore, there is evidence e-cigs may cause changes that promote pneumococcal binding to respiratory epithelium, predisposing to infection.
doi.org/10.1113/JP2795…
#CCSSA2022

However, not only the lungs are affected, all organs are. This is partly dependent on the contents of the aerosol, but also on the process itself.
#CCSSA2022

Potential pulmonary injury patterns include
-lipoid pneumonia
-acute eosinophilic pneumonia
-hypersensitivity pneumonia
-ARDS
-Diffuse alveolar haemorrhage
-acute fibrosing organising pneumonia
-granulomatous pneumonitis
-organising pneumonia
#CCSSA2022

Interesting is the pattern on CT scan, where the lung peripheries are spared. This is not unique to this type of lung injury, although it is rare.
doi.org/10.1016/j.amjm…
#CCSSA2022

In the early days, the CDC had a definition of EVALI, and this has since been expanded. Look out for updated definitions. E-cigarette, or Vaping Product, Use Associated Lung Injury (EVALI) is the current term.
#CCSSA2022

Regarding cancer - there are definitely carcinogens released, their link to an actual cancer risk will take time to prove (given the pathogenesis of cancer).
doi.org/10.1097/CEJ.00…
#CCSSA2022