Amid the COVID pandemic, a new study from researchers at Intermountain Healthcare in Salt Lake City finds that patients who experience an E-cigarette or vaping associated lung injury (EVALI) can suffer from cognitive impairment and symptoms more than a year later.
Given that the average age of an EVALI patient in the Intermountain study was 31 years old, these injuries can have profound, life-long effects, researchers say.
“EVALI is a serious disease that has serious complications from the start. Now, we’re finding the long-term consequences are akin to those who have had sepsis or acute respiratory distress syndrome,” said Denitza Blagev MD, a pulmonary and critical care physician at Intermountain Healthcare and principal investigator of the study. “These patients ‘recover,’ but even in that recovery, our study shows that for a percentage of those patients, they may never return to normal.”
Long term cognitive and mood disorders have been increasingly recognized as a complication of severe critical illness in post-intensive care syndrome (PICS). The constellation of cognitive impairment, anxiety, depression, and residual long-term breathing problems place EVALI as a serious illness that leads to PICS, said Dr. Blagev.
An E-cigarette or vaping associated lung injury can leave patients struggling to breathe and experiencing chest pain, nausea, fever, and chills. As of February 2020, e-cigarette and EVALI injuries killed 68 people and hospitalized more than 2,800.
“It’s especially troubling to consider that the consequences of EVALI are as severe as other critical illness, because patients with EVALI tend to be younger and healthier than other patients who become critically-ill,” she said.
In the study, presented at the 2021 American Thoracic Society International Conference, the Intermountain research team examined 91 patients who suffered from EVALI, a year after their initial diagnosis. The median age of patients was 31.1 years old.
The Intermountain researcher team found:
- 15 percent of the patients have severe trouble breathing (stopping for breath after walking 100 yards or a few minutes on ground level, or too breathless to leave the house or breathless when dressing)
- 39 percent of the patients have mild cognitive impairment
- 57 percent of the patients have anxiety
- 34 percent of the patients have depression
- 2 to 3 percent of the patients tested positive for COVID-19
Although some patients with EVALI required intensive care treatment, many patients with EVALI were diagnosed and treated early in the disease course and avoided mechanical ventilation and a prolonged ICU care, which are typically associated with the severe long-term consequences of PICS.
“The fact that such a large percentage of patients, many young, experienced such serious consequences a year after their initial diagnosis speaks to the severity and long-term outcomes of an EVALI diagnosis,” added Dr. Blagev.
Researchers found no significant racial or ethnic disparities in these outcomes.
Dr. Blagev also said that the medical community must remember that EVALI is still happening and has not stopped after vitamin E acetate, an additive tied to the summer 2019 outbreak that led to the recognition of EVALI, has largely been removed from vaping products.
Despite these health risks, younger people continue to vape, as well.
The 2020 National Youth Tobacco survey found that e-cigarettes are the most commonly used tobacco products among American youth – and have been since 2014. The survey found that about one in in 20 middle school students and one in five high school students reported that they’d used e-cigarettes in the past 30 days.
“We are continuing to diagnose people with EVALI, even amid the COVID-19 pandemic,” Dr. Blagev added. “The continued rise of vaping product use in young people coupled with the severe long-term consequences of an EVALI diagnosis are especially alarming.”
Next, researchers will conduct lung function tests on these patients (versus asking them to report symptoms); evaluate if depression and anxiety are a result of EVALI or if they were present before the injury, which may have led these patients to vape in the first place; evaluate whether these patients are more susceptible to viral infections compared to others without a history of EVALI, and work to understand whether patients change their behavior after an EVALI diagnosis.
The Intermountain research was funded by the National Heart, Lung and Blood Institute and the Intermountain Research and Medical Foundation.