Almost all teens hospitalized with e-cigarette, or vaping, product use-associated lung injury (EVALI) reported vaping delta-9-tetrahydrocannabinol (THC), the primary psychoactive ingredient in cannabis, according to a retrospective study published today in Pediatrics.
Researchers reviewed the charts of all 13 patients with EVALI who presented to a children’s hospital in Texas from December 2018 to November 2019. They described the diagnosis, evaluation and management of the patients in “Clinical Features of EVALI in Teenagers.”
Fifty-four percent of the patients were female, 46% were Hispanic and the mean age was 15.9 years. Ninety-two percent of the patients reported vaping THC, and 62% of patients said they vaped nicotine.
All patients had diffuse bilateral ground-glass opacities on chest computed tomography scans. Respiratory symptoms, including cough, shortness of breath and chest pain, were reported in 85% of the patients. Eighty-five percent also had gastrointestinal (GI) symptoms, with vomiting and nausea being the most common. Four patients had GI distress without respiratory symptoms.
About two-thirds of the patients required nasal cannula. One patient required two courses of veno-venous extracorporeal membrane oxygenation, chest tube placement for persistent air leak syndrome and eventual tracheostomy.
Findings unique to this study include:
- Oral and/or intravenous glucocorticoid treatment appeared to reverse lung function deficits.
- About half of the patients had stressors in at least three of the five psychosocial risk domains. Risk domains included home environment, academic difficulty, behavior problems, mental health and substance use.
Vitamin E acetate, which is used as a thickening agent to dilute THC oil, has been reported by the Centers for Disease Control and Prevention as a causative factor in EVALI. Authors note that while the mechanism of lung injury remains unclear, exposure to THC adulterated with vitamin E acetate appears likely.
Patients in the study cited friends and acquaintances as sources of the THC products. One patient reported obtaining products from an unregulated distributor; retail dispensaries are prohibited in Texas.
Authors of a related commentary titled “Curbing Youth E-cigarette Use Must Remain a Priority” encourage those caring for adolescents to support efforts toward cessation. They also call for broader regulations, including requiring e-cigarette makers to submit a formal application and undergo review by the Food and Drug Administration. The deadline set for May has been modified to Sept. 9 due to COVID-19.
