E-cigarette, Or Vaping, Associated Lung Injury Research Articles

The Emerging Cloud: a survey of vapers, their health and utilization of healthcare within the UK.

Recent work in the UK estimated the prevalence of current cannabinoid-based vaping to be higher than in the USA, a factor previously associated with e-cigarette or vaping-associated lung injury (EVALI). Research in the USA has demonstrated that attendances to emergency departments relating to e-cigarettes began to rise before the EVALI outbreak, suggesting that vapers also experience milder forms of vaping-related illness. Quantify symptom prevalence and healthcare utilization amongst current UK vapers. Voluntary online survey of individuals aged 16 and over within the UK. Anonymized data were collected on demographics, vaping/smoking status and vaping substances used. Current vapers were asked about the presence of 10 prevalent symptoms from previous US EVALI case series, healthcare attendances and diagnoses given. Risk-ratios were calculated to compare the likelihood of symptoms and attendances between substances. A total of 2477 complete responses were analysed. In all, 397 respondents were current vapers. Symptom prevalence within the previous 12 months ranged from 3.8% to 30.5% (bloody sputum, cough). Healthcare attendances per symptomatic respondent ranged from 0.1 to 1.4 (bloody sputum, shortness of breath). Current vapers of cannabinoid-based products (alone/in combination) had the most attendances per symptomatic respondent for 9/10 symptoms and were more likely to report symptoms aside from 'cough' (nicotine-free e-liquids [risk ratio = 1.7]). Clinicians reportedly never diagnosed vaping-related illness. UK vapers experience symptoms previously reported in EVALI cases for which they also seek healthcare. Users of cannabinoid-based products were more likely to report symptoms and accounted for a higher healthcare burden. UK vapers may also experience vaping-related illness that does not meet EVALI case criteria.

927: DABBING LUNG INJURY MANAGED BY VV ECMO

Introduction: E-cigarette or vaping-associated lung injury (EVALI) is an uncommon complication of e-cigarettes or vaping. Most cases are associated with tetrahydrocannabinol (THC) containing products. “Dabbing” refers to the process of ingesting high concentrations of THC-containing oils or waxes with butane solvents to vaporize cannabinoids for inhalation. Another distinction is the presence of impurities and unpurged butane in the vapors inhaled by the users. Description: A 29-year-old male presented with cough, dyspnea, and fever seven days prior to admission. He reported smoking marijuana but denied vaping. Initial chest radiograph demonstrated multifocal pneumonia. PCR for SARS-CoV-2 was negative. He required four liters of supplemental oxygen. Physical exam was remarkable for diffuse pulmonary crackles. Broad spectrum antibiotics for pneumonia were initiated. Oxygen requirements rapidly increased, prompting intubation 48 hours from presentation. Ventilator settings escalated to a positive end-expiratory pressure of 18 cm H2O with 100% FiO2. Computed tomography angiography ruled out pulmonary embolism, however showed diffuse patchy nodular and confluent opacities. Respiratory cultures grew commensal flora and blood cultures were negative. Comprehensive laboratory investigations for an infectious etiology and autoimmune vasculitis were negative. In further discussion with the patient’s wife, he has been “dabbing” for the past six months. High dose intravenous steroids were initiated. The patient continued to have refractory hypoxemic and hypercapnic respiratory failure with ARDS requiring prone positioning. The patient ultimately required transition to veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient received 12 days of VV-ECMO and was eventually liberated after 19 days of ventilator support. At discharge he was asymptomatic, at his baseline level of function, and required no supplemental oxygen. He was discharged on daily steroids with a taper and outpatient follow-up. Discussion: The necessity of VV-ECMO utilization in “dabbing” associated acute lung injury represents a rare severe presentation. Dabbing is emerging as a trend among young adults and represents an under-investigated cause of severe inhalational lung injury.

LEFT SIDE PREDOMINANT E-CIGARETTE OR VAPING USE-ASSOCIATED LUNG INJURY (EVALI): A CHALLENGING DIAGNOSIS OF EXCLUSION

LEFT SIDE PREDOMINANT E-CIGARETTE OR VAPING USE-ASSOCIATED LUNG INJURY (EVALI): A CHALLENGING DIAGNOSIS OF EXCLUSION

The unseen cloud: a survey of vaping practices and the acquisition of vaping products within the UK.

