Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000059.xml
Pneumologie 2020; 74(02): 77-87
DOI: 10.1055/a-1078-8126
DOI: 10.1055/a-1078-8126
Übersicht
E-Zigaretten – Funktionsweise, Inhaltsstoffe und die Vaping-assoziierte akute Lungenschädigung
E-Cigarettes – Operating Principle, Ingredients, and Associated Acute Lung InjuryDie Anstellung von HCE wird durch Förderungsnummer U54DA036151 des „US National Institute on Drug Abuse“ gemeinsam mit der „US FDA Center for Tobacco Products“ (CTP) unterstützt. Der Inhalt liegt in der alleinigen Verantwortung der Autoren und spiegelt nicht unbedingt die offiziellen Ansichten des NIH oder der „Food and Drug Administration“ wider.
Zusammenfassung
Seit April 2019 kam es in den USA zu über 2000 Erkrankungen, bei denen zumeist junge Patienten mit schweren Lungenschädigungen in Krankenhäuser eingewiesen wurden. Im Verlauf sind bisher mehr als 40 Patienten verstorben. Nur ein einziger Zusammenhang konnte zwischen diesen Patienten ermittelt werden: Sie waren alle Nutzer von elektronischen Zigaretten (E-Zigaretten). Mittlerweile wird das Krankheitsbild im Englischen als EVALI bezeichnet (engl. „e-cigarette, or vaping, product use associated lung injury”, E-Zigaretten- oder Vaping-assoziierte Lungenschädigung). Basierend auf zumeist US-amerikanischen Studien zum Thema soll diese Übersichtsarbeit einen Einblick in die Definition, die Epidemiologie, das Krankheitsbild, den typischen Verlauf und potenzielle Auslöser, wie z. B. Vitamin-E-Acetat, von EVALI geben. Zusätzlich soll ein allgemeiner Überblick über die prinzipielle Funktionsweise von E-Zigaretten, die Inhaltsstoffe der verdampften Flüssigkeiten (E-Liquids) sowie die damit verbundenen Inhalationsrisiken gegeben werden.
Abstract
Beginning in April of 2019, the US saw > 2,000 cases of hospitalized, often young, patients with severe acute lung injury, of which over 40 died, and the only existing connection between patients was their use of electronic cigarettes (e-cigarettes). The acronym EVALI („e-cigarette, or vaping, product use associated lung injury”) has since been established for the condition. This review article is intended to provide an overview of recent, mainly US literature on EVALI, including the case definition, epidemiology, clinical presentation, typical disease progression, as well as potential triggers. Ancillary to this, the review further provides a general overview of the basic function of e-cigarettes, the ingredients of the liquids used in these (e-liquids), as well as a brief description of the associated potential inhalation risks.
