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A new study from Intermountain Healthcare of Salt Lake City found that those who suffer a vaping-associated lung injury (EVALI) sometimes experience symptoms, including cognitive impairment, over a year later.
Considering that the average age of the persons in this study was 31 years old, these injuries can have a life-long and profound effect.
“EVALI is a disease that has severe complications from the very beginning. Now, we’re discovering that the long-term effects are similar to patients who have had acute respiratory distress syndrome or even sepsis,” commented Denitza Blagev MD, the primary investigator of the Intermountain Healthcare study. “These people ‘recover,’ but despite that recovery, our study demonstrates that for some of those patients, they might never return to normal.”
The EVALI research study was funded by the National Heart, Lung, and Blood Institute as well as the Intermountain Research and Medical Foundation.
Mood disorders and long-term cognitive disorders are acknowledged as a complication of severe critical illness in post-intensive care syndrome (PICS). The grouping of anxiety, depression, cognitive impairment, and long-term breathing difficulties means that EVALI is a serious condition that can lead to PICS.
A lung injury associated with vaping can leave people with breathing difficulties as well as chest pain, nausea, chills, and fever. By the first few months of 2020, e-cigarette and EVALI injuries hospitalized more than 2,800 people, resulting in 68 deaths.
“It’s very troubling when you consider that the consequences of EVALI are equally severe compared to critical illness. This is because people with EVALI are often younger and healthier than other people who become critically ill,” said Dr. Blagev.
The Intermountain study was presented at the 2021 American Thoracic Society International Conference. The researchers examined 91 people suffering from EVALI, one year following their initial diagnosis. The average age of the study participants was 31 years old.
The Intermountain study found:
• 15% of the study participants had severe trouble breathing. This included stopping to catch their breath after walking 100 yards on level ground, or who were too breathless to get dressed or leave the house.)
• 39% had mild cognitive impairment.
• 57% suffered from anxiety.
• 34% suffered from depression.
• 2 to 3% tested positive for COVID-19.
While some EVALI patients required intensive care treatment, many were diagnosed and treated early. This avoided the use of ventilators and a long stay in the intensive care unit, generally associated with the serious long-term effects of PICS.
“The fact that a large percentage of young EVALI sufferers experienced severe consequences a year following their initial diagnosis speaks to the serious long-term consequences of EVALI,” said Dr. Blagev.
The Intermountain researchers found no significant ethnic or racial differences in the study data.
Dr. Blagev wished to remind the medical community that the incidence of EVALI continues, despite the removal of vitamin E acetate to vaping products. This is an additive thought to have triggered the 2019 outbreak of lung injuries that led to the diagnosis of EVALI.
A 2020 National Youth Tobacco Survey found that among American youth, e-cigarettes are the most commonly used tobacco products. That has been the case since 2014. The 2020 survey also found that 1 in 5 high school students and around 1 in 20 middle school students had used e-cigarettes in the past month.
“Even amid the COVID-19 pandemic, we continue to diagnose people with EVALI, ” said Dr. Blagev. “The continuing rise of vaping among young people in conjunction with the serious long-term consequences of EVALI is particularly alarming.”
The Intermountain research team will next test lung function on the study participants (as opposed to having them report symptoms). The team will also evaluate whether anxiety and depression are a result of EVALI or if they were present previously; mood disorders may have led the study participants to vape in the first place. The team also wants to find out whether these individuals are more susceptible to viral infections compared to those who do not suffer from EVALI. Finally, the Intermountain researchers want to find out whether the study participants changed their behavior after their EVALI diagnosis.
Among American adolescents, it’s estimated 10.5% of middle school students and 27.5% of high school students vaped during the previous 30 days. This is a significant increase from 20.8% of high school students in 2018 to 27.5% the next year.
Among adolescent vapers, it’s estimated that 72.2% of high school students and 59.2% of middle school students preferred flavored e-cigarettes.
The number of high school students using tobacco products in 2019 jumped by 38% over just one year. The CDC attributes this massive increase to the popularity of e-cigarettes.