Autopsies, Biopsies Link Lung Injuries to E-Cigarette Use 

August 7, 2020

A new case study  assesses biopsy and autopsy tissues to characterize pathological patterns in suspected EVALI cases .

A new study from the US Center for Disease Control and Prevention (CDC) identified and characterized pathologies potentially linked to e-cigarette or vaping product use-associated lung injury (EVALI). Through tissue samples of both biopsies and autopsies from suspected EVALI patients, they found an association between e-cigarette/vaping use and acute or subacute lung injuries.

The investigators, led by Sarah Reagan-Steiner, MD, and colleagues, also noted previous shortcomings of systematic characterization in autopsy findings.

The biopsy (n = 10) and autopsy (n = 13) tissues submitted for analysis were from individuals either with a history of smokeless tobacco product use or respiratory, gastrointestinal, or constitutional-related symptoms. Other tissues came from those who had shown pulmonary infiltrates or opacities on their chest imaging or who had a sudden death from an undetermined cause.

The investigators supplemented their review process with patient medical records, evaluated histopathology, and a performance of infectious disease testing as necessary.

A total of 21 out of the 23 samples met the surveillance case definitions for EVALI. Reagan-Steiner and colleagues found that evidence of acute to subacute lung injuries, including diffuse alveolar damage or organizing pneumonia, were present in all 10 lung biopsies. They also found these similar patterns to be present in 9 (69%) of the autopsy cases.

The additional autopsies that did not follow these patterns revealed other pulmonary pathology not necessarily consistent with EVALI. These included bronchopneumonia, bronchoaspiration, and chronic interstitial lung disease.

Thus, they acknowledged a link between acute lung injury patterns in both biopsies and autopsies in suspected EVALI cases.

“Acute to subacute lung injury can have numerous causes,” they suggested, “however, if it is identified in an individual with a history of e-cigarette, or vaping, product use, and no alternative cause is apparent, a diagnosis of EVALI should be strongly considered.”

Nevertheless, Reagan-Steiner and team concluded, a thorough review of autopsy tissues in EVALI-suspected deaths can also help identify alternative, EVALI-unrelated diagnoses.

Although the use of e-cigarettes among US adults has increased over the past few years, long-term health implications due to use is still largely unclear and under-analyzed.

According to a study presented in March at the American College of Cardiology (ACC) 2020 Scientific Sessions, a survey of 930,000 US adults found a near doubling of smokeless tobacco product usage from 2016-2018. With the relative novelty of such products, it becomes all the more necessary for investigators to analyze vaping and e-cigarette prevalence and any related health risks.

Another previously published study led by Denitza P. Blagev, MD, suggested a link between longer time spent in hospitals due to EVALI and readmission risk. According to their analysis, patients with longer hospitalizations were likely to experience readmission 30 days following discharge, though this link was not reflected in time spent in the ICU.

Although much is still unknown about EVALI and its implications, many such studies have sought to better understand its links to overall patient/user health.

The study, “Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series” was published online at The Lancet Respiratory Medicine.