Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers

Abstract

The authors described the spectrum of disease seen in patients admitted with electronic cigarette or vaping product-use–associated lung injury (EVALI). This is the first focused case series of EVALI in children.All patients aged 13 to 18 years admitted to the authors’ tertiary care, university-affiliated children’s hospital (Dallas, TX) with a diagnosis of EVALI.This was a retrospective chart review of patients admitted with EVALI from December 2018 to November 2019.A total of 13 patients were admitted with EVALI. Patients endorsed usage of δ-9-tetrahydrocannabinol (THC) (12), nicotine and THC (7), and nicotine (1). Symptoms included subjective fever (100%), respiratory symptoms (85%), and GI symptoms (85%). A total of 23% of abnormal lung CTs were identified on abdominal computed tomography scans in patients undergoing a primary gastrointestinal evaluation. Respiratory support included room air (1), nasal cannula (8), bilevel positive airway pressure (2), intubation (1), and venovenous extracorporeal membrane oxygenation (1). Four patients required supplemental oxygen at discharge. Five patients had pulmonary function tests pre- and postglucocorticoid administration. forced expiratory volume in 1 second and forced vital capacity both increased significantly after glucocorticoids.The clinical severity of EVALI in adolescents is variable. The majority of admitted patients required some form of oxygenation support. Glucocorticoids were a successful treatment with objective improvement in pulmonary function tests postglucocorticoid administration.This is an important case series for pediatricians to learn from, regarding EVALI. As we learn more about this potentially fatal condition, common threads have emerged that are supported by these findings, including the use of vaping products for THC and various alterations to the vaping device. It is important for pediatricians and all health care professionals who work with adolescents to recognize the dangers associated with vaping and e-cigarette use as well as learn skills to communicate these risks with individual patients. Although federal and state regulations have been enacted to try and limit the use of these products in children and adolescents, millions remain vulnerable.