A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Search Results
2.3. Statistical Analysis
3. Results
3.1. Classification of Cases
3.2. Respiratory
3.3. CDC Reports on Respiratory Cases
3.4. Traumatic Injury
3.5. Poisoning
3.6. Allergy
3.7. Effect on Medication Metabolism and Plasma Levels
3.8. Ulcerative Colitis
3.9. Misuse of E-liquid
3.10. Injury Caused by Falling with E-cigarette in Mouth
3.11. Additional Diagnoses and Health Effects Attributed to Electronic Cigarette Use
4. Discussion
4.1. Respiratory Injuries
4.2. Accidents
4.3. Poisonings
4.4. Substance Abuse
4.5. Seizures and Effect on Medication Metabolism
4.6. Regulatory Gap
4.7. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Type of Injury | USA | UK | EU-Other | Other |
---|---|---|---|---|
Respiratory | 36 (88%) | 1 (2%) | - | 4 (10%) |
Traumatic injury | 32 (76%) | 5 (12%) | 3 (7%) | 2 (5%) |
Poisoning | 6 (24%) | 2 (8%) | 9 (36%) | 8 (32%) |
Allergy | 1 (25%) | 2 (50%) | 1 (25%) | - |
Effect on medication metabolism and plasma levels | 2 (67%) | - | 1 (33%) | - |
Ulcerative colitis | 1 (50%) | - | 1 (50%) | - |
Misuse of e-liquid | - | - | 2 (100%) | - |
Injury caused by falling with e-cigarette in mouth | 1 (100%) | - | - | - |
Additional diagnoses and health effects attributed to electronic cigarette use | 5 (38%) | 4 (31%) | 2 (15%) | 2 (15%) |
Variable | n = 58 |
---|---|
Sex (%) | |
Male | 69% |
Female | 31% |
Age in years median (IQR) | 23 (19–33) |
Dual user (e-cig+ combustible cigarette) | |
Yes | 10% |
No | 16% |
Unspecified | 74% |
E-cig for cessation | |
Yes | 13% |
No | 71% |
Unspecified | 16% |
Medical history (%) | |
No medical history | 66% |
Asthma/ Allergy | 21% |
Other * | 14% |
Substances used (%) | |
CBD/THC | 36% |
CBD/THC and Nicotine | 10% |
CBD/THC and unknown liquid | 10% |
Nicotine | 3% |
Unknown/unspecified liquid | 40% |
Symptoms (%) | |
Dyspnea | 83% |
Cough | 59% |
Dyspnea and Cough | 53% |
Chest pain | 22% |
Hemoptysis | 9% |
Fever | 40% |
Respiratory arrest | 5% |
Gastrointestinal symptoms | 26% |
CT (%)—available for 52 cases | |
GGO | 38% |
GGO + consolidation | 12% |
Opacities | 10% |
Multiple nodules | 6% |
GGO + multiple nodules | 6% |
Other | 28% |
Interventions | |
High flow nasal cannula therapy | 18% |
Intubation/ mechanical ventilation | 31% |
ECMO | 15% |
Bronchoscopy | 78% |
Diagnosis | |
EVALI | 26% |
Organizing pneumonia/BOOP/Respiratory bronchiolitis | 21% |
Lipoid pneumonia | 16% |
Eosinophilic pneumonia | 7% |
Pneumothorax | 7% |
Hypersensitivity pneumonitis | 5% |
Organizing pneumonia and lipoid pneumonia | 5% |
Asthma exacerbation | 3% |
ARDS | 2% |
ARDS-DAD-Organizing pneumonia | 2% |
DAH | 2% |
EVALI and secondary pneumothorax | 2% |
Epiglottitis | 2% |
Possible EVALI on asthma grounds | 2% |
Corticosteroid administration | 73% |
Outcome | |
Recovered | 83% |
Discharged but hospitalized again | 5% |
Persisting complications | 10% |
Deceased | 2% |
Paper | Country | Bronchoalveolar Lavage (BAL) | Transbronchial Biopsy | Open Lung Biopsy |
---|---|---|---|---|
He et al., 2017 [38] | USA | Possible DAH | Organizing pneumonia | |
Modi et al., 2015 [47] | USA | LLM (Oil Red O positive) | ||
Mantilla et al., 2016 [45] | USA | No cytology information | BOOP | |
Mukhopadhyay et al., 2019 [40] | USA | Macrophage predominant | DAD (acute and organizing) | |
None obtained | Organizing pneumonia | |||
LLM (Oil Red O positive) | Organizing ALI | |||
