(ABC4 Utah) The immediate impacts of e-cigarette or vaping-associated lung injury (EVALI) are well known – patients may have trouble breathing, chest pain, nausea, fever, and chills – but new research from Intermountain Healthcare in Salt Lake City is shedding more light on these injuries, finding that many patients can experience significant chronic issues that persist for a year or more.
Findings from the new Intermountain research, published in the Annals of the American Thoracic Society, found that patients who suffered from EVALI had a high risk of developing respiratory disability, cognitive impairment, symptoms of depression, anxiety, and post-traumatic stress one year after their injury.
Researchers also found that despite the continuing physical impact on their health, more than half of the patients in the study – 62% – continued to vape or smoke.
“Even at 12 months after an EVALI diagnosis, the majority of our patients still had serious residual effects,” said Denitza Blagev, MD, principal investigator of the study and a pulmonary and critical care physician at Intermountain Healthcare. “Considering that most patients enrolled in this trial were young and did not have any significant co-morbidities at the time of their diagnosis, it’s concerning.”
Results of the study are published just as the US Centers for Disease Control released preliminary data from the 2019 National Youth Tobacco Survey (NYTS) showing that electronic cigarette use among U.S. teens continues to rise, with roughly five million reporting vaping within the past month, including 11.3% of high school students and 2.8% of middle school students.
In the Intermountain study, researchers identified 73 EVALI patients treated at Intermountain Healthcare or University of Utah Health, who also completed a 12-month follow-up between July 20, 2020, and August 15, 2021.
These patients were mostly male, with a mean age of 31.1 years old. At the time of their injury, 59% did not require admission to an intensive care unit.
At the 12-month follow-up mark, the Intermountain researchers found:
- 48% of patients had respiratory limitations
- 59% of patients had anxiety and/or depression
- 62% of patients had post-traumatic stress
- 38% of patients had quit all vaping and smoking behaviors
- 6.4% of patients reported a COVID-19 infection
Patients also reported their own experience of the impact of EVALI, including the impact of healthcare costs via the Behavioral Risk Factor Surveillance Survey questions.
Those findings were presented at the American Thoracic Society Meeting in San Francisco, May 18, 2022. The findings found:
- 13% of patients reported they were unable to work
- 54% reported they were still paying off healthcare bills
- 44% reported difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition
- 24% reported significant shortness of breath
- 16% reported difficulty with dressing or bathing
- 35% reported vaping or using e-cigarettes, 20% reported smoking, and 54% reported using marijuana
These statistics are alarming on multiple levels, said Dr. Blagev.
“These are not minor complications, and they are still happening even in patients whose injuries were not severe enough to require ICU care,” she said. “These long-term issues are also happening in relatively young people who could face a long life of continuing complications.”
The high rate of vaping and tobacco use among survivors was not surprising, Dr. Blagev added.
“It’s not for a lack of motivation or a lack of understanding how severe this could still be, especially for patients that have depression, anxiety, and PTSD and who might be reaching for those vaping behaviors to cope,” she said. “It’s so hard.”
That doesn’t mean clinical should give up. In fact, discovering that those participants who did quit tended to be younger points to the importance of targeted outreach, especially considering young people are still vaping, she noted.
“The big intervention here is going to be trying to raise awareness and implement policies that we know work to reduce vaping among young people,” said Dr. Blagev. “And we need to better address mental health issues among young people so that they have more help than self-medicating with vaping and marijuana use.”
That includes campaigns about the dangers of tobacco use, vaping, and EVALI specifically, but also that it continues to be a problem despite vitamin-E acetate, an additive tied to these lung injuries, having largely been removed from vaping products.
“We need to focus on preventing vaping in young people to prevent EVALI,” said Dr. Blagev.