Vaping of cannabinoid-based products and informal acquisition of vaping products were associated with the outbreak of E-cigarette or vaping associated lung injury (EVALI) in the USA. Current prevalence of cannabinoid-based vaping within the UK is not known and literature regarding the acquisition of vaping products is limited. To estimate the prevalence of nicotine-based, nicotine-free and cannabinoid-based product vaping within the UK and to determine where vaping products are acquired. A voluntary online survey of individuals aged 16 and over within the UK was conducted using a convenience sample. Data were collected on respondent demographics, smoking/vaping history and acquisition of e-liquids/products. A total of 2478 responses were included. Median age 45 years (interquartile range 35-57). Prevalence of current vaping of nicotine-based e-liquids, nicotine-free e-liquids and cannabinoid-based products was 14.4%, 11.2% and 5.49%, respectively. Current nicotine-based and nicotine-free vaping was most prevalent in 25-34 years olds (22.4% and 19.2% of respondents). Current cannabinoid-based vaping was most prevalent in 16-24 years olds. The most common 'ever' used cannabinoid-based products were cannabidiol oil/cannabigerol oil and cannabis leaves (4.8%). Specialist vaping stores were the most common source of 'ever' acquisition for all products. 36.8% and 40.5% of respondents who had ever vaped nicotine-based and nicotine-free e-liquids reported prior acquisition from informal sources. This survey reported a higher prevalence of current cannabinoid-based vaping within the UK (5.5%) than previously reported in the USA (2.0%). In addition to the informal acquisition of vaping products as demonstrated within the survey, these results highlight potential underestimation of the risk of EVALI within the UK.

Hemoptysis in an adolescent with EVALI

E-cigarette or vaping associated lung injury (EVALI) has increased in prevalence after first being noted in an outbreak among teenagers in 2019 and later became recognized as a public health crisis and unique disease entity. This article is protected by copyright. All rights reserved.

Prospectively Assessed Long-Term Outcomes of Patients with E-Cigarette- or Vaping-associated Lung Injury.

Rationale: E-cigarette- or vaping-associated lung injury (EVALI) was first identified in 2019. The long-term respiratory, cognitive, mood disorder, and vaping behavior outcomes of patients with EVALI remain unknown. Objectives: To determine the long-term respiratory, cognitive, mood disorder, and vaping behavior outcomes of patients with EVALI. Methods: We prospectively enrolled patients with EVALI from two health systems. We assessed outcomes at 1 year after onset of EVALI using validated instruments measuring cognitive function, depression, anxiety, post-traumatic stress, respiratory disability, coronavirus disease (COVID-19) infection, pulmonary function, and vaping behaviors. We used multivariable regression to identify risk factors of post-EVALI vaping behaviors and to identify whether admission to the intensive care unit (ICU) was associated with cognitive, respiratory, or mood symptoms. Results: Seventy-three patients completed 12-month follow-up. Most patients were male (66.7%), young (mean age, 31 ± 11 yr), and White (85%) and did not need admission to the ICU (59%). At 12 months, 39% (25 of 64) had cognitive impairment, whereas 48% (30 of 62) reported respiratory limitations. Mood disorders were common, with 59% (38 of 64) reporting anxiety and/or depression and 62% (39 of 63) having post-traumatic stress. Four (6.4%) of 64 reported a history of COVID-19 infection. Despite the history of EVALI, many people continued to vape. Only 38% (24 of 64) reported quitting all vaping and smoking behaviors. Younger age was associated with reduced vaping behavior after EVALI (odds ratio, 0.93; P = 0.02). ICU admission was not associated with cognitive impairment, dyspnea, or mood symptoms. Conclusions: Patients with EVALI, despite their youth, commonly have significant long-term respiratory disability; cognitive impairment; symptoms of depression, anxiety, post-traumatic stress; and persistent vaping.

