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• W3027811924 abstract "The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury. The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury. The US outbreak of vaping-related acute lung injury, recently named EVALI (E-cigarette- or vaping product use-associated acute lung injury), has reignited concerns about the health effects of vaping. Most recent reports indicate a known 2,807 cases, which includes 68 deaths in the ongoing EVALI outbreak.1Centers for Disease Control and Prevention (2019)Outbreak of lung injury associated with the use of E-cigarette use, or vaping.https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.htmlDate accessed: June 30, 2020Google Scholar Public health concern is compounded by the uptake of vaping among the youth and never smokers,2Berry K.M. Fetterman J.L. Benjamin E.J. et al.Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths.JAMA Netw Open. 2019; 2e187794Crossref Scopus (174) Google Scholar some of whom later transition to cigarette use.3Barrington-Trimis J.L. Urman R. Leventhal A.M. et al.E-cigarettes, cigarettes, and the prevalence of adolescent tobacco use.Pediatrics. 2016; 138e20153983Crossref Scopus (78) Google Scholar,4Spindle T.R. Hiler M.M. Cooke M.E. Eissenberg T. Kendler K.S. Dick D M. Electronic cigarette use and uptake of cigarette smoking: a longitudinal examination of US college students.Addict Behav. 2017; 67: 66-72Crossref PubMed Scopus (142) Google Scholar For the last five years, vaping prevalence has increased steadily such that vaping has surpassed cigarettes as the most common way to consume nicotine among youth, and presently one quarter of high school seniors are regularly vaping.5Surgeon General’s advisory on e-cigarette use among youth. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf. Accessed June 30, 2020.Google Scholar, 6McCabe S.E. Veliz P. McCabe V.V. Boyd C.J. Initiation sequence of e-cigarette and cigarette smoking among US adolescents: a national study.Am J Addict. 2019; 28: 285-294Crossref PubMed Scopus (14) Google Scholar, 7Miech R. Johnston L. O’Malley P.M. Bachman J.G. Patrick M.E. Trends in adolescent vaping, 2017-2019.N Engl J Med. 2019; 381: 1490-1491Crossref PubMed Scopus (193) Google Scholar Originally patented by a pharmacist in China in 2003, vaping has gained in popularity internationally, and there has been an exponential growth in the number of devices, brands, and flavors on the market.8Grana R. Benowitz N. Glantz S.A. E-cigarettes.Circulation. 2014; 129: 1972-1986Crossref PubMed Scopus (908) Google Scholar,9Zhu S.-H. Sun J.Y. Bonnevie E. et al.Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation.Tob Control. 2014; 23: iii3-iii9Crossref PubMed Scopus (678) Google Scholar Vaping was introduced to the US markets in 2007 but only recently has there been increasing interest among public health groups and medical professionals as to the potential health effects of vaped products.5Surgeon General’s advisory on e-cigarette use among youth. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf. Accessed June 30, 2020.Google Scholar,10Kaisar M.A. Prasad S. Liles T. Cucullo L. A decade of e-cigarettes: limited research & unresolved safety concerns.Toxicology. 2016; 365: 67-75Crossref PubMed Scopus (106) Google Scholar,11Chun L.F. Moazed F. Calfee C.S. Matthay M.A. Gotts J.E. Pulmonary toxicity of e-cigarettes.Am J Physiol Lung Cell Mol Physiol. 2017; 313: L193-L206Crossref PubMed Scopus (195) Google Scholar Vape pens, alternatively called e-cigarettes, e-hookahs, or electronic nicotine delivery systems are devices that generate aerosols of a variety of substances, including nicotine, tetrahydrocannabinol (THC), or cannabidiol. Although early evidence found reduced carcinogen exposure from vaping compared to smoking conventional cigarettes,12Royal College of Physicians (London) & Tobacco Advisory GroupNicotine without smoke: tobacco harm reduction: a report. Royal College of Physicians, London, UK2016Google Scholar,13National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. National Academies Press; 2018.Google Scholar the ongoing outbreak of lung injury