Suggested management of e-cigarette or vaping product use associated lung injury (EVALI)

Abstract

Respiratory care physicians are confronted with a new pulmonary syndrome linked to e-cigarette consumption. Electronic cigarettes have been known since 2003 and are known by different names such as "e-cigs", "vape pens", "e-hookahs" or "electronic nicotine delivery systems (ENDS)". In recent years, e-cigarettes have advanced from the more primitive first-generation devices to the current fourth generation devices. The modern devices feature higher voltages and higher temperatures and therefore produce more aerosol volume from heating liquids. Inhaling these aerosolized liquids is also called vaping. Although the liquid composition has many possible variations, it mostly contains propylene glycol (PG), glycerin, flavorings with or without nicotine. E-cigarettes from JUUL, which is the top-selling brand in the United States (US), have a USBlike shape and all contain nicotine in high doses. These high nicotine levels are achieved by using specific nicotine salts that allow inhalation of such high nicotine doses with less irritation than with traditional tobacco cigarettes. Other devices have also been used to inhale a number of psychoactive drugs added to e-liquids, such as the cannabis derivative tetrahydrocannabinol (THC), cannabinoid oils (CBD), cocaine, heroin and amphetamines (1).

Topics & Concepts