A Case Series of E-cigarette or Vaping-Associated Lung Injury With a Review of Pathological and Radiological Findings

There has been a recent outbreak of e-cigarette or vaping-associated lung injury (EVALI) but the exact pathophysiology remains unknown. Tetrahydrocannabinol (THC) and vitamin E derivates are the major components in vaping-generated aerosols that are associated with EVALI. So far, there is no standard treatment for EVALI. Most cases are treated with antibiotics and steroids. Counseling for smoking cessation is an integral part of care for EVALI patients. Referral to addiction medicine may be beneficial. Considering the nonspecific presenting symptoms and the growing popularity of vaping devices, providers need to consider EVALI in the differential diagnosis of bilateral patchy ground-glass opacities with respiratory, constitutional, or gastrointestinal symptoms in patients using e-cigarettes. Here, we present four EVALI cases and review the pertinent imaging and pathological findings.

Vaping discussion in the COVID-19 pandemic: An observational study using Twitter data.

BackgroundWith the spread of COVID-19, significant concerns have been raised about the potential increased risk for electronic cigarette (e-cigarette) users for COVID-19 infection and related syndromes. Social media is an increasingly popular source for health information dissemination and discussion, and can affect health outcomes.ObjectiveThis study aims to identify the topics in the public vaping discussion in COVID-19–related Twitter posts in order to get insight into public vaping-related perceptions, attitudes and concerns, and to discern possible misinformation and misconceptions around vaping in the COVID-19 pandemic.MethodsUsing the tweets ID database maintained by Georgia State University’s Panacea Lab, we downloaded the tweets related to COVID-19 from March 11, 2020, when the World Health Organization declared COVID-19 a pandemic, to February 12, 2021. We used R to analyze the tweets that contained a list of 79 keywords related to vaping. After removing duplicates and tweets created by faked accounts or bots, the final data set consisted of 11,337 unique tweets from 7,710 different users. We performed the latent Dirichlet allocation (LDA) algorithm for topic modeling and carried out a sentiment analysis.ResultsDespite fluctuations, the number of daily tweets was relatively stable (average number of daily tweets = 33.4) with a sole conspicuous spike happening on a few days after August 11, 2020 when a research team published findings that teenagers and young adults who vape face a much higher risk of COVID-19 infection than their peers who do not vape. Topic modeling generated 8 topics: linkage between vaping and risk of COVID-19 infection, vaping pneumonia and the origin of COVID-19, vaping and spread of COVID-19, vaping regulation, calling for quitting vaping, protecting youth, similarity between e-cigarette or vaping-associated lung injury (EVALI) and COVID-19, and sales information. Daily sentiment scores showed that the public sentiment was predominantly negative, but became slightly more positive over the course of the study time period.ConclusionsWhile some content in the public discourse on vaping before the COVID-19 pandemic continued in Twitter posts during the COVID-19 time period, new topics emerged. We found a substantial amount of anti-vaping discussion and dominantly negative sentiment around vaping during COVID-19, a sharp contrast to the predominantly pro-vaping voice on social media in the pre-COVID-19 period. Continued monitoring of social media conversations around vaping is needed, and the public health community may consider using social media platforms to actively convey scientific information around vaping and vaping cessation.

43.3 Cannabis Vaping in Adolescents: A Review of Prevalence, Comorbidities, Appraisal of Lung Injury, and Long-Term Complications

As of 2020, there were 2807 hospitalizations for electronic cigarette (e-cigarette)- or vaping-associated lung injury (EVALI) reported to the CDC, of which 15% were adolescents. As per a 2020 NIDA survey, there was a twofold increase in marijuana vaping in adolescents from 2017 to 2019. Recent studies have shown associations between marijuana smoking or vaping with bronchitis, increased risk of respiratory infections, and acute lung injury. Eighty-five percent of patients with vaping-associated lung injury had tetrahydrocannabinol (THC) or its metabolites in alveolar fluid samples. The objective of this study is to review the available literature on cannabis vaping in adolescents and understand the possible risks and pulmonary complications of vaping. We conducted a systematic review of literature using PubMed with keywords “cannabis” OR “marijuana,” “vaping” OR "e-cigarettes," “lung injury” OR “pneumonia,” in all fields. We included RCTs, cross-sectional studies, longitudinal studies, review articles, and case reports published until December 2020. The search resulted in 63 articles. After filtering for children and adolescents, 15 articles (2 cross-sectional surveys, 1 retrospective cohort, 7 case series or reports, 4 review articles, and 1 novel mental health metric) were identified for abstract and full paper review. We are currently conducting retrospective chart reviews of patients admitted to a tertiary care children’s hospital for lung infection or injury. Upon review of the selected 15 articles, there were no relevant longitudinal studies, which focused on the adolescents with e-cigarette- and cannabis-associated lung injuries or pneumonia. Out of the works that included adolescents, many focused on and surveyed only adults. The literature from PubMed about adolescent cannabis vaping was limited to a few case reports and case series. There are no comprehensive studies that have rigorously investigated cannabis vaping in adolescents. There needs to be more investigations into how e-cigarettes containing THC affects the adolescent population. Many complications have been associated with vaping of cannabis, nicotine, and combined products, such as COVID-19 susceptibility, EVALI, and pain and sedative management. More research needs to be done to explore these connections, especially in adolescents.

