Philippe Camus, M.D.

Dijon, France

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The Drug-Induced Respiratory Disease Website

E-cigarette - E-vaporizers - ENDS - Vaping - Dabbing

PMIDs 31990264, 32758560, 34130236. Reached epidemic proportions mid-2019, then subsided. THC, and vitamin-E acetate at the forefront of possible culprit agents. Substances of toxicological interest include ethylene glycol, glycerine, flavoring agents including diacetyl, cannabis (PMID 26347431), tetrahydrocannabinol THC (PMID 25383564, 31491070), vitamin E acetate, ‘sexual enhancers’ such as tadalafil, poppers (NO), or other drugs of abuse (PMID 30245461, 30835796). There is also the risk of nicotine poisoning if contents of a cartridge is taken orally and swallowed, notably by/in children. Careful history taking of exposure to tobacco smoke, inhalants, inhaled stimulants, inhaled drugs and/or substances of abuse is indicated in every patient. E-cigarette in patients on oxygen therapy may produce severe facial burns. (PMID 24338077, 24350225, 24575993, 24732161, 25383564, 27705269, 28522559, 31491070, 31491071, 31491072, 31491073). Battery explosion and fire can injure the mouth, teeth, face, eye, skin and/or thigh.

I - Cardiac arrhythmia(s)/dysrhythmia(s) (AF, VT, VF, TdP) - QTc prolongation)

I.a

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)
I.e

Bradycardia

II - Myocardial dysfunction - Heart failure

II.a

Left ventricular dysfunction/failure

XIV - Pleural involvement

XIV.a

Pleural effusion (uni or bilateral) (can accompany ILD induced by the drug)
XIV.f

Pneumothorax

XV - Chest pain

XV.d

Chest tightness

XVI - Hemorrhage - Bleeding - Hematoma(s)

XVI.e

Alveolar hemorrhage (AH), diffuse AH (DAH)
XVI.h

Coagulopathy
XVI.i

Hemoptysis
XVI.m

BAL: Gross or microscopic bleeding/hemorrhage

XXI - Mediastinal involvement/injury

XXI.c

Pneumomediastinum

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

Acute lung injury - ARDS
XXII.c

Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

XXIII - Hemoglobinopathies (acquired, reversible)

XXIII.a

Methemoglobinemia

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (ILD)
XXIV.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)
XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

XXVII - Dyspnea, lone

XXVII.a

Dyspnea, unexplained otherwise

XXIX - Small airway involvement

XXIX.a

Bronchospasm - Wheezing - Asthma
XXIX.c

Severe or catastrophic bronchospasm or asthma attack (can be fatal)
XXIX.f

Deterioration/exacerbation of preexisting asthma or COPD

XXX - Imaging features

XXX.e

Imaging: An area or areas of consolidation
XXX.f

Imaging: Alveolar opacities or haze with a batwing or butterfly distribution
XXX.l

Imaging: Ground-glass opacities / GGO shadowing

XXXI - Eye catchers

XXXI.e

Eye catcher: A batwing or butterfly pattern on chest imaging

XXXIII - Histopathology (for pulmonary pathology see in ‘Pneumotox’ (a free companion App)

XXXIII.k

Path: Alveolar hemorrhage

XXXIV - Infections

XXXIV.b

Respiratory tract infection incl. pneumonia

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.p

Multisystem/systemic inflammatory response/syndrome

XXXVIII - Miscellaneous - Varia

XXXVIII.c

Antiphospholipid antibodies w/wo the APL syndrome