Introduction:
E-cigarettes or electronic cigarettes are incorporated in place of regular cigarettes. These can be used by people who are adults and are not pregnant. They are proven to be less harmful than regular cigarettes. However, some studies suggest that these can cause various lung issues as well.
What Are E-cigarettes?
E-cigarettes or electronic cigarettes are a term used for electronically delivering nicotine or vaping products. These were incorporated as an alternative to cigarette smoking. Their basic aim was to replace cigarette smoking or stop it, as these were considered less harmful than regular cigarettes. As per certain studies, in a randomized controlled trial it has been validated and a significantly better abstinence rate with ECs compared with nicotine replacement (18 percent when compared to 9.9 percent) was observed. A wide meta-analysis concluded some pieces of evidence that fully substituting combustible tobacco cigarettes for ECs reduces users’ exposure to various toxicants and carcinogens.
These can be beneficial to some extent for adults who smoke and are not having their pregnancy if used as a complete substitute in place of regular cigarettes and possibly other tobacco products that are smoked.
E-cigarettes are not regarded as safe products for youth, young adults, pregnant adults, and adults who do not use tobacco products currently as well. E-cigarettes do have the potential to benefit some people and harm others but scientists still are working to evaluate whether e-cigarettes are effective in finding a way out for adults to quit smoking.
Why Are E-cigarettes Harmful?
The e-cigarettes are considered harmful as they possess aerosol that users exhale from the device. It can possess harmful substances such as:
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Nicotine.
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Ultrafine particles can go deep into the lungs after inhaling.
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Flavoring compounds like diacetyl, a chemical linked to a serious lung disease.
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Volatile organic compounds.
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Chemicals that have the potential to result in cancer.
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Heavy metals like nickel, tin, and lead.
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It gets hard for consumers to identify what e-cigarette products exactly have in them. For example, some e-cigarettes marketed as zero percent nicotine content have been found to have nicotine in them.
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The aerosol present in the e-cigarettes can also contain substances that cause serious issues to the body. This includes cancer-causing chemicals and small particles that penetrate deep into the lungs. However, the aerosol present in e-cigarettes frequently contains less harmful chemicals than smoke from burned tobacco products.
What Is Vaping-Associated Lung Injury (EVALI)?
E-cigarette or vaping use-associated lung injury (EVALI), initially termed vaping-associated pulmonary illness (VAPI), is an acute respiratory illness in which a range of clinical and pathological findings resembling various lung diseases can be noted. Currently, EVALI is seen as an epidemic across the United States. E-cigarettes or vaping product-associated lung injury (EVALI) were sporadically reported. Its rise has been arising since 2019. As per the last updated statement by the Centers for Disease Control and Prevention (CDC), there have been more than 2,800 cases noted across the United States of America only, after which these cases were not reported further by the CDC. In a retrospective analysis of a large national database in Korea, analyzing the association between the use of e-cigarettes and critical cases of pneumonia did not show any cases of EVALI.
What Is the Pathogenesis of Vaping-Associated Lung Injury (EVALI)?
The specific pathogenic mechanisms for EVALI are not completely understood yet. Lipid-laden macrophages with vacuolization and vacuolated pneumocytes are a usual pathological feature seen in various EVALI cases. This is consistent with chemical-induced pneumonitis. In a recent study, around 94 percent of reported cases of EVALI had vitamin E acetate (an additive in some tetrahydrocannabinol-containing e-cigarettes) in their bronchoalveolar lavage (BAL) samples.
Volatile organic compounds have been shown to be linked with various ill effects. The two mostly seen flavoring chemicals used with e-cigarettes are diacetyl and 2,3-pentanedione, which induce transcriptional changes and downregulate the expression of genes, resulting in ciliary dysfunction at a cellular level and predisposing patients to severe respiratory diseases. Aldehydes incorporated in liquid flavoring agents, such as diacetyl and acetylpropionyl, can result in bronchiolitis. Compounds like glycerin and propylene glycol, when mixed within the solvent, decompose at high temperatures and emit carbonyl compounds like formaldehyde, acetaldehyde, and acrolein. These injure the airway epithelium through oxidative stress and the inflammatory cascade.
What Are the Signs and Symptoms of Vaping-Associated Lung Injury (EVALI)?
The primary signs and symptoms seen in vaping-associated lung injury (EVALI) are:
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Shortness of breath.
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Cough.
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Chest pain.
Some of the other symptoms identified are:
Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal pain.
How Is Vaping-Associated Lung Injury (EVALI) Diagnosed?
EVALI can be diagnosed based on the following factors according to the CDC criteria:
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Firstly, a history is taken of using an e-cigarette in the past 90 days before the appearance of initial symptoms.
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The presence of pulmonary infiltrates is checked, which indicates tissue damage (which are hazy spots when seen on a plain chest radiograph or chest CT).
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A urine drug screening for THC, although non-specific, might help in identifying e-cigarette use and help in further diagnosis.
How Is Vaping-Associated Lung Injury (EVALI) Managed?
The primary step to managing EVALI is to discontinue the use of all kinds of smoking. Further treatment can be symptomatic. Antibiotics can be administered as needed. The treatment options for EVALI also comprise corticosteroids and oxygen therapy. Many people might also require hospitalization in severe cases. In case hypoxemia gets worse, patients can be transferred to the intensive care units as well.
Conclusion
E-cigarettes are the substitutes brought in place of regular cigarettes. As per certain studies, these have less hazardous effects than regular ones. E-cigarette or vaping-associated pulmonary injury (VAPI), also called e-cigarette or vaping product use-associated lung injury (EVALI), is an acute or subacute respiratory illness that can be differentiated by several clinicopathologic findings that resemble various pulmonary diseases. Various lung injuries are noted due to a compound called vitamin E acetate (an additive in some tetrahydrocannabinol-containing e-cigarettes). They also contain nicotine that is not at all good for people as it possesses cancer-causing components.
