New research from Intermountain Healthcare shows many people who vape or use e-cigarettes can experience significant chronic issues that can persist up to a year or more.
The study, published in the Annals of the American Thoracic Society, found patients who suffered from e-cigarette or vaping associated lung injury, abbreviated EVALI, had a high risk of developing depression, anxiety, post-traumatic stress and respiratory disability one year after their injury.
“Even at 12 months after an EVALI diagnosis, the majority of our patients still had serious residual effects,” said Dr. Denitza Blagev, principal investigator of the study and a pulmonary and critical care physician at Intermountain Healthcare. “Considering that most patients enrolled in this trial were young and did not have any significant comorbidities at the time of their diagnosis is really concerning.”
During the study, 73 EVALI patients treated at Intermountain Healthcare or University of Utah Health, completed a 12-month follow-up between July 20, 2020, and Aug. 15, 2021. The majority of patients were males, approximately 31 years of age.
During that follow-up, findings showed 48% of patients had respiratory limitations, 59% had anxiety and/or depression, 62% had post-traumatic stress and 6.4% had a COVID-19 infection.
Reporting their own experiences through the Behavioral Risk Factor Surveillance survey, 13% of patients said they were unable to work, 54% were still paying off health care bills, 44% said they had difficulty concentrating, remembering or making decisions due to a physical, mental or emotional conditions, 24% reported shortness of breath and 16% had difficulty dressing or bathing. In total, 54% reported using marijuana, 35% reported vaping or using e-cigarettes and 20% reported smoking.
Despite the continuing impact on their health, Intermountain researchers