Silent danger: fatal disease linked to e-cigarette use

A recent national school health survey revealed an alarming fact: on average, 16.8% of young people between the ages of 13 and 17 have already tried electronic cigarettesknown as vapes.

This statistic makes us reflect on the impact of this trend and the possible consequences for public health if these teenagers become regular users of these products.

Unlike previous generations, who were exposed to traditional cigarettes, new generations of children and adolescents have shown greater vulnerability to the use of electronic cigarettes. Nowadays, at events aimed at young people, it is almost impossible not to come across a variety of electronic cigarettes.

It is important to highlight that, in addition to being harmful to health — which is the focus of our discussion today — the use of these devices is prohibited in our country. All electronic cigarettes used in Brazil are acquired illegally.

Those who market these products are committing a series of crimes, including illegal advertising, tax evasion and health violations.

EVALI: ‘vape disease’

EVALI stands for “E-cigarette and Vaping-Associated Lung Injury.” This is a new clinical condition identified in users of these devices.

But after all, is vaping bad for you? The answer is yes, and we will understand why.

This is a difficult disease to diagnose, which requires the exclusion of other clinical conditions. There are no specific laboratory tests or definitive diagnostic markers for this disease. Furthermore, the signs and symptoms are similar to those of many other respiratory diseasessuch as influenza.

The suspicion of EVALI arises mainly when there is a history of use of vapes and electronic cigarettes in the patient’s anamnesis.

Main symptoms:

• Dyspnea
• Cough
• Chest pain
• Fever
• Chills
• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Tachycardia.

To date, the exact cause of EVALI is not known. However, it has been identified that vitamin E acetate, one of the chemical additives present in some products, may be a possible cause.

A study published in 2020 in the New England Journal of Medicine analyzed bronchoalveolar lavage samples from 51 patients and found vitamin E in 48 of them.

It is important to note that vaping can also aggravate several chronic lung diseases, such as asthma, leading to hospitalizations and increasing the morbidity and mortality associated with these conditions.

In the United States, most hospitalizations and deaths related to EVALI occurred in patients using substances containing THC, liquid marijuana.

Treatment for ‘vaping sickness’

Treatment consists of providing medical support according to each patient’s needs, and may vary between outpatient treatment and hospital admission.

Outpatient treatment is indicated for cases in which the patient is clinically stable, with saturation above 95% in room air, absence of severe dyspnea and comorbidities or pre-existing lung diseases.

However, outpatient treatment requires frequent 24- to 48-hour monitoring.

Hospital admission is recommended in cases where there is a decline in general health, reduced saturation, presence of viral or bacterial co-infection and exacerbation of underlying diseases.

Although corticosteroids have been shown to reduce hospital stay and improve recovery, further studies are needed to evaluate their effectiveness.

The CDC (Center for Disease Control and Prevention) provides a proposed treatment algorithm for EVALI.

Use of vapes in Brazil

The marketing, import and advertising of all types of electronic smoking devices have been prohibited in Brazil since 2009, according to RDC No. 46, of August 28.

In July 2022, Anvisa (National Health Surveillance Agency) unanimously approved a report that maintained the ban, import and advertising of these electronic smoking devices.

In addition to the ban, measures were adopted to reduce the supply and demand for these products, including inspection actions in conjunction with other bodies and educational campaigns.

The National Cancer Institute (INCA) also expressed its position on the use of these devices:

“Electronic devices are neither effective nor safe for human consumption. Studies have shown that these electronic devices attract children, adolescents and young people to consume nicotine, making them dependent on this substance.”stated Liz Maria de Almeida, representative of INCA.

Concern about the use of electronic cigarettes among adolescents is valid and requires action to prevent the worsening of risks to public health.

Raising awareness of the dangers associated with vaping and implementing restrictive policies are essential to protect future generations from the harm caused by these devices.