Publication History
Received: 19 November 2019
Accepted: 19 December 2019
Article published online:
03 February 2020
© Georg Thieme Verlag KG
Stuttgart · New York
-
Literatur
- 1 Grana R, Benowitz N, Glantz SA. E-cigarettes: A scientific review. Circulation 2014; 129: 1972-1986
- 2 Regan AK, Promoff G, Dube SR. et al. Electronic nicotine delivery systems: Adult use and awareness of the „e-cigarette“ in the USA. Tob Control 2013; 22: 19-23
- 3 Blount BC, Karwowski MP, Morel-Espinosa M. et al. Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use – Associated Lung Injury – 10 States, August–October 2019. MMWR Morb Mortal Wkly Rep 2019; 68: 1040-1041
- 4 Taylor J, Wiens T, Peterson J. et al. Characteristics of E-cigarette, or Vaping, Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement – Minnesota, 2018 and 2019. MMWR Morb Mortal Wkly Rep 2019; 68: 1096-1100
- 5 Benowitz NL. Pharmacology of Nicotine: Addiction, Smoking-Induced Disease, and Therapeutics. Annu Rev Pharmacol Toxicol 2009; 49: 57-71
- 6 Rosbrook K, Green BG. Sensory effects of Menthol and Nicotine in an E-cigarette. Nicotine Tob Res 2016; 18: 1588-1595
- 7 Duell AK, Pankow JF, Peyton DH. Free-Base Nicotine Determination in Electronic Cigarette Liquids by 1 H NMR Spectroscopy. Chem Res Toxicol 2018; 31: 431-434
- 8 Bowen A, Xing C. US Patent No. US20150020824A1: Nicotine Salt Formulations for Aerosol Devices and Methods Thereof. 2015 4. Im Internet (Stand: 02.12.2019): https://patentimages.storage.googleapis.com/7b/19/a5/f83e0523a833d9/US20140345631A1.pdf
- 9 EU Richtlinie für Tabakerzeugnisse (Tobacco Products Directive: TPD). 2014 Im Internet (Stand: 02.12.2019): https://ec.europa.eu/health/tobacco/products_de
- 10 Jensen RP, Luo W, Pankow JF. et al. Hidden formaldehyde in e-cigarette aerosols. N Engl J Med 2015; 372: 392-394
- 11 Sleiman M, Logue JM, Montesinos VN. et al. Emissions from electronic cigarettes: Key parameters affecting the release of harmful chemicals. Environ Sci Technol 2016; 50: 9644-9651
- 12 Ramachandra Rao S, Ravishankar G. Vanilla flavour: production by conventional and biotechnological routes. J Sci Food Agric 2000; 80: 289-304
- 13 Omaiye EE, McWhirter KJ, Luo W. et al. High concentrations of flavor chemicals are present in electronic cigarette refill fluids. Sci Rep 2019; 9 DOI: 10.1038/s41598-019-39550-2.
- 14 Erythropel HC, Davis LM, de Winter TM. et al. Flavorant-Solvent Reaction Products and Menthol in JUUL E-Cigarettes and Aerosol. Am J Prev Med 2019; 57: 425-427
- 15 Krüsemann EJZ, Havermans A, Pennings JLA. et al. A comprehensive overview of common e-liquid ingredients and how they can be used to predict an e-liquidʼs flavor category. Tob Control in press. DOI: 10.1136/tobaccocontrol-2019-055447.
- 16 Erythropel HC, Jabba SV, DeWinter TM. et al. Formation of flavorant-propylene Glycol Adducts With Novel Toxicological Properties in Chemically Unstable E-Cigarette Liquids. Nicotine Tob Res 2019; 21: 1248-1258
- 17 Havermans A, Krüsemann EJZ, Pennings J. et al. Nearly 20 000 e-liquids and 250 unique flavour descriptions: An overview of the Dutch market based on information from manufacturers. Tob Control 2019; DOI: 10.1136/tobaccocontrol-2019-055303.
- 18 Gotts JE, Jordt SE, McConnell R. et al. What are the respiratory effects of e-cigarettes?. BMJ 2019; 366 DOI: 10.1136/bmj.l5275.
- 19 National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press; 2018. DOI: 10.17226/24952
- 20 Clapp PW, Jaspers I. Electronic Cigarettes: Their Constituents and Potential Links to Asthma. Curr Allergy Asthma Rep 2017; 17 DOI: 10.1007/s11882-017-0747-5.
- 21 Gillman IG, Kistler KA, Stewart EW. et al. Effect of variable power levels on the yield of total aerosol mass and formation of aldehydes in e-cigarette aerosols. Regul Toxicol Pharmacol 2016; 75: 58-65
- 22 Khlystov A, Samburova V. Flavoring compounds dominate toxic aldehyde production during E‑cigarette vaping. Environ Sci Technol 2016; 50: 13080-13085
- 23 Viswam D, Trotter S, Burge PS. et al. Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Case Rep 2018; 2018 DOI: 10.1136/bcr-2018-224350.
