Journal of Health Care Communications Open Access

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E-cigarette/Vaping Associated Lung Injury (EVALI) Severity Correlates with Reduced Diffusing Capacity, Need for Lung Biopsy, and Deposition of Titanium in Lung Tissue

Andrew Weber, Vicken Khazar, Samuel Escobar, Robert Promisloff, Keely Cheslack-Postava, Juergen Thieme, Mary Lee-Wong and Anthony M Szema*

Originally marketed as a safer tool for cigarette smoking cessation, electronic cigarettes (e-cigarettes) and vaping devices have now been associated with e-cigarette/vaping associated lung injury (EVALI). Examination of lung tissue from these patients is infrequent. We now report a cohort of 19 vaping adults hospitalized with EVALI (IRB 20- 0094 Feinstein Institutes of Medical Research, Northwell Health). 8 patients were biopsied and one patient’s lung tissue was examined at Brookhaven National Laboratory’s National Synchrotron Light Source II Beam Line ID-5 for the presence of metals. This sample contained abundant amounts of titanium and small amounts of chromium, iron, zinc, calcium, and copper. Vaping coils contain titanium, which is heated via a battery and aerosolized in the inhaled plume. Titanium is pro-inflammatory and may induce lung scarring. Subjects who vaped more frequently and for a longer duration had a lower DLCO, increased necessity of undergoing a lung biopsy, and a longer duration of hospitalization. Lung volumes and spirometry were normal in all patients. Concurrent cannabis use was selfreported in 95% of subjects, while concurrent tobacco use was 32%. 26% were diagnosed with COVID-19 pneumonia during their hospitalization.

EVALI may result in hospitalization and respiratory failure. An etiology for EVALI is not yet determined. We report, for the first time, titanium, among other metals, in the biopsy of a patient with EVALI. Titanium may induce lung injury among the 2.55 million adolescents who vape regularly. We earlier reported oxidized titanium in lung tissue of soldiers exposed to burn pits in Iraq and Afghanistan with Iraq Afghanistan War Lung Injury (IAW-LI). Those samples also indicate titanium was burned before inhalation. The role of titanium in both these inhalational lung injuries requires further investigation.

Published Date: 2023-10-25; Received Date: 2023-09-27