103. Adding Sbirt as a Vital Sign to Annual Adolescent Health Evaluations

The objective of this study was to evaluate the use of screening, brief intervention and referral to treatment (SBIRT) at the timing of a routine annual physical exam as an effective tool for the early identification of substance use behavior and motivation to change behavior, especially in the setting of the increase risk of severe COVID-19 symptoms and e-cigarette or vaping associated lung injury (EVALI) associated with adolescents who vape.

SHORT-TERM PULMONARY FUNCTION TEST CHARACTERISTICS IN PATIENTS DIAGNOSED WITH E-CIGARETTE- OR VAPING-ASSOCIATED LUNG INJURY

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The E-cigarette, or vaping, associated lung injury (EVALI) outbreak in 2019 caused many young people to be hospitalized with severe lung disease. What, if any, residual pulmonary abnormalities assessed by pulmonary function tests (PFTs) remain at short term follow-up in patients with EVALI is unknown. METHODS: We studied all patients who presented with EVALI at Intermountain Healthcare facilities between June 1, 2019 and January 13, 2020. We reviewed PFTs on all patients who were at least 30 days post discharge. We included PFTs with spirometry, lung volume, and/or diffusing capacity for carbon monoxide (DLCO) corrected for hemoglobin and reported patterns of abnormalities for all abnormal PFTs. RESULTS: 114 patients presented with EVALI and 111 were alive at least 30 days post-discharge. 28% (31/111) had at least one PFT performed at a median of 36 days (IQR 17 – 53) post-discharge. 52% (16/31) of patients with PFTs performed had abnormal PFTs. 2 of the 16 patients (13%) with abnormal PFTs at follow-up had abnormal PFTs at baseline. 65% (20/31) of patients had PFTs performed with spirometry, single-breath total lung capacity testing, and DLCO testing. 19% (6/31) had PFTs with spirometry, total lung capacity testing with plethysmography, and DLCO testing. 16% (5/31) had PFTs with spirometry only. There were six patterns of abnormalities. 19% (6/31) had obstruction only, 16% (5/31) had DLCO reduction only with normal spirometry, 6% (2/31) had obstruction with DLCO reduction. 3% (1/31) had restriction and DLCO reduction, 3% (1/31) had obstruction and suggested restriction, and 3% (1/31) had DLCO reduction and suggested restriction. The patients with suggested restriction had a low forced expiratory volume in one second (FEV1) and low forced vital capacity (FVC) without TLC plethysmography measurement. 44% of patients with abnormal PFTs (7/16) had a second, follow up PFT at a median of 135 days (IQR 79 - 145) post-discharge. None of these 7 patients had baseline PFTs prior to their EVALI diagnosis. 43% (3/7) of these follow up PFTs improved to normal, the other 4 had residual abnormalities. CONCLUSIONS: Many patients with EVALI had abnormal PFTs at least 30 days post-discharge with the most common abnormalities being obstruction only, DLCO reduction only, and obstruction with DLCO reduction. Patients who had PFT abnormalities continued to improve (some to normal predicted values) with subsequent testing. CLINICAL IMPLICATIONS: Many patients diagnosed with EVALI have persistent PFT abnormalities at follow up. Further study of the long-term effects of EVALI on pulmonary function is needed. DISCLOSURES: No relevant relationships by Braden Anderson, source=Web Response No relevant relationships by Denitza Blagev, source=Web Response No relevant relationships by Colin Grissom, source=Web Response No relevant relationships by David Guidry, source=Web Response No relevant relationships by Dixie Harris, source=Web Response No relevant relationships by Michael Lanspa, source=Web Response No relevant relationships by Susan Rea, source=Web Response

