E-Cigarettes, Vaping & their Implications · • Safer than cigarettes, and you can use them to quit • But can also use them to get addicted Teens and vaping • 27% high schoolers
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• “Today, I’m directing the FDA’s Center for Tobacco Products (CTP) to revisit this compliance policy as it applies to deemed ENDS products that are flavored, including all flavors other than tobacco, mint and menthol. The changes I seek would protect kids by having all flavored ENDS products (other than tobacco, mint and menthol flavors or non-flavored products) sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification.”
Washington post, 2017
– Several senior officials of previous tobacco firms have ties to administration
– Chad Readler – Acting assistant attorney general for civil division – Represented RJ Reynolds Law Firm previously
• Contributed $1 Million to inauguration
– FDA Head Scott Gottlieb
• Served on board of EC firm Kure until May 2016
• March 15, 2018
• FDA states that they plan to reduce the amount of nicotine levels in
What about “Experimenters”• Using E-cigs and progressing to smoking
– Smoked cigarettes, but not yet > 100
– 12-17 years of age via survey with 1 year follow up from the Population Assessment of Tobacco and Health Survey
• When using E-cigarettes vs not:
– 2x more likely to:
• Established smoker - > 100 cigarettes
• Current smoker – smoked in the last 30 days
• Both established current smoker
• Among experimenters:
– E-cigarette was positively and independently associated with progression to current est. smoking, suggesting that e-cigarettes do not divert from, and may encourage cigarette smoking
Chaffee et al. Electronic Cigarette Use and the Progression From Experimentation to Established
Smoking. Pediatrics Volume 141, Number 4, March, 2016
• Improved and breathing tube removed 5 days later
• Discharged on steroid course
• Based on symptoms, imaging, inciting agent, lab results and response to steroids –diagnosed with hypersensitivity pneumonitis
10/08/2019
19
Eosinophilic pneumonia
• 18 yo female
• Presented with cough, shortness of breath, chest pain
• Started vaping 2 months prior
• Low oxygen saturations on exam
• Blood count showed elevated white blood cells, 0.5% eosinophils
• CXR – possible pneumonia – started on antibiotics
• Had worsening saturations, respiratory distress
• Chest CT – patchy airspace disease and nodules
Arter et al. Acute eosinophilic pneumonia following electronic cigarette use. Respiratory Medicine Case Reports
27 (2019) 100825
AEP• Worsening respiratory failure – transferred to ICU
• Bronchoscopy performed
– 26% eosinophils
– No microbes noted
• Diagnosis of acute eosinophilic pneumonia
• High dose systemic steroids administered
– Marked improvement in 2 days
10/08/2019
20
Case report
• Life-threatening Vesicular Bronchial Injury Requiring Veno-Venous Extracorporeal Membrane Oxygenation rescue in an Electronic Nicotine Delivery System User
• Came into ED with chest pain and dyspnea
• Admitted for work up
• Increased respiratory support despite normal CXR
• CT showed nodular infiltrates in the lower lobes, mediastinal adenopathy
• Admitted to e-cigarette use – equal to 2 packs/day cigarettes
• Mechanically ventilated with breathing tube
Carter, Thomas et al. Clin Pract Cases Emerg Med.2017;1(3):212-217
10/08/2019
21
Thomas et al case report
• Bronchoscopy:
- “extensive airway trauma and thermal injury”
- Eventually underwent VV ECMO – lung bypass
- Eventually improved over time
Case report
• Previous research :
- Capable of heating liquid solutions to temperature 350C
“Comparing harm of e-cigarettes with cigarettes is like comparing apples to oranges…”
“Our data shows that e-cigarettes have a signature of harm in the lung that is both similar and unique, which challenges the concept that switching from
cigarettes to e-cigarettes is a healthier alternative”
1. Castaldelli-Maia et al. Tobacco smoking: From “glamour” to stigma”. A comprehensive review. Psychiatry and Clinical Neurosciences 2016;70:24-33
2. Franck, Caroline et al. Electronic Cigarettes in North America. History, Use, and Implications for Smoking Cessation. Circulation 2014;129:1945-1952
3. Burstyn, Igor. Peering through the mist: systematic review of what chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health 2014, 14:18
4. Weaver, Michael et al. Clinical case conference electronic cigarettes: a review of safety and clinical issues. J Addict Med. 2014;8(4):234-240
5. Hess, Isabel et al. A systematic review of the health risks from passive exposure to electronic cigarette vapour. Public Health Res Pract. 2016;26(2):e2621617
6. England, Lucinda MD et al. Nicotine and the Developing Human: A Neglected Element in the Electronic Cigarette Debate. Am J Prev Med. 2015;49(2):286-293
7. Suter, Melissa et al. Is There Evidence for Potential Harm of Electronic Cigarette Use in Pregnancy? Birth Defects Res A Clin Mol Teratol. 2015;103(3):186-195
8. Lippi, Giuseppe MD et al. E-Cigarettes and Cardiovascular Risk: Beyond Science and Mysticism. Semin Thromb Hemost 2014;40:60-65
9. Kalkhoran MD, Sara et al. E-Cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116-128
10. McRobbie, H et al. Electronic cigarettes for smoking cessation and reduction (Review). Cochrane Database of Systematic Reviews. 2014;12: Art. No CD010216
references
11.Lacasse MD Yves et al. E-cigarette use in patients receiving home oxygen therapy. Can Respir J. 2015;22(2):83-85
12.Bhatnagar, Aruni et al. Electronic Cigarettes. A Policy Statement From the American Heart Association. Circulation. 2014;130:1418-1436
13.Breland, Alison et al. Science and Electronic Cigarettes: Current Data, Future Needs. J Addict Med. 2014;8(4):223-233
14.Etter, Jean-Francois. E-cigarettes: Methodological and Ideological Issues and Research Priorities. BMC Medicine. 2015;13:32
References
• 15. Chafee, Benjamin et al. Electronic Cigarette Use and Progression From
Experimentation to Established Smoking. Pediatrics, March, 2018.
• 16. Goldenson, Nicholas et al. Associations of Electronic Cigarette Nicotine
Concentration With Subsequent Cigarette Smoking and Vaping Levels in
Adolescents
• 17. Reidel, Boris et al. E-Cigarette Uses Causes Innate Immune Response
in the Lung, Involving Increased Neutrophilic Activation and Altered Mucin