Soerianto Winny, Jaspers Ilona
Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Pediatr Pulmonol. 2025 Jan;60(1):e27448. doi: 10.1002/ppul.27448. Epub 2024 Dec 23.
E-cigarette, or vaping products produce an aerosol by heating nicotine, or cannabis including tetrahydrocannabinol (THC) and cannabidiol (CBD), mixed with other chemicals that help make the aerosol. They are increasingly popular among teenagers and young adults, with a 2023 survey reporting that 2.13 million middle and high school students in the United States used e-cigarettes within the last 30 days. The use of e-cigarette, or vaping products could lead to an acute pulmonary inflammatory syndrome called e-cigarette, or vaping, product use-associated lung injury (EVALI). We review the challenges in diagnosing and treating EVALI, especially during the COVID-19 pandemic.
We conducted a literature search on June 10, 2024 using the PubMed database. We searched for articles, case reports and CDC reports investigating the pathogenesis, treatment, and challenges of diagnosing EVALI during the COVID-19 pandemic.
The exact causes of EVALI are not completely understood, although it has been linked to the use of THC and vitamin E acetate. There are no specific biomarkers to diagnose EVALI and it is typically diagnosed through a process of eliminating other possible conditions. Eight studies detailed cases where pediatric patients were initially diagnosed with COVID-19 or community-acquired pneumonia, despite multiple negative COVID-19 tests, and were later found to have EVALI.
After alerting the public about the removal of vitamin E acetate from vape liquids in 2020, there has been a decline in cases of EVALI, although they are still detected. Therefore, it is necessary to continue looking for diagnostic markers of EVALI and further investigate the toxicity of vapes and e-cigarettes to prevent the recurrence of another EVALI epidemic, especially among teenagers and young adults.
电子烟或雾化产品通过加热尼古丁或大麻（包括四氢大麻酚（THC）和大麻二酚（CBD））与其他有助于产生气溶胶的化学物质混合来产生气溶胶。它们在青少年和年轻人中越来越受欢迎，2023年的一项调查显示，美国有213万中学生和高中生在过去30天内使用过电子烟。使用电子烟或雾化产品可能会导致一种名为电子烟或雾化产品使用相关肺损伤（EVALI）的急性肺部炎症综合征。我们回顾了诊断和治疗EVALI的挑战，特别是在新冠疫情期间。
我们于2024年6月10日使用PubMed数据库进行了文献检索。我们搜索了调查新冠疫情期间EVALI发病机制、治疗及诊断挑战的文章、病例报告和美国疾病控制与预防中心（CDC）报告。
尽管EVALI与THC和维生素E醋酸酯的使用有关，但其确切病因尚未完全明确。目前尚无诊断EVALI的特异性生物标志物，通常通过排除其他可能情况的过程来诊断。八项研究详细介绍了儿科患者的病例，这些患者最初尽管新冠病毒检测多次呈阴性，但仍被诊断为新冠病毒感染或社区获得性肺炎，后来被发现患有EVALI。
2020年向公众发出关于从电子烟液中去除维生素E醋酸酯的警告后，EVALI病例有所下降，尽管仍有病例被检测到。因此，有必要继续寻找EVALI的诊断标志物，并进一步研究电子烟和气溶胶的毒性，以防止另一次EVALI流行的复发，尤其是在青少年和年轻人中。
