Editorial
Severe Lung Disease Associated with Vaping: A First Warning
Enfermedad pulmonar grave asociada a vapeo: primer aviso
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Jiménez-Ruiz, Marcos Garcia Rueda, Jaime Signes-Costa Miñana" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Carlos A." "apellidos" => "Jiménez-Ruiz" "email" => array:1 [ 0 => "carlos.jimenez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marcos" "apellidos" => "Garcia Rueda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jaime" "apellidos" => "Signes-Costa Miñana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Presidente de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Director del Programa de Investigación Integrada en Tabaquismo, SEPAR, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Coordinador del Área de Tabaquismo, SEPAR, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad pulmonar grave asociada a vapeo: primer aviso" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of e-cigarettes and other vaping products has soared in recent years around the world.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> These devices are now commonly used by adolescents and young adults in the Anglosphere.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> A study conducted in Spain in 2014 showed that 10.3% of the population had used e-cigarettes at some time.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> A more recent study indicates that the use of these devices is increasing.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> Many factors have contributed to this propagation, most significantly campaigns by the tobacco multinationals promoting their use, the support given by certain health institutions,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5,6</span></a> and the debate that has been generated among groups of health professionals who are against<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">7–9</span></a> or in favor<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5,6</span></a> of their use. The outcome is that a large part of the general population of smokers has been taken in by the ‘harm reduction strategy’ and remain entrenched in the use of alternative forms of tobacco consumption in the futile belief that they are safe.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However the truth is that smoking is brutal and merciless. In July 2019, the Health Departments of Wisconsin (WDHS) and Illinois (IDPH) received reports of some cases of severe lung disease of unclear etiology associated with the use of e-cigarettes or other vaping devices. This prompted both departments to initiate a study of the reported cases that culminated in a report analyzing 53 cases of this new vaping-related lung disease.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> The article described the epidemiological, pathological, clinical, radiological, and analytical characteristics and the course of the disease and defined criteria for distinguishing between probable and confirmed cases.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> In summary, subjects had a mean age of about 19 years, 83% were men, and all had used vaping devices (many to inhale tetrahydrocannabinol) 90 days prior to the presentation of symptoms (the most common being cough, expectoration, dyspnea, chest pain, vomiting, nausea, abdominal pain, fever and headache) and presented diffuse pulmonary infiltrates that could not be attributed to other causes. Up to 95% required admission, 58% to the ICU, and 1 patient (2%) died.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> The most recent data available at the time of writing (November 2019) show that the epidemic has spread to all US states (with the exception of Alaska), and that 2051 cases have been detected with 39 confirmed deaths from the disease, while others are still under investigation.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> Most of these patients used the devices to inhale tetrahydrocannabinol and had obtained the fluids from unofficial or illegal sources.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> The disease is currently known as e-cigarette or vaping product use-associated lung injury (EVALI). Vitamin E acetate has been found in the bronchoalveolar lavage fluid of some patients, and is being evaluated as the cause of this process.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Smoking is a chronic disease that causes about 6 million deaths annually, according to the most recent WHO data.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> The Framework Convention on Tobacco Control (FCTC) and the MPOWER strategy have been shown to be the most effective and safe tools for combating this epidemic.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> Despite the claims of sectors close to the tobacco companies, it is patently untrue that these strategies are failing and unable to control smoking.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> On the contrary, correctly implemented strategies that are properly monitored for compliance produce undeniable short- and medium-term benefits in any given country. This study analyzed data from 126 countries and found that those that had implemented the measures recommended by the FCTC had a greater reduction in smoking prevalence and lower rates of morbidity and mortality associated with this disease.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> The MPOWER strategy advocates monitoring the tobacco epidemic, expanding smoke-free spaces, raising tobacco prices, and providing help to smokers wishing to stop smoking, among other interventions.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are no shortcuts to victory in this epidemic. The only route map is that indicated by the MPOWER strategy and the FCTC. It is essential that all healthcare professionals trust in and ensure strict adherence to the recommendations of these organizations. The efforts of the leading scientific institutions in the field of respiratory health in supporting this strategy<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">7–9</span></a> and in speaking out against the more lukewarm, conformist opinions of other scientific institutions that uphold the use of vaping devices have been laudable.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A question that remains unanswered is whether the epidemic already observed in the United States of America is emerging in other countries. The Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has created the Registry of Vaping-Related Severe Pulmonary Disease (<a href="https://separ.es/node/1634"><span class="elsevierStyleUnderline">https://separ.es/node/1634</span></a>). A letter has been sent to all members of our society informing professionals of the characteristics of this disease and urging them to rule out EVALI in any patient with suspected symptoms and always enquire after any history of e-cigarette or other vaping product use (internal communication sent to all SEPAR partners in November 2019). This Registry will act a basis for research on this disease and will help to quickly control the propagation of this habit, should it occur Spain.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To sum up, smoking is one of the world's leading health problems. The FCTC and the MPOWER strategy are the most effective and safe instruments for controlling it. Harm reduction strategies do not work in controlling this epidemic. E-cigarettes and other vaping devices have short, medium and long-term health risks. The emergence of this new disease that already affects more than 2000 individuals and has caused the death of 39 must be taken as a first warning.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Ruiz CA, Garcia Rueda M, Signes-Costa Miñana J. Enfermedad pulmonar grave asociada a vapeo: primer aviso. Arch Bronconeumol. 2020;56:691–692.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Surgeon general's advisory on e-cigarette use among youth" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2018" "editorial" => "Department of Health and Human Services, Office of the Surgeon General" "editorialLocalizacion" => "Washington, DC" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Notes from the field: Use of electronic cigarettes and any tobacco product among middle and high school students—United States, 2011–2018" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 2 | 11 |
| 2024 October | 36 | 34 | 70 |
| 2024 September | 36 | 26 | 62 |
| 2024 August | 63 | 51 | 114 |
| 2024 July | 40 | 23 | 63 |
| 2024 June | 59 | 25 | 84 |
| 2024 May | 87 | 28 | 115 |
| 2024 April | 31 | 26 | 57 |
| 2024 March | 53 | 21 | 74 |
| 2024 February | 22 | 13 | 35 |
| 2023 May | 3 | 0 | 3 |
| 2023 March | 10 | 4 | 14 |
| 2023 February | 52 | 20 | 72 |
| 2023 January | 31 | 30 | 61 |
| 2022 December | 57 | 29 | 86 |
| 2022 November | 80 | 24 | 104 |
| 2022 October | 65 | 46 | 111 |
| 2022 September | 47 | 28 | 75 |
| 2022 August | 45 | 51 | 96 |
| 2022 July | 39 | 41 | 80 |
| 2022 June | 35 | 33 | 68 |
| 2022 May | 50 | 39 | 89 |
| 2022 April | 39 | 43 | 82 |
| 2022 March | 229 | 48 | 277 |
| 2022 February | 48 | 20 | 68 |
| 2021 November | 1 | 0 | 1 |
| 2021 September | 2 | 2 | 4 |
| 2021 March | 3 | 0 | 3 |
| 2020 December | 1 | 0 | 1 |
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