A Problem To Be Solved: Vaping and EVALI in Coronavirus Days

Abstract

Coronavirus disease 2019 (COVID-19) outbreak was declared as a global pandemic by the World Health Organization (WHO) on March 11, 2020. The disease has a high infectivity and the most common symptoms are related to respiratory system. Electronic cigarettes (e-cigarettes), considered by many as an alternative for cigarette smoking, rapidly gained popularity in recent years. Despite a legal age requirement of 18 years for purchasing e-cigarettes, use of vaping products has been increasing particularly among younger people. These products are known to cause a special type of disease called “e-cigarette, or vaping, product use-associated lung injury” (EVALI) which may be highly fatal. Diagnostic criteria for EVALI consists of a mixture of non-specific systemic symptoms (eg, fever, chills, and vomiting) and respiratory symptoms (eg, shortness of breath, cough, chest pain, dispnea, and hypoxia), along with detection of lung opacities and ground-glass opacities (GGOs) on imaging. Commonly, findings of EVALI reveal similarities with those of coronavirus disease 2019 (COVID-19). In the literature, there are numerous studies indicating e-cigarette users (vapers) have impaired immune response that might increase vulnerability to COVID-19 infection and death. However, studies claiming that smoking has protective effects against COVID-19 still exist in the literature. In this narrative review, we aimed to clarify confusions on effects of vaping on COVID-19 patients and prevent misdiagnoses of EVALI due to similarities of these diseases in many aspects.