Researchers To Present Case Report Of E-cigarette Associated Acute Inhalation Lung Injury At 81st CHEST Annual Meeting

Researchers To Present Case Report Of E-cigarette Associated Acute Inhalation Lung Injury  At 81st CHEST Annual Meeting

The 81st annual meeting of the American College of Chest Physicians (CHEST), being held October 24-28 at the Palais des congrès de Montréal in Canada, begins this week, with a program that will feature clinicians and researchers from around the globe present unique case studies on pulmonary, critical care and sleep medicine topics.

The American College of Chest Physicians is publisher of the journal CHEST, and a global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. CHEST’s mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. The organization serves as an essential connection to clinical knowledge and resources for its 18,700 members from around the world who provide patient care in pulmonary, critical care, and sleep medicine.

Attendees at the Montreal meeting will hear and participate in focused discussion of innovations in interventional pulmonology, featuring lectures on the physiology of obstructive lung disease, imaging modalities for COPD, lung volume reduction surgery, bronchoscopic lung volume reduction, and bronchial thermoplasty, as well as “Interventional Pulmonology: Year in Review,” delivered by the American Association for Bronchology and Interventional Pulmonology (AABIP) president, and a hands-on session demonstrating the use of endobronchial ultrasound, navigational bronchoscopy, valve placement for bronchopleural fistula, and more. Founded in 1993, the AABIP is an interdisciplinary society dedicated to excellence in clinical care, education, and research in the rapidly expanding fields of bronchoscopy and interventional pulmonology. The official journal of the AABIP is the Journal of Bronchology & Interventional Pulmonology. A wine and cheese reception will follow.

The Montreal meeting program will include:
• Interdisciplinary programs
• Simulation programs
• Postgraduate courses
• More than 300 general sessions
• Expanded MOC opportunities
• Original investigation presentations
• New diagnostic and treatment solutions in the exhibit hall

For more information about CHEST 2015, visit http://chestmeeting.chestnet.org, or follow the CHEST meeting hashtag, #CHEST2015, on social media. A CHEST 2015 mobile app is also available for both Apple iOS and Android devices. More information and download links can be found at: http://psav.mobi/chest/

A major topic of discussion at CHEST 2015 will be the steadily increasing popularity of electronic cigarettes worldwide, with little currently known about their effects on health. Results of a new clinical trial (ClinicalTrials.gov identifier: NCT02203162) published in CHEST suggest that the single use of an electronic cigarette approximating the nicotine exposure of one tobacco cigarette reduces sensitivity of the cough reflex.

The Original Research article, entitled Effect Of Electronic Cigarette Use On Cough Reflex Sensitivity (CHEST Journal, 2015; 148 (4_MeetingAbstracts): 83A DOI: 10.1378/chest.2281610) is coauthored by Peter V. Dicpinigaitis, MD, FCCP; Alfredo Lee Chang, MD; Alis J. Dicpinigaitis; and Abdissa Negassa, PhD of the Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.

The coauthors explain that the aim of their study was to evaluate the effect of a single exposure to electronic cigarette vapor on cough reflex sensitivity. Thirty adult lifetime nonsmokers with no history of asthma or respiratory diseases underwent cough reflex sensitivity measurement employing Capsaicin, the pungent extract of red peppers, which was used to induce a safe cough in the subjects and establish their baseline cough reflex sensitivity prior to use of electronic cigarette containing nicotine in a vehicle of distilled water.

The participants received a cough challenge at baseline, 15 minutes, and 24 hours after electronic cigarette exposure (30 puffs 30 seconds apart). The endpoint of cough challenge is C5, the concentration of capsaicin inducing 5 coughs. The number of coughs induced by each electronic cigarette inhalation was counted, and a subgroup of eight subjects subsequently underwent an identical protocol with a non-nicotine-containing electronic cigarette. Fifteen minutes after the e-cigarette vaping session, subjects were tested again using the capsaicin cough challenge and then tested again after 24 hours.

