Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA.
J Med Toxicol. 2020 Jul;16(3):295-310. doi: 10.1007/s13181-020-00772-w. Epub 2020 Apr 16.
Electronic cigarettes (e-cigarettes) are battery-operated devices to insufflate nicotine or other psychoactive e-liquid aerosols. Despite initial claims of e-cigarettes as a nicotine-cessation device, aggressive marketing of e-cigarettes has led to an explosion in adolescents' and young adults' use over the last few years. Coupled with a lack of adequate investigation and regulation of e-cigarettes, the USA is facing an outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) starting in mid-2019. While little long-term health hazard data are available, the components and constituents of e-cigarettes may adversely impact health. Propylene glycol and glycerin are humectants (water-retaining excipients) that generate pulmonary irritants and carcinogenic carbonyl compounds (e.g., formaldehyde, acetaldehyde, and acrolein) when heated in e-cigarettes. Metals contained in heating coils and cartridge casings may leach metals such as aluminum, chromium, iron, lead, manganese, nickel, and tin. Flavoring agents are considered safe for ingestion but lack safety data for inhalational exposures. Diacetyl, a common buttery flavoring agent, has known pulmonary toxicity with inhalational exposures leading to bronchiolitis obliterans. In 2019, clusters of lung injury associated with e-cigarette use were identified in Wisconsin and Illinois. Patients with EVALI present with a constellation of respiratory, gastrointestinal, and constitutional symptoms. Radiographically, patients have bilateral ground glass opacifications. As of February 18, 2020, the Centers for Disease Control has identified 2807 hospitalized patients diagnosed with either "confirmed" or "probable" EVALI in the US. Currently, vitamin E acetate (VEA) used as a diluent in tetrahydrocannabinol vape cartridges is implicated in EVALI. VEA cuts tetrahydrocannabinol oil without changing the appearance or viscosity. When inhaled, pulmonary tissue lacks the mechanism to metabolize and absorb VEA, which may lead to its accumulation. While most EVALI patients were hospitalized, treatment remains largely supportive, and use of corticosteroids has been associated with clinical improvement. The outbreak of EVALI highlights the need for regulation of e-cigarette devices and e-liquids. Clinicians need to be aware of the health hazards of e-cigarettes and be vigilant in asking about vaping.
电子烟（e-cigarettes）是一种通过电池供电来吸入尼古丁或其他精神活性电子液体气溶胶的装置。尽管最初声称电子烟是一种尼古丁戒除装置，但电子烟的大力营销导致青少年和年轻人在过去几年中电子烟使用量猛增。再加上对电子烟的调查和监管不足，美国正面临自 2019 年年中以来电子烟或蒸气产品使用相关肺损伤（EVALI）的爆发。虽然目前电子烟的长期健康危害数据有限，但电子烟的成分和成分可能会对健康产生不利影响。丙二醇和甘油是保湿剂（保水赋形剂），在电子烟中加热时会产生肺部刺激物和致癌的羰基化合物（例如甲醛、乙醛和丙烯醛）。加热线圈和墨盒外壳中所含的金属可能会浸出铝、铬、铁、铅、锰、镍和锡等金属。调味剂被认为可安全摄入，但缺乏吸入暴露的安全性数据。二乙酰，一种常见的奶油味调味剂，在吸入暴露时会导致细支气管炎性闭塞，具有已知的肺部毒性。2019 年，在威斯康星州和伊利诺伊州发现了与电子烟使用相关的肺损伤集群。EVALI 患者表现出一系列呼吸道、胃肠道和全身症状。影像学上，患者有双侧磨玻璃混浊。截至 2020 年 2 月 18 日，疾病控制中心已在美国确认 2807 名住院患者患有“确诊”或“可能”EVALI。目前，四氢大麻酚电子烟盒中用作稀释剂的维生素 E 醋酸酯（VEA）与 EVALI 有关。VEA 切割四氢大麻酚油而不改变其外观或粘度。吸入时，肺组织缺乏代谢和吸收 VEA 的机制，这可能导致其积累。虽然大多数 EVALI 患者住院治疗，但治疗仍然主要是支持性的，皮质类固醇的使用与临床改善相关。EVALI 的爆发凸显了对电子烟设备和电子烟液进行监管的必要性。临床医生需要意识到电子烟的健康危害，并警惕询问蒸气使用情况。