raises serious questions about the safety of vaping.14Perrine C.G. Characteristics of a multistate outbreak of lung injury associated with e-cigarette use, or vaping: United States, 2019.MMWR Morb Mortal Wkly Rep. 2019; 68: 860-864Crossref PubMed Scopus (114) Google Scholar, 15Layden J.E. Ghinai I. Pray I. et al.Pulmonary illness related to e-cigarette use in Illinois and Wisconsin: preliminary report.N Engl J Med. 2020; 382: 903-916Crossref PubMed Scopus (486) Google Scholar, 16European Respiratory SocietyElectronic cigarettes: a task force report from the European Respiratory Society.https://erj.ersjournals.com/content/53/2/1801151.longDate accessed: October 2, 2019Google Scholar, 17Glantz S.A. Bareham D.W. E-cigarettes: use, effects on smoking, risks, and policy implications.Annu Rev Public Health. 2018; 39: 215-235Crossref PubMed Scopus (280) Google Scholar One difficulty in identifying the causative agent of the ongoing EVALI outbreak is the sheer number of vape products and distributors on the market. Estimates from 2014 found >450 brands and 8000 different vape flavors on the market, with an average 250 new flavors added each month; these numbers have increased almost certainly substantially since then.9Zhu S.-H. Sun J.Y. Bonnevie E. et al.Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation.Tob Control. 2014; 23: iii3-iii9Crossref PubMed Scopus (678) Google Scholar Vape shops include both legitimate and illegitimate distributors who sell a wide array of flavors, THC or cannabidiol oils, and other untested and unregulated additives whose safety and toxicity profile remains unknown.3Barrington-Trimis J.L. Urman R. Leventhal A.M. et al.E-cigarettes, cigarettes, and the prevalence of adolescent tobacco use.Pediatrics. 2016; 138e20153983Crossref Scopus (78) Google Scholar Vape aerosols harbor a number of toxic substances, that include volatile organic compounds, heavy metals, and ultrafine particles.18E-Cigarette use among youth and young adults: a report of the Surgeon General. 298. https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf. Accessed September 30, 2019.Google Scholar, 19Manigrasso M. Buonanno G. Fuoco F.C. Stabile L. Avino P. Aerosol deposition doses in the human respiratory tree of electronic cigarette smokers.Environ Pollut. 2015; 196: 257-267Crossref PubMed Scopus (113) Google Scholar, 20Gaur S. Agnihotri R. Health effects of trace metals in electronic cigarette aerosols—a systematic review.Biol Trace Elem Res. 2019; 188: 295-315Crossref PubMed Scopus (61) Google Scholar, 21Lechasseur A. Altmejd S. Turgeon N. et al.Variations in coil temperature/power and e-liquid constituents change size and lung deposition of particles emitted by an electronic cigarette.Physiol Rep. 2019; 7e14093Crossref PubMed Scopus (30) Google Scholar Sporadic cases of vaping-related respiratory illnesses have been reported since 2012; however, the current outbreak did not begin until the summer of 2019.15Layden J.E. Ghinai I. Pray I. et al.Pulmonary illness related to e-cigarette use in Illinois and Wisconsin: preliminary report.N Engl J Med. 2020; 382: 903-916Crossref PubMed Scopus (486) Google Scholar Most recently implicated in 2,807 cases and 68 deaths, the EVALI outbreak has prompted the formation of a lung injury task force by the Centers for Disease Control and Prevention (CDC).1Centers for Disease Control and Prevention (2019)Outbreak of lung injury associated with the use of E-cigarette use, or vaping.https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.htmlDate accessed: June 30, 2020Google Scholar In this review, we summarize the available literature on the health effects of vaping. Our review encompasses 216 cases spanning 41 reports that involved parenchymal pulmonary disease precipitated by vaping at the time of this writing (January 23, 2020) and represents the largest such compilation of cases to date. PubMed searches of the terms “vape,” “vaping,” “e-cigarette,” “electronic cigarette,” “EVALI,” “electronic nicotine device,” “lung,” “injury,” “case,” “ARDS,” “DAD,” “diffuse alveolar damage,” “bronchiolitis obliterans,” and “lipoid” were performed, yielding a total of 2270 studies published through January 23, 2020. Duplicates and irrelevant articles were then screened out. Ultimately 295 studies were assessed for eligibility, of which 169 articles were included in our review. Of these, 41 articles were case reports (e-Fig 1). Given its potential role in smoking cessation, the health effects of vaping have been the subject of intense interest in the scientific literature.8Grana R. Benowitz N. Glantz S.A. E-cigarettes.Circulation. 