- 24 McCauley L, Markin C, Hosmer D. An unexpected consequence of electronic cigarette use. Chest 2012; 141: 1110-1113
- 25 Madison MC, Landers CT, Gu BH. et al. Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine. J Clin Invest 2019; 129: 4290-4304
- 26 Schachter EN. Popcorn worker’s lung. N Engl J Med 2002; 347: 360-361
- 27 Bandell M, Story GM, Hwang SW. et al. Noxious cold ion channel TRPA1 is activated by pungent compounds and bradykinin. Neuron 2004; 41: 849-857
- 28 Clapp PW, Lavrich KS, van Heusden CA. et al. Cinnamaldehyde in flavored e-cigarette liquids temporarily suppresses bronchial epithelial cell ciliary motility by dysregulation of mitochondrial function. Am J Physiol Cell Mol Physiol 2019; 316: L470-L486
- 29 Bradford LE, Rebuli ME, Ring BJ. et al. Danger in the vapor? ECMO for adolescents with status asthmaticus after vaping. J Asthma 2019; 1-5 DOI: 10.1080/02770903.2019.1643361.
- 30 Creswell J, Kaplan S. How Juul Hooked a Generation on Nicotine. New York Times; 2019 Im Internet (Stand: 02.12.2019): https://www.nytimes.com/2019/11/23/health/juul-vaping-crisis.html
- 31 NYTS. Youth Tobacco Use: Results from the 2014 National Youth Tobacco Survey. Cent Tob Prod 2014; 2014 Im Internet (Stand: 12.02.2019): https://www.fda.gov/tobacco-products/youth-and-tobacco/youth-tobacco-use-results-national-youth-tobacco-survey
- 32 Cullen KA, Gentzke AS, Sawdey MD. et al. E-Cigarette Use among Youth in the United States. JAMA – J Am Med Assoc 2019; 2019 DOI: 10.1001/jama.2019.18387.
- 33 Leventhal AM, Miech R, Barrington-Trimis J. et al. Flavors of e-Cigarettes Used by Youths in the United States. JAMA – J Am Med Assoc 2019; DOI: 10.1001/jama.2019.17968.
- 34 Kong G, Bold KW, Morean ME. et al. Appeal of JUUL among adolescents. Drug Alcohol Depend 2019; 205 DOI: 10.1016/j.drugalcdep.2019.107691.
- 35 Barrington-Trimis JL, Leventhal AM. Adolescents’ use of „pod mod“ e-cigarettes-urgent concerns. N Engl J Med 2018; 379: 1099-1102
- 36 Kastaun S, Brown J, Brose LS. et al. Study protocol of the German Study on Tobacco Use (DEBRA): a national household survey of smoking behaviour and cessation. BMC Public Health 2017; 17: 1-8
- 37 Drogen- und Suchtbericht. 2019 Im Internet (Stand: 12.02.2019): https://www.drogenbeauftragte.de/fileadmin/dateien-dba/Drogenbeauftragte/4_Presse/1_Pressemitteilungen/2019/2019_IV.Q/DSB_2019_mj_barr.pdf
- 38 Layden JE, Ghinai I, Pray I. et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report. N Engl J Med 2019; 1-14 DOI: 10.1056/NEJMoa1911614.
- 39 Corum J. Vaping Illness Tracker. New York Times; 2019 Im Internet (Stand: 02.12.2019): https://www.nytimes.com/interactive/2019/health/vaping-illness-tracker.html
- 40 Itoh M, Aoshiba K, Herai Y. et al. Lung injury associated with electronic cigarettes inhalation diagnosed by transbronchial lung biopsy. Respirol Case Reports 2018; 6 DOI: 10.1002/rcr2.282.
