2020 respiratory care seminar.pptx - read-only · 2020. 10. 1. · alejandro comellas, md division...
TRANSCRIPT
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Alejandro Comellas, MDDivision of Pulmonary and Critical Care Medicine
University of Iowa
Vaping and lung health
Disclosure
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• Dr. Meredith Frey has nothing to disclose for this presentation
• Dr. Alejandro Comellas reports:– Grant/research support from NIH and industry– Is a consultant for GSK and VIDA
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Learning Objectives
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Upon completion of this activity, participants should be able to:• Understand how vaping compares to combustible smoke • Review the different diagnostic tools that are used to determine
effects of vaping on lung health • Describe the effects of vaping on lung health in youth
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How popular is vaping?
E-cigarette use among adults
E-cigarette use among 11th
graders**More than doubled between 2016‐2018
E-cigarette use among 11th
graders*
Adult Tobacco Use in Iowa. 2018. Iowa Department of Public Health Youth Survey. 2018.
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Reasons for use
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Popularity and
acceptance among peers
Enjoyment of flavors
Smoking cessation
Ability to vape where smoking not
allowed
Perception of safety or
alternative to traditional cigarettes
Park E, et al. J Pediatr Nurse. 2019;48:82-91.Rhoades DA, et al. BMC Public Health. 2019;19(1):1211.
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Electronic Nicotine Delivery Systems (ENDS)
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3rd – 4th Gen2nd Gen
1st Gen
Harmful Additives
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• Nicotine• Humectants (propylene glycol,
vegetable glycerin)• Flavoring • Tobacco-specific nitrosamines
(TSNAs)• Cannabidiol (CBD)• Tetrahydrocannabinol (THC)• Diluents
• Nicotine • Tobacco-specific nitrosamines
(TSNAs)• Ethanol• Acetone• Benzene• Ammonia• Butane
Glasser A, et al. Am J Prev Med. 2017;52(2):e33-e66.
ENDS Traditional Cigarettes
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Nicotine Content in ENDS
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Measured nicotine content of 20 e-liquids
Products contained85-121% nicotine relative to labeling
Measured nicotine content of 91 e-liquids
Products labeled as “nicotine-free”
contained nicotine
Nicotine Delivery
1 0Yingst JM, et al. PLoS One. 2019;14(7):e0220300.Voos N, et al. Expert Opin Drug Deliv. 2019;13:1-11
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Nicotine Delivery
Yingst JM, et al. PLoS One. 2019;14(7):e0220300.Voos N, et al. Expert Opin Drug Deliv. 2019;13:1-11
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Nicotine Delivery
1 2Yingst JM, et al. PLoS One. 2019;14(7):e0220300.Voos N, et al. Expert Opin Drug Deliv. 2019;13:1-11
Nicotine exposure with traditional cigarettes versus e-cigarettes
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Device Tampering
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Alteration of e-liquid
Other substance use in e-
cigarettes
Kenne D, et al. Subst Abuse. 2017;11:117822187733736.Blount B, et al. N Engl J Med. 2020;382:697-705. .
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Pulmonary Function Tests
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Methacholine Challenge Test and Peak Flows
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PFTs and Obstructive Lung Diseases
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PFT COPD Asthma
Spirometry obstructive obstructive or normal
Lung Volumes air trapping/hyperinflation normal to air trapping and/or hyperinflation
DLCO reduced normal or increased
Computed Tomography Imaging
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Chest CT
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Normal Lung COPD lung
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Challenge of Vaping vs Combustible smoke
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• Vaping Aerosols are exceedingly different from conventional tobacco smoke
• ENDS evolve rapidly as they introduce new devices, flavors and chemicals
• If vaping follow in the footsteps of conventional tobacco smoking, it may take years to decades before profound physiological changes are evident
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Chronic Obstructive Pulmonary Disease (COPD) Natural History
2 3Fletcher C, et al. BMJ 1977; 1:1645-48
Health Effects of Vaping
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Health Effects of Vaping
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• Reactive airway disease• Cardiovascular effects • Psychological effects • Risk of infection • E-cigarette or vaping
product-use associated lung injury (EVALI)
Short-term Long-term
Animal model and vaping
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• Short Term– Increased flow resistance– Increased airway
reactivity
• Long Term– Emphysema– Higher airway resistance– Airway obstruction– Airway inflammation
Tsai M, et al. J Physiol. 2020 Sep 25. doi: 10.1113/JP279754. Online ahead of print
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COPD Natural History
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Twin with childhood asthma
COPD Natural History
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Vaping history as an adolescent?
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IDENTICAL TWIN SISTERS
E-cigarette or vaping use-associated lung injury (EVALI)
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• Vitamin E acetate (VEA) an additive in tetrahydrocannabinoids (THC) containing vaping products VEA induced lung injury in a mouse model
Blount BC, et al. NEJM. 2020; 382:697-705Bhat TA, et al. NEJM. 2020; 382:1175-1177
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Simah Herman, 18, shared the images of her holding up handwritten signs on Instagram, as
the Californian teen was on a ventilator after suffering from lung
failure
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Prevalence of Lung Injury and Death
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23 cases • 0 deaths
805 cases • 12 deaths
• Age range 17-60 years old • 18 linked to use of THC• 78% male
Centers for Disease Control. 2019.Iowa Department of Public Health. 2019.
Vaping and COVID-19
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• Higher incidence of COVID-19 among adolescent and young adult e-cigarette and dual users
• Considerations:
Exposure to nicotine and
harmful additives
Spread through touching hands to mouth, face
Sharing devices among youth
Gaiha MS, et al. J Adol Health. 2020.
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Unintended Consequences
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Burns and ExplosionsBurns and Explosions
• Thermal, chemical, or electrical • Most commonly affected areas:
• Thigh, groin
Unintentional IngestionUnintentional Ingestion
• Liquid nicotine exposures in pediatrics
Brownson E, et al. N Engl J Med. 2016;375:14.Govindarajan P, et al. Pediatrics. 2018;141(5):e20173361.
Patient Safety Counseling
3 6FDA. Center for Tobacco Products. 2020.
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Patient Safety Counseling
FDA Safety Reporting
FDA. Center for Tobacco Products. 2020.3 7
Pilot CTSA Grant
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• Team Science – Eric Hoffman– Peter Thorne– Stanley Kruger– Nagpal Prashant– Sajan Goud Lingala – Alejandro Comellas
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Cardiopulmonary effects of electronic cigarettes in young adults (survey)
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Table 1. Number of Returned Surveys per Participant.
Participant Control ENDS Combustible Smoking Only
Number of Participants 26 22 7
Number of Surveys 687 541 113
Average Completed Surveys per 30 days
26.4% 24.6% 16.1%
• The control group had only 4% who reported wheezing more than once a month, compared to 36% in the ENDS group.
• Cough reporting was more variable with cough 50% of the time during the month reported in 23% of controls and 55% in ENDS users.
Cardiopulmonary effects of electronic cigarettes in young adults (Future studies)
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Key Points
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• Vaping and combustible smoke both may have significant impact on lung health, but may variabilities in nicotine delivery and harmful additives
• CT scan and MRI are examples of diagnostic tools that can be used to determine effects of vaping on lung health
• Many short-term consequences associated with vaping have been identified, but long-term consequences are relatively unknown
[email protected]@uiowa.edu
Questions?
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