2014; 129: 1972-1986Crossref PubMed Scopus (908) Google Scholar,22Shields P.G. Berman M. Brasky T.M. et al.A review of pulmonary toxicity of electronic cigarettes in the context of smoking: a focus on inflammation.Cancer Epidemiol Biomark Prev. 2017; 26: 1175-1191Crossref PubMed Scopus (79) Google Scholar,23Pisinger C. Døssing M. A systematic review of health effects of electronic cigarettes.Prev Med. 2014; 69: 248-260Crossref PubMed Scopus (349) Google Scholar Challenges in reviewing the literature include conflicts of interest in funding24Pisinger C. Godtfredsen N. Bender A.M. A conflict of interest is strongly associated with tobacco industry-favourable results, indicating no harm of e-cigarettes.Prev Med. 2019; 119: 124-131Crossref PubMed Scopus (45) Google Scholar and small-scale human studies. In the remainder of this section, we will summarize the work that has been done to evaluate the components of a vape aerosol, in vitro and in vivo studies, and the available studies in human subjects. The vape pen is composed of a battery-powered heating element, fluid reservoir, and an atomizer that aerosolizes the vaping solution (Fig 1). Vaping solution, often called vape juice or e-liquid, typically is composed of a mixture of water, a carrier (commonly propylene glycol or vegetable glycerin), nicotine and/or THC, and flavorant.2Berry K.M. Fetterman J.L. Benjamin E.J. et al.Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths.JAMA Netw Open. 2019; 2e187794Crossref Scopus (174) Google Scholar Vape pen aerosols have been found to harbor a number of toxic compounds, which include carbonyls, toluene, benzene, acrolein, and propylene oxide25Lee M.-S. LeBouf R.F. Son Y.-S. Koutrakis P. Christiani D.C. Nicotine, aerosol particles, carbonyls and volatile organic compounds in tobacco- and menthol-flavored e-cigarettes.Environ Health. 2017; 16: 42Crossref PubMed Scopus (57) Google Scholar,26Cai H. Wang C. Graphical review: the redox dark side of e-cigarettes; exposure to oxidants and public health concerns.Redox Biol. 2017; 13: 402-406Crossref PubMed Scopus (28) Google Scholar and the heavy metals manganese and zinc that arise from the vaping coil itself.27Olmedo P. Goessler W. Tanda S. et al.Metal concentrations in e-cigarette liquid and aerosol samples: the contribution of metallic coils.Environ Health Perspect. 2018; 126027010Crossref PubMed Scopus (181) Google Scholar Thermal degradants of cannabinoids demonstrated a wide array of hydrocarbons and volatile organic compounds.28Meehan-Atrash J. Luo W. McWhirter K.J. Strongin R.M. Aerosol gas-phase components from cannabis e-cigarettes and dabbing: mechanistic insight and quantitative risk analysis.ACS Omega. 2019; 4: 16111-16120Crossref PubMed Scopus (27) Google Scholar Certain vape pens allow users to adjust the temperature at which aerosolization occurs, which results in increased concentrations of formaldehyde production and induces increased tissue hypoxia and airway epithelial injury.18E-Cigarette use among youth and young adults: a report of the Surgeon General. 298. https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf. Accessed September 30, 2019.Google Scholar,29Chaumont M. Bernard A. Pochet S. et al.High-wattage e-cigarettes induce tissue hypoxia and lower airway injury: a randomized clinical trial.Am J Respir Crit Care Med. 2018; 198: 123-126Crossref PubMed Scopus (20) Google Scholar Propylene glycol serves as a common carrier of vape solution and provides the characteristic “smoke” effect of vaping. Although propylene glycol is considered widely to be safe for oral ingestion by the food industry, the safety of inhaling heated propylene glycol products has been called into question. The CDC cites