Ann Am Thorac Soc. 2023 Jan;20(1):1-17. doi: 10.1513/AnnalsATS.202209-796ST.
E-cigarette or vaping product use-associated lung injury (EVALI) is a severe pulmonary illness associated with the use of e-cigarettes or vaping products that was officially identified and named in 2019. This American Thoracic Society workshop was convened in 2021 to identify and prioritize research and regulatory needs to adequately respond to the EVALI outbreak and to prevent similar instances of disease associated with e-cigarette or vaping product use. An interdisciplinary group of 26 experts in adult and pediatric clinical care, public health, regulatory oversight, and toxicology were convened for the workshop. Four major topics were examined: ) the public health and regulatory response to EVALI; ) EVALI clinical care; ) mechanisms contributing to EVALI; and ) needed actions to address the health effects of EVALI. Oral presentations and group discussion were the primary modes used to identify top priorities for addressing EVALI. Initiatives including a national EVALI case registry and biorepository, integrated electronic medical record coding system, U.S. Food and Drug Administration regulation and enforcement of nicotine e-cigarette standards, regulatory authority over nontobacco-derived e-cigarettes, training in evaluating exogenous exposures, prospective clinical studies, standardized clinical follow-up assessments, ability to more readily study effects of cannabinoid e-cigarettes, and research to identify biomarkers of exposure and disease were identified as critical needs. These initiatives will require substantial federal investment as well as changes to regulatory policy. Overall, the workshop identified the need to address the root causes of EVALI to prevent future outbreaks. An integrated approach from multiple perspectives is required, including public health; clinical, basic, and translational research; regulators; and users of e-cigarettes. Improving the public health response to reduce the risk of another substantial disease-inducing event depends on coordinated actions to better understand the inhalational toxicity of these products, informing the public of the risks, and developing and enforcing regulatory standards for all e-cigarettes.
电子烟或蒸气产品使用相关肺损伤（EVALI）是一种与电子烟或蒸气产品使用相关的严重肺部疾病，于 2019 年正式确定并命名。本次美国胸科学会研讨会于 2021 年召开，旨在确定和优先考虑研究和监管需求，以充分应对 EVALI 疫情，并防止类似与电子烟或蒸气产品使用相关的疾病发生。研讨会召集了 26 名在成人和儿科临床护理、公共卫生、监管监督和毒理学方面具有专业知识的跨学科专家。研讨会重点研究了四个主要议题：）EVALI 的公共卫生和监管应对措施；）EVALI 的临床护理；）导致 EVALI 的机制；）应对 EVALI 健康影响所需的行动。口头报告和小组讨论是确定解决 EVALI 问题的首要任务的主要方式。包括建立全国性 EVALI 病例登记库和生物标本库、整合电子病历编码系统、美国食品和药物管理局监管和执行尼古丁电子烟标准、对非烟草衍生电子烟的监管权、评估外源性暴露的培训、前瞻性临床研究、标准化临床随访评估、更方便研究大麻素电子烟影响的能力，以及识别暴露和疾病生物标志物的研究等倡议被确定为关键需求。这些倡议需要大量联邦投资和监管政策的改变。总体而言，研讨会确定需要解决 EVALI 的根本原因，以防止未来疫情的爆发。需要从多个角度采取综合方法，包括公共卫生、临床、基础和转化研究、监管机构以及电子烟使用者。通过协调行动，改善公共卫生应对措施，降低再次发生重大疾病诱发事件的风险，需要更好地了解这些产品的吸入毒性，向公众宣传风险，并制定和执行所有电子烟的监管标准。
