Vaping-Linked Lung Injuries Can Leave Long-Term Symptoms

Many who suffer vaping-related lung damage will have long-term health problems lasting at least a year, a new study reports.

A substantial proportion of patients continue to be wracked with breathing difficulty, brain fog and mood disorders a year after their initial diagnosis with EVALI (E-Cigarette or Vaping Use-Associated Lung Injury), according to researchers at Intermountain Healthcare in Salt Lake City.

“I think people are becoming aware that a severe lung illness can have other total body consequences, be it EVALI or COVID,” said lead researcher Dr. Denitza Blagev, a pulmonary and critical care physician.

“We have known that about critical illness in general. If you’re in the intensive care unit, you can have total body consequences as a result, even after you get over your critical illness. And we are finding that for EVALI as well,” Blagev added.

Despite these aftereffects, about three out of five EVALI patients continued to vape or smoke despite their lung injury and the associated health impacts, Blagev and her colleagues found.

“Even in this population of patients, it was only 38% of patients who were able to quit all vaping and smoking after their diagnosis,” she said.

For the study, the researchers tracked 73 EVALI patients treated at Intermountain Healthcare or University of Utah Health between mid-July 2020 and mid-August 2021.

Most of the patients were men (average age 31). Not all had severe illness: three in five cases did not require admission to an intensive care unit.

Twelve months after their diagnosis, many EVALI patients said they still had lingering health problems that sometimes affected their quality of life:

• 48% had respiratory limitations
• 59% had anxiety and/or depression
• 62% of patients had post-traumatic stress
• 44% reported difficulty concentrating, remembering or making decisions due to a physical, mental or emotional condition
• 24% reported significant shortness of breath

“The chemicals used in e-cigarettes can cause long-term damage to the lungs when breathed in, chemicals like formaldehyde,” said Dr. Panagis Galiatsatos, director of the Tobacco Treatment Clinic at Johns Hopkins School of Medicine, in Baltimore. “I’m not surprised that a patient who develops EVALI is going to have long-term consequences, not in the slightest.”

Think of your lungs like your skin, he suggested.

“If I cut you with a knife, you have a permanent scar,” Galiatsatos said. “That’s what these patients are having. They have these scar-like phenomena in their lungs.”

Many EVALI patients also were struggling with what Blagev calls “financial toxicity.” About 13% reported they were unable to work, and 54% reported they were still paying off health care bills a year later.

But a year after their EVALI diagnosis, about 35% said they were still vaping or using e-cigarettes; 20% were smoking; and 54% using marijuana, the researchers found.

This speaks to the addictive power of nicotine, Galiatsatos said, and the need to steer these patients into effective tobacco-cessation programs.

“Young people clearly aren’t getting the proper management for nicotine addiction” during their treatment for EVALI, he said. “If they’re relapsing, it means someone is not effectively caring for them.”

A good deal of the lung damage caused by EVALI is permanent scarring, so patients have to learn to live with it, Galiatsatos said.

“I try to tell the patient you can accommodate it,” he said. “It’ll take some endurance training, some medications, and infection control. Any time you get a new infection, your lungs will be prone to scarring.”

About 6% of EVALI patients caught COVID-19 during that year of follow-up, further endangering their lungs, but Blagev said it’s hard to say from these data how EVALI influences the risk of developing COVID.

“If you had EVALI, you might be more likely to wear masks and be more worried about getting COVID than the average 20- or 30-year-old,” Blagev said.

The findings were recently published in the Annals of the American Thoracic Society.

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More information

The American Lung Association has more about EVALI.

SOURCES: Denitza Blagev, MD, pulmonary and critical care physician, Intermountain Healthcare, Salt Lake City; Panagis Galiatsatos, MD, MHS, director, Tobacco Treatment Clinic, Johns Hopkins School of Medicine, Baltimore; Annals of the American Thoracic Society, June 7, 2022