E-CIGARETTE-ASSOCIATED LUNG INJURY IN A HEALTHY FEMALE: A CASE REPORT

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: This is a case of a 30-year-old woman presenting with four days of dyspnea found to have E-cigarette or vaping-associated lung injury (EVALI). CASE PRESENTATION: The patient reported having 1 week dyspnea on exertion. She noted to have fevers, intermittent chills, night sweats, dry persistent cough, and diarrhea. Patient had history of asthma during childhood. She had been using electronic cigarettes with marijuana 4 days a week for at least 6 months, however due to news reports she recently stopped prior to presentation. Cartridges would last unaltered for 1 week from dispensaries. Vitals signs were notable for tachycardia and pulse oximetry of 86% on ambient air. Pulmonary exam showed scattered rales with no wheezing. Laboratory results showed a leukocytosis of 28,000 cells/mm3, procalcitonin was 0.64 ng/mL (normal < 0.08 ng/mL), and nasopharynx swab detected human rhinovirus/enterovirus on polymerase chain reaction (PCR). Due to continued oxygen desaturation on ambient air and tachycardia for two-day duration despite antibiotics and supportive care a high-resolution computed topography (HRCT) of the chest was obtained. HRCT demonstrated widespread ground glass opacities and scattered septal thickening bilaterally without lobar predominance, with diffuse subpleural sparing. There were dense consolidations seen bilaterally. Bronchoalveolar lavage (BAL) with a transbronchial biopsy were performed. Right middle and left upper lobe BAL pathology revealed oil-red O stain showing intracytoplasmic lipid droplets in alveolar macrophages consistent with lipid laden-macrophages. Transbronchial biopsy showed pneumonitis; there was interstitial edema, inflammation, mild fibrosis, hyperplasia of type II pneumocytes. Patient was treated with corticosteroids resulting in improved oxygenation. DISCUSSION: EVALI is becoming a more prevalent, being formally recognized in 2019 as non-combustible aerosol inhalation injury. Patients frequently present with hypoxia and ground glass opacities marked by subpleural sparing consistent with an inhalation injury. However bronchoscopy may be needed for diagnosis. Histopathology can vary widely; generally there is fibrinous pneumonitis and oil-red-O staining lipid-laden macrophages. Despite evidence of viral infection, the patient's clinical, radiological, and histopathological findings were consistent with EVALI. No single agent has been implicated in the pathogenesis of EVALI. However an agent of interest that has been implicated in in the pathogenesis of EVALI is vitamin E acetate which has been associated with impairment of pulmonary surfactant. The impaired surfactant and fibrinous pneumonitis frequently seen could explain the severity of this disease process. CONCLUSIONS: Further investigations are needed to determine histopathological implications, treatment options, and the use of E-cigarettes as an alternative to traditional smoking. Reference #1: Layden J, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report. New England Journal of Medicine. (2019) Sept 6 Reference #2: Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews (2016), Issue 9. Reference #3: Maddock SD et al. Pulmonary Lipid-Laden Macrophages and Vaping. New England Journal of Medicine. 381.15 (2019):1488. DISCLOSURES: No relevant relationships by Mario Fonseca-Paricio, source=Web Response No relevant relationships by Alan Gandler, source=Web Response No relevant relationships by Boyd Hehn, source=Web Response