LLM (Oil Red O positive) | Organizing pneumonia | |||
LLM (Oil Red O positive) | Organizing ALI | |||
Macrophage predominant | Organizing pneumonia | |||
Macrophage predominant | Organizing pneumonia | |||
Arter et al., 2019 [56] | USA | 26% eosinophils | ||
Agustin et al., 2018 [62] | USA | Recurrent DAH | ||
Sommerfeld et al., 2018 [60] | USA | LLM (Oil Red O positive) | ||
Khan et al., 2018 [41] | USA | Organizing pneumonia | ||
Flower et al., 2017 [43] | Australia | Non-diagnostic | Non-diagnostic | RUL: black pigmentation and bullae |
Thota D and Latham E, 2014 [57] | USA | Negative cultures | ||
McCauley et al., 2012 [11] | USA | LLM (Oil Red O positive) | ||
Itoh et al., 2018 [33] | Japan | LLM (Oil Red O positive) | Acute alveolitis intra-alveolar fibrosis | |
Dicpinigaitis et al., 2019 [51] | USA | LLM (Oil Red O positive) | ||
Landman et al., 2019 [39] | Canada | Negative cultures | Non-specific acute inflammation and reactive changes | |
Viswam et al., 2018 [50] | UK | Pink cloudy fluid Negative microbiology and cytology | LLM and cholesterol clefts | |
Maddock et al., 2019 [49] | USA | 49% neutrophils, >50% LLM (Oil Red O positive) | ||
~50% LLM (Oil Red O positive) | ||||
~30% LLM (Oil Red O positive) | ||||
~75% LLM (Oil Red O positive) | ||||
Layden et. al, 2019 [42] | USA | 78% neutrophils, some LLM (Oil Red O positive) | ||
Sharma et al., 2019 [37] | USA | Lymphocytes predominance and rare eosinophils | ||
Pokhrel et al., 2019 [31] | USA | LLM predominance | ||
Neutrophil predominance | ||||
LLM predominance | ||||
Abeles et al., 2019 [28] | USA | 51% PMN, negative cultures, rare LLMs | ||
Casanova et al. 2019 [30] | USA | 55% LLMs | ||
Ocampo-Gonzalez and Park, 2019 [32] | USA | 80% LLM (Oil Red O positive) | ||
Attis et al., 2018 [61] | USA | Macrophage predominance | ||
Aftab et al., 2019 [35] | USA | 91% neutrophils | ||
Buus et al., 2019 [29] | USA | Macrophages/ neutrophils/ lymphocytes | ||
Lu et al., 2020 [44] | USA | Ιntra-alveolar fibrin and neutrophils | ||
Youmans et al., 2020 [64] | USA | 50% monocytes, 40% lymphocytes, 10% neutrophils | Non-diagnostic | Acute and organizing DAD with foamy macrophages |
Antwi-Amoabeng et al., 2020 [59] | USA | 75% eosinophils | ||
Ansari-Gilani et al., 2020 [46] | USA | Unremarkable | Poorly define granulomas | |
Unremarkable | ||||
Abbara et al., 2019 [48] | USA | Lipoid pneumonia |
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Tzortzi, A.; Kapetanstrataki, M.; Evangelopoulou, V.; Behrakis, P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. Int. J. Environ. Res. Public Health 2020, 17, 2248. https://doi.org/10.3390/ijerph17072248
Tzortzi A, Kapetanstrataki M, Evangelopoulou V, Behrakis P. A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. International Journal of Environmental Research and Public Health. 2020; 17(7):2248. https://doi.org/10.3390/ijerph17072248
Chicago/Turabian StyleTzortzi, Anna, Melpo Kapetanstrataki, Vaso Evangelopoulou, and Panagiotis Behrakis. 2020. "A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist" International Journal of Environmental Research and Public Health 17, no. 7: 2248. https://doi.org/10.3390/ijerph17072248
APA StyleTzortzi, A., Kapetanstrataki, M., Evangelopoulou, V., & Behrakis, P. (2020). A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist. International Journal of Environmental Research and Public Health, 17(7), 2248. https://doi.org/10.3390/ijerph17072248