Based on a comparison of results, a significant decrease in cough reflex sensitivity was shown within the subjects as compared with their baseline levels. The subgroup of 8 subjects demonstrated the largest degree of cough reflex inhibition and had no suppression after exposure to a non-nicotine-containing electronic cigarette. Furthermore, more coughing was induced by the nicotine-containing vs.non-nicotine-containing device

From the study results, the investigators conclude that a single session of electronic cigarette use, approximating nicotine exposure of one tobacco cigarette, induces significant inhibition of cough reflex sensitivity, and exploratory analysis of a subgroup of subjects suggests that nicotine is responsible for this observation. The trial data, consistent with prior research shows that nicotine also promotes cough immediately after ingestion, suggesting that nicotine has a dual action: an immediate stimulation of the cough reflex and a delayed central antitussive effect.

The entire study, Chest Effect Of Electronic Cigarette Use On Cough Reflex Sensitivity,can be viewed in the Online First section of CHEST.

Another presentation among Diffuse Lung Disease Global Case Reports at the Montreal meeting is entitled “Good, Bad, and Ugly on Vaping” (Chest. 2015;148(4_MeetingAbstracts):385A. doi:10.1378/chest.2279115), to be presented on Tuesday, October 27, 2015 at 01:30 PM – 02:30 PM, coauthored by Rajeev Narang, MD; Devina Narang; Shreya Narang; justin salman; Nhu Quyen; and George Udeani, DSc of Christus Spohn Shoreline at Corpus Christi, Texas, who describe a patient with no significant past medical history who developed hypersensitivity pneumonitis due to e-cigarette use.

The coauthors describe a 23-year-old morbidly obese male patient with no significant past medical history ho presented to the Emergency Department with worsening productive cough, rust colored sputum, and shortness of breath. The patient admitted to using an e-cigarette device for the last six months.

The researchers say the patient’s vital signs showed him to be tachypnic, tachycardic, and febrile. crackles could be heard in the right lung field, the patients WBC was 9.3 K/L, and his electrolytes and liver enzymes were within normal limits. The patient was started on nebulizer treatments and antibiotics for suspected community acquired pneumonia. A computer tomography (CT) scan of his chest showed countless patchy nodular parenchymal opacities, widely distributed throughout the lungs. Patient underwent fiber optic bronchoscopy; BALF cultures were negative. BAL cell count and differential showed 80% lymphocytes, which is universally noted in most cases of hypersensitivity pneumonitis. Tuberculin skin test, fungal serologies, autoimmune panels, ANCA serologies and HIV titer were also negative. ACE level was normal. Transbronchial biopsy of the left and right lungs exhibited noncaseating epithelioid granulomas.

The patient was thus diagnosed with acute hypersensitivity pneumonitis due to e-cigarette aerosol exposure, and improved rapidly with cessation of e-cigarette usage and steroid treatment, and was discharged home.

The coauthors conclude that adverse effects associated with e-cigarette usage and aerosol exposure are not well understood, noting that studies have linked e-cigarette vaping sessions to onset of eosinophilic and lipoid pneumonia, as well as sub-acute bronchiolitis. Furthermore, they report that e-cigarette aerosols have been identified as inducing pro-inflammatory mediators in human lung tissue and mouse models.

And while there is paucity of solid data implicating E-cigarette use with significant lung disease, they note that this patient’s flu-like symptoms, atypical radiological findings, bronchoscopic finding and lung biopsy, results were all consistent with hypersensitivity pneumonitis (HP), and that rapid improvement with cessation of vaping supports the clinical diagnosis. The coauthors say they are unaware of any previous association between HP onset and E-cigarette use.

They conclude that while e-cigarette use has been increasing rapidly as means to quit smoking, with many different manufacturers producing ann array of flavored juices for vaping, the U.S. FDA does not regulate these products. The coauthors not that there have been some confirmed reports of lung disease associated with e-cigarette use, and present a confirmed case of hypersensitivity pneumonitis associated with vaping, observing that it’s likely that many more cases exist which have not come to clinical attention, indicating need for further investigation in the pathogenesis of lung disease associated with E-cigarette use as well as need to regulate these products based on safety concerns associated with their use.

For more information about CHEST, visit:
http://chestnet.org

Sources:
The American College of Chest Physicians (CHEST)
81st CHEST annual meeting
CHEST journal
The American Association for Bronchology and Interventional Pulmonology (AABIP)

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