reports of propylene glycol-containing fogs that caused respiratory irritation among theater workers.30Centers for Disease Control and Prevention National Institute for Occupational Safety and Health. Comment_from_the_National_Institue_for_Occupational_Safety_and_Health_NIOSH-508.pdf. https://www.cdc.gov/niosh/topics/flavorings/pdfs/Comment_from_the_National_Institue_for_Occupational_Safety_and_Health_NIOSH-508.pdf. Accessed September 25, 2019.Google Scholar,31Varughese S. Teschke K. Brauer M. Chow Y. van Netten C. Kennedy S M. Effects of theatrical smokes and fogs on respiratory health in the entertainment industry.Am J Ind Med. 2005; 47: 411-418Crossref PubMed Scopus (79) Google Scholar Nuclear magnetic resonance studies have demonstrated the presence of formaldehyde as a byproduct of heating propylene glycol in vape pens.32Jensen R.P. Luo W. Pankow J.F. Strongin R.M. Peyton D.H. Hidden formaldehyde in e-cigarette aerosols.N Engl J Med. 2015; 372: 392-394Crossref PubMed Scopus (421) Google Scholar Additional studies of thermal decomposition of propylene glycol under the conditions present in a vape pen have shown the generation of multiple potentially carcinogenic compounds that include acrolein, acetaldehyde, and glycidol.33Jensen R.P. Strongin R.M. Peyton D.H. Solvent Chemistry in the electronic cigarette reaction vessel.Sci Rep. 2017; 7: 42549Crossref PubMed Scopus (109) Google Scholar The flavorants added to vape solution increasingly have garnered attention as a potentially unrecognized health risk.3Barrington-Trimis J.L. Urman R. Leventhal A.M. et al.E-cigarettes, cigarettes, and the prevalence of adolescent tobacco use.Pediatrics. 2016; 138e20153983Crossref Scopus (78) Google Scholar Two common flavorants, diacetyl and 2,3-pentanedione, were found to be present in the majority of a sample of 51 common vape solutions that were tested.34Allen J.G. Flanigan S.S. LeBlanc M. et al.Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes.Environ Health Perspect. 2016; 124: 733-739Crossref PubMed Scopus (15) Google Scholar The commonality and high concentrations of diacetyl that were found were of particular concern because diacetyl was implicated as the likely causative agent in an outbreak of bronchiolitis obliterans in an occupational setting (microwave popcorn worker’s lung).35Kreiss K. Gomaa A. Kullman G. Fedan K. Simoes E.J. Enright P.L. et al.Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant.N Engl J Med. 2002; 347: 330-338Crossref PubMed Scopus (382) Google Scholar,36Holden V. Hines S. Update on flavoring-induced lung disease.Curr Opin Pulm Med. 2016; 22: 158-164Crossref PubMed Scopus (28) Google Scholar In vitro analysis found that exposure of airway epithelium cells to either diacetyl or 2,3-pentanedione resulted in disruption of genes that direct cilia biogenesis and directly resulted in impaired ciliary number and function.37Park H.-R. O'Sullivan M. Vallarino J. et al.Transcriptomic response of primary human airway epithelial cells to flavoring chemicals in electronic cigarettes.Sci Rep. 2019; 9: 1400Crossref PubMed Scopus (71) Google Scholar,38Carson J.L. Zhou L. Brighton L. et al.Temporal structure/function variation in cultured differentiated human nasal epithelium associated with acute single exposure to tobacco smoke or E-cigarette vapor.Inhal Toxicol. 2017; 29: 137-144Crossref PubMed Scopus (22) Google Scholar Cinnamaldehyde,39Behar R.Z. Luo W. Lin S.C. et al.Distribution, quantification and toxicity of cinnamaldehyde in electronic cigarette refill fluids and aerosols.Tob Control. 2016; 25: ii94-ii102Crossref PubMed Scopus (108) Google Scholar,40Clapp P.W. Pawlak E.A. Lackey J.T. et al.Flavored e-cigarette liquids and cinnamaldehyde impair respiratory innate immune cell function.Am J Physiol Lung Cell Mol Physiol. 2017; 313: L278-L292Crossref PubMed Scopus (139) Google Scholar benzaldehyde,41Kosmider L. Sobczak A. Fik M. et al.Cherry-flavoured electronic cigarettes expose users to the inhalation irritant, benzaldehyde.Thorax. 