Improvement in Pulmonary Function Following Discontinuation of Vaping or
E-cigarette Use in Adolescents with EVALI
Abstract
Introduction: In 2019, an alarming number of cases coined as
e-cigarette, or vaping, product use associated lung injury (EVALI) was
described in adolescents ranging from mild respiratory distress to
fulminant respiratory failure. Limited data has been published on
outcomes at short term follow-up. We aimed to describe pulmonary
manifestations, function and radiologic findings after corticosteroid
therapy in a cohort of adolescent patients. Methods: A retrospective
chart review of all patients presenting to our institution between July
and December 2019 with EVALI was conducted. Patients who had pulmonary
follow-up were included. Spirometry was performed prior to discharge
from the hospital and during outpatient follow-up. A paired t-test was
used to compare serial spirometry data between visits. Results: Eight
patients (6 males) were included. Two patients required intubation with
mechanical ventilation, 2 required bilevel positive airway pressure
(BPAP), and 3 required oxygen supplementation. All patients received
glucocorticoids (3 receiving pulse dosing). Initial spirometry revealed
decreased forced expiratory volume in one second (FEV1) and forced vital
capacity (FVC) with clinically and statistically significant improvement
at follow-up. Diffusing capacity of the lungs for carbon monoxide (DLCO)
was decreased in 2/6 patients initially and in 4/5 at follow-up.
Radiographic manifestations also improved after vaping was discontinued.
Conclusion: In our cohort of patients with EVALI, at short term follow
up, all normalized their spirometry parameters. However, most did not
normalize their DLCO on follow up, raising concern for risk of
developing chronic lung disease later in life.