A LUNG ABSCESS IN AN E-CIGARETTE USER

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Since their marketing in the US in 2007, e-cigarettes or vaping products are considered an alternative for patients who would like to quit smoking. More teenagers have been using e-cigarettes recreationally and e-cigarette or vaping associated lung injury (EVALI) has been reported in an increasing number, especially related to either aerosolized vitamin-E product or tetrahydrocannabinol (THC). EVALI has been described with multiple clinical presentations, the most common being acute respiratory distress syndrome (ARDS)-like picture, including over 2,000 of related deaths nationwide as of January of 2020, without established pathophysiology. There’s no case report to date demonstrating e-cigarette use associated with lung abscess. CASE PRESENTATION: We present a case of a 21-year-old white male with past medical history of anxiety and depression who presented with a 3-week history of fatigue, weakness, progressive cough productive of dark gray sputum, and pleuritic chest pain. He had preceding fever, night sweats and had been having nausea, vomiting, diarrhea, and significant weight loss. He denied swallowing dificulty or risks of aspiration. His only medication was fluoxetine. He vaped 1 Jule pod every week for the past 2 years, but denied alcohol use or use of any other illicit drugs. His initial vital signs were within normal limits. He had no fever and his oxygenation on room air was normal. His physical exam revealed a cachectic individual without cyanosis. His lung exam was unremarkable. His initial labs were significant for leukocytosis with left shift, elevated ESR, CRP, and mild hyponatremia. His CXR revealed a cavity-like lesion around his right hilar area, confirmed to be lung abscess by non-contrast chest CT. There was reactive adenopathy.He was then managed conservatively with IV ampicillin-sulbactam, to which he responded clinically, and later was sent home on PO amoxicillin-clavulanate to finish a 6-week course of antibiotics. He committed to completely quit vaping after admission. Upon follow up, he continued to improve clinically and his repeat CXR showed complete resolution of his mass-like lesion resolved 3 weeks after discharge. DISCUSSION: E-cigarette smoking or vaping is now considered to be one of the emerging health outbreaks in the US, with increasing numbers identified by CDC, FDA, and state health authorities. CDC recommends that if e-cigarettes and vaping is suspected as a possible etiology for a patient’s pulmonary disease, a detailed history of the substances used, the sources, and the devices used should be obtained, and efforts should be made to determine if any remaining product, devices, or liquids are available for testing. The majority of cases reported have been lung injury sometimes associated with life-threatening hypoxemia. CONCLUSIONS: We present a case of lung abscess potentially related to e-cigarette or vaping product use. Reference #1: DeVito EE, Krishnan-Sarin S. E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure. Curr Neuropharmacol. 2018;16(4):438–459. doi:10.2174/1570159X15666171016164430 DISCLOSURES: No relevant relationships by Yuri Choi, source=Web Response No relevant relationships by Kanjit Leungsuwan, source=Web Response

ASSESSMENT OF VAPING PRACTICES IN PATIENTS WITH CYSTIC FIBROSIS

SESSION TITLE: Diffuse Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Smoking prevalence has decreased over the last several decades in the United States. However, new generations of tobacco and non-tobacco products such as electronic cigarettes (e-cigarettes) are being increasingly used, particularly in the young adult population. E-cigarettes are battery-powered devices that heat a liquid in order to develop vaporized products, including nicotine and marijuana. While originally thought to be less harmful than traditional cigarettes, e-cigarettes have been shown to have significant consequences including hospitalization and mechanical ventilation. Beginning in July 2019, there have been reports of previously healthy, young individuals developing respiratory failure, with e-cigarette use being identified as an antecedent factor. This new entity, E-cigarette or Vaping Associated Lung Injury (EVALI) has resulted in bans in several states. While the prevalence of e-cigarette use, and the rise of EVALI has been studied in the general population, to our knowledge there is no existing data about the prevalence of e-cigarette use among young adults with chronic lung disease. Individuals with Cystic Fibrosis (CF) offer a unique perspective on the impact of e-cigarette use on the young adult population with lung disease. METHODS: We administered a voluntary survey for patients with CF seen at the Rhode Island Cystic Fibrosis Center, as well as for adolescent and young adult primary care patients seen in the Medicine-Pediatrics Primary Care Clinic. The survey addressed patient experience with cigarettes and e-cigarettes, perceptions of substance use, validated quality of life scales (CFQR for CF patients, RAND-SF36 for non-CF patients), and an assessment of social desirability in order to assess risk of bias. RESULTS: Preliminary results from this observational study demonstrate avoidance of tobacco products and smoking amongst patients with CF compared to an age-matched cohort of the general population (Table 1). CONCLUSIONS: Patients with CF overwhelmingly described e-cigarette use as likely to cause significant lung damage within a brief period of time. A small portion of CF patients had tried smoking in the past, but no patients were identified as having a recent smoking history. Patients without CF averaged higher quality of life measures. While feelings of anxiety, sadness, and isolation were roughly comparable between the groups, physical symptoms were notably more bothersome in the CF patient group. CLINICAL IMPLICATIONS: This study demonstrates different social behaviors among CF and non-CF individuals in regards to cigarette and e-cigarette use. Adult CF patients were specifically able to verbalize risks associated with recreational inhalational products implying that a targeted educational program about EVALI is likely not necessary. DISCLOSURES: No relevant relationships by Roger Auth, source=Web Response no disclosure submitted for Debasree Banerjee; No relevant relationships by Michael Blundin, source=Web Response No relevant relationships by Sarah Rhoads, source=Web Response