- 41 Siegel DA, Jatlaoui TC, Koumans EH. et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury – United States, October 2019. MMWR Morb Mortal Wkly Rep 2019; 68: 919-927
- 42 Schier JG, Meiman JG, Layden J. et al. Severe Pulmonary Disease Associated with Electronic-Cigarette-Product Use – Interim Guidance. MMWR Morb Mortal Wkly Rep 2019; 68: 787-790
- 43 Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. 2019 Im Internet (Stand: 05.12.2019): https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
- 44 Davidson K, Brancato A, Heetderks P. Outbreak of Electronic-Cigarette – Associated Acute Lipoid Pneumonia. MMWR Morb Mortal Wkly Rep 2019; 68: 784-786
- 45 Triantafyllou GA, Tiberio PJ, Zou RH. et al. Vaping-Associated Acute Lung Injury: A Case Series. Am J Respir Crit Care Med 2019; DOI: 10.1164/rccm.201909-1809LE.
- 46 Mukhopadhyay S, Mehrad M, Dammert P. et al. Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping). Am J Clin Pathol 2019; 1-10 DOI: 10.1093/ajcp/aqz182.
- 47 Butt YM, Smith ML, Tazelaar HD. et al. Pathology of Vaping-Associated Lung Injury. N Engl J Med 2019; 1-2 DOI: 10.1056/NEJMc1913069.
- 48 Dicpinigaitis PV, Trachuk P, Fakier F. et al. Vaping-Associated Acute Respiratory Failure Due to Acute Lipoid Pneumonia. Lung 2019; 10-12 DOI: 10.1007/s00408-019-00277-6.
- 49 Khan MS, Khateeb F, Akhtar J. et al. Organizing pneumonia related to electronic cigarette use: A case report and review of literature. Clin Respir J 2018; 12: 1295-1299
- 50 He T, Oks M, Esposito M. et al. „Tree-in-Bloom“: Severe Acute Lung Injury Induced by Vaping Cannabis Oil. Ann Am Thorac Soc 2017; 14: 468-470
- 51 Agustin M, Yamamoto M, Cabrera F. et al. Diffuse Alveolar Hemorrhage Induced by Vaping. Case Rep Pulmonol 2018; 2018: 1-3
- 52 Arter ZL, Wiggins A, Hudspath C. et al. Acute eosinophilic pneumonia following electronic cigarette use. Respir Med Case Reports 2019; 27: 100825
- 53 Bonilla A, Blair AJ, Alamro SM. et al. Recurrent spontaneous pneumothoraces and vaping in an 18-year-old man: a case report and review of the literature. J Med Case Rep 2019; 13: 283
- 54 Sommerfeld CG, Weiner DJ, Nowalk A. et al. Hypersensitivity Pneumonitis and Acute Respiratory Distress Syndrome From E-Cigarette Use. Pediatrics 2018; 141: e20163927
- 55 Maddock SD, Cirulis MM, Callahan SJ. et al. Pulmonary Lipid-Laden Macrophages and Vaping. N Engl J Med 2019; 1488-1489 DOI: 10.1056/nejmc1912038.
- 56 Henry TS, Kligerman SJ, Raptis CA. et al. Imaging Findings of Vaping-Associated Lung Injury. AJR Am J Roentgenol 2019; 1-8 DOI: 10.2214/AJR.19.22251.
- 57 Henry TS, Kanne JP, Kligerman SJ. Imaging of Vaping-Associated Lung Disease. N Engl J Med 2019; 1486-1487 DOI: 10.1056/nejmc1911995.
- 58 Lung Illnesses Associated with Use of Vaping Products. 2019 Im Internet (Stand: 05.12.2019): https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products#Analysis
- 59 E-Zigaretten und E-Liquids. 2019 Im Internet (Stand: 02.12.2019): https://www.bvl.bund.de/DE/Arbeitsbereiche/03_Verbraucherprodukte/02_Verbraucher/05_Tabakerzeugnisse/04_EZigaretten_ELiquids/bgs_EZigaretten_ELiquids_Tabakerzeugnisse_node.html