2016; 71: 376-377Crossref PubMed Scopus (145) Google Scholar 2,5-dimethylpyrazine (chocolate flavoring),42Sherwood C.L. Boitano S. Airway epithelial cell exposure to distinct e-cigarette liquid flavorings reveals toxicity thresholds and activation of CFTR by the chocolate flavoring 2,5-dimethypyrazine.Respir Res. 2016; 17: 57Crossref PubMed Scopus (91) Google Scholar among other flavorants,43Behar R.Z. Luo W. McWhirter K.J. Pankow J.F. Talbot P. Analytical and toxicological evaluation of flavor chemicals in electronic cigarette refill fluids.Sci Rep. 2018; 8: 8288Crossref PubMed Scopus (93) Google Scholar have adverse respiratory effects as well. Vitamin E acetate has emerged as a potential common exposure among patients who are affected by EVALI. Generally found as an oil suspension, vitamin E acetate is a common additive to vape pen solutions and was likely used as a diluent because of its physical properties and relatively easy accessibility.44Blount B.C. Evaluation of bronchoalveolar lavage fluid from patients in an outbreak of e-cigarette, or vaping, product use-associated lung injury: 10 states, August-October 2019.MMWR Morb Mortal Wkly Rep. 2019; 68: 1040-1041Crossref PubMed Scopus (123) Google Scholar The Food and Drug Administration analysis of vape pens and paraphernalia that were acquired from patients affected by EVALI found vitamin E acetate in 51% of THC-containing products45Commissioner O. of the. Lung illnesses associated with use of vaping products. http://www.fda.gov.laneproxy.stanford.edu/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products. Accessed February 7, 2020.Google Scholar; vitamin E acetate was identified in 94% of BAL specimens that were collected from affected patients.46Blount B.C. Karwowski M.P. Shields P.G. et al.Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI.N Engl J Med. 2020; 382: 697-705Crossref PubMed Scopus (381) Google Scholar The exact mechanism by which vitamin E acetate may mediate lung injury is uncertain; however, studies suggest vitamin E acetate disruption of pulmonary surfactant functioning.47Massey J.B. She H.S. Pownall H.J. Interaction of vitamin E with saturated phospholipid bilayers.Biochem Biophys Res Commun. 1982; 106: 842-847Crossref PubMed Scopus (103) Google Scholar In vitro evaluation of airway epithelium shows that vape condensates cause an increased oxidative stress,48Lerner C.A. Sundar I.K. Yao H. et al.Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung.PloS One. 2015; 10: e0116732Crossref PubMed Scopus (434) Google Scholar proinflammatory cytokines,49Lerner C.A. Rutagarama P. Ahmad T. Sundar I.K. 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A systematic review of health effects of electronic cigarettes.Prev Med. 2014; 69: 248-260Crossref PubMed Scopus (349) Google Scholar,52Hiemstra P.S. Bals R. Basic science of electronic cigarettes: assessment in cell culture and in vivo models.Respir Res. 2016; 17: 127Crossref PubMed Scopus (52) Google Scholar, 53Scheffler S. Dieken H. Krischenowski O. Förster C. Branscheid D. Aufderheide M. et al.Evaluation of E-cigarette liquid vapor and mainstream cigarette smoke after direct exposure of primary human bronchial epithelial cells.Int J Environ Res Public Health. 2015; 12: 3915-3925Crossref PubMed Scopus (127) Google Scholar, 54Kaur G. Pinkston R. McLemore B. Dorsey W.C. Batra S. Immunological and toxicological risk assessment of e-cigarettes.Eur Respir Rev. 2018; 27: 170119Crossref PubMed Scopus (63) Google Scholar Vaping products also alter lung lipid homeostasis by activating the alveolar macrophages55Madison M.C. Landers C.T. Gu B.H. et al.Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine.J Clin Invest. 2019; 129: 4290-4304Crossref PubMed Scopus (185) Google Scholar and neutrophils.56Reidel B. Radicioni G. Clapp P.W. et al.E-cigarette use causes a unique innate immune response in the lung, involving increased neutrophilic activation and altered mucin secretion.Am J Respir Crit Care Med. 2018; 197: 492-501Crossref PubMed Scopus (204) Google Scholar Mice that are exposed to vaped aerosols have increased airway hyperresponsiveness,57Larcombe A.N. Janka M.A. Mullins B.J. Berry L.J. Bredin A. Franklin P.J. et al.The effects of electronic cigarette aerosol exposure on inflammation and lung function in mice.Am J Physiol Lung Cell Mol Physiol. 