Diagnosis and Acute Management of E-Cigarette or Vaping Product Use–Associated Lung Injury in the Pediatric Population: A Systematic Review

To assess quantitative data on the presentation, investigative findings, patterns of lung injury, and interventions of pediatric cases of e-cigarette or vaping-associated lung injury (EVALI) in the acute care setting. A literature search using keywords was performed on April 17, 2020, in accordance with PRISMA guidelines. Three thousand five hundred fifty-eight articles were retrieved from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library. Studies were evaluated for inclusion based on predetermined inclusion and exclusion criteria by 2 independent reviewers. The search yielded a total of 3558 individual results, 145 of which were evaluated by full text review, resulting in 23 articles included in this systematic review. Two of these articles were identified by manual search of article references. A total of 61 cases of EVALI were described, and 10 major patterns of lung injury were identified for which presenting symptoms, diagnostic and laboratory investigations, interventions, and outcomes were synthesized. Cases of EVALI in the pediatric population have been reported in patients as young as 13years and often present with respiratory, constitutional, abdominal, and cardiovascular signs and symptoms. Diagnostic findings vary based on the underlying lung injury pattern. However, typical patterns of common findings were identified, including the presence of ground-glass opacities on computed tomography scan and leukocytosis. Mainstays of treatment include the use of corticosteroids, antibiotics, and ventilatory support, including extracorporeal membrane oxygenation. Outcomes range from complete or near complete recovery of lung function to death.

The vaping epidemic: Calling nurses to action.

Youth e-cigarette use was declared a national epidemic in 2018. This article discusses e-cigarette- or vaping-associated lung injury (EVALI) and highlights the unique role nurses can have as advocates, patient educators, and champions of health promotion and disease prevention for their patients and families.

The vaping epidemic: Calling nurses to action.

Youth e-cigarette use was declared a national epidemic in 2018. This article discusses e-cigarette- or vaping-associated lung injury (EVALI) and highlights the unique role nurses can have as advocates, patient educators, and champions of health promotion and disease prevention for their patients and families.

SUN-201 Adrenal Insufficiency After Treatment for Vaping Associated Pulmonary Injury

Background: In 2019 a record number of patients were admitted to our children’s hospital with e-cigarette or vaping-associated lung injury (EVALI). The majority of patients were treated with high-dose prednisone therapy including 3 days of 1000 mg daily followed by a 4 week wean. Because of the concern for iatrogenic adrenal insufficiency, all patients were then placed on a 3-4 weak hydrocortisone taper followed by ACTH stimulation testing. The purpose of this study is to document the incidence of iatrogenic adrenal insufficiency following a 2 months glucocorticoid wean. Methods: All patients seen by the Pulmonary team for EVALI who also received high dose prednisone therapy were referred to Pediatric Endocrinology for ACTH testing. A low dose (1 mcg) ACTH stimulation test was performed with cortisol measurements at baseline, 30 minutes, and 60 minutes. A passing result was any cortisol over 18 ug/dl. Results: An anticipated 20-25 patients will have had ACTH stimulation testing by the time of abstract presentation. Of those that have already completed testing, three of four patients failed the first time. Discussion: High-dose prednisone therapy for EVALI is associated with significant rates of iatrogenic adrenal insufficiency, even after slow hydrocortisone wean. Structures need to be implemented to teach patients about adrenal insufficiency prior to hospital discharge and organize adequate post-discharge follow-up until HPA function returns.

Pulmonary Disease Related to E-Cigarettes

The potential role of E-cigarettes in smoking cessation is debatable, and whether they are harmful remains controversial worldwide. However, several cases of E-cigarette or vaping-associated lung injury (EVALI) have been reported in the United States. In this review, we discuss and summarize EVALI cases.