2017; 313: L67-L79Crossref PubMed Scopus (86) Google Scholar increased airway eosinophils, elevated cytokine levels, impaired immunologic response to infection,48Lerner C.A. Sundar I.K. Yao H. et al.Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung.PloS One. 2015; 10: e0116732Crossref PubMed Scopus (434) Google Scholar,58Lim H.B. Kim S.H. Inhallation of e-cigarette cartridge solution aggravates allergen-induced airway inflammation and hyper-responsiveness in mice.Toxicol Res. 2014; 30: 13-18Crossref PubMed Scopus (98) Google Scholar,59Sussan T.E. Gajghate S. Thimmulappa R.K. et al.Exposure to electronic cigarettes impairs pulmonary anti-bacterial and anti-viral defenses in a mouse model.PloS One. 2015; 10e0116861Crossref PubMed Scopus (279) Google Scholar and increased lung oxidative stress markers.60Glynos C. Sofia-Iris B. 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Hepokoski M. et al.Chronic inhalation of e-cigarette vapor containing nicotine disrupts airway barrier function and induces systemic inflammation and multiorgan fibrosis in mice.Am J Physiol Regul Integr Comp Physiol. 2018; 314: R834-R847Crossref PubMed Scopus (121) Google Scholar and the development of lung parenchymal changes that are consistent with COPD.63Garcia-Arcos I. Geraghty P. Baumlin N. et al.Chronic electronic cigarette exposure in mice induces features of COPD in a nicotine-dependent manner.Thorax. 2016; 71: 1119-1129Crossref PubMed Scopus (195) Google Scholar Vaping aerosols cause cellular DNA damage in rats64Canistro D. Vivarelli F. Cirillo S. et al.E-cigarettes induce toxicological effects that can raise the cancer risk.Sci Rep. 2017; 17: 2028Crossref Scopus (106) Google Scholar; a single vape puff is enough to cause bronchoconstriction in guinea pigs.65Khosravi M. Lin R.L. Lee L.-Y. Inhalation of electronic cigarette aerosol induces reflex bronchoconstriction by activation of vagal bronchopulmonary C-fibers.Am J Physiol Lung Cell Mol Physiol. 2018; 315: L467-L475Crossref PubMed Scopus (6) Google Scholar Patients with COPD and chronic bronchitis who use e-cigarettes are at an increased risk of exacerbations compared with those who have never used e-cigarettes.66Bowler R.P. Hansel N.N. Jacobson S. et al.Electronic cigarette use in US adults at risk for or with COPD: analysis from two observational cohorts.J Gen Intern Med. 2017; 32: 1315-1322Crossref PubMed Scopus (61) Google Scholar Spirometric evaluation of smokers who have been exposed to vape aerosols shows an increase in airflow resistance and decreases in exhaled nitric oxide.67Vardavas C.I. Anagnostopoulos N. Kougias M. Evangelopoulou V. Connolly G.N. Behrakis P.K. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide.Chest. 2012; 141: 1400-1406Abstract Full Text Full Text PDF PubMed Scopus (404) Google Scholar Inhaled vaped products in adult smokers induce airway epithelial injury, as evidenced by an increase in serum CC16 levels, and such results could be replicated even with sham vaping.68Chaumont M. van de Borne P. Bernard A. et al.Fourth generation e-cigarette vaping induces transient lung inflammation and gas exchange disturbances: results from two randomized clinical trials.Am J Physiol Lung Cell Mol Physiol. 2019; 316: L705-L719Crossref PubMed Scopus (75) Google Scholar Airways of chronic vapers are erythematous and friable, and their airway epithelium samples have differential gene expression, notably in mucin gene pathways.69Ghosh A. Coakley R.C. Mascenik T. et al.Chronic e-cigarette exposure alters the human bronchial epithelial proteome.Am J Respir Crit Care Med. 2018; 198: 67-76Crossref PubMed Scopus (141) Google Scholar Exposure of healthy subjects to" @default.
• W3027811924 created "2020-05-29" @default.
• W3027811924 creator A5005339466 @default.
• W3027811924 creator A5036470541 @default.
• W3027811924 date "2020-10-01" @default.
• W3027811924 modified "2023-10-18" @default.
• W3027811924 title "Vaping-Related Acute Parenchymal Lung Injury" @default.
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• W3027811924 doi "https://doi.org/10.1016/j.chest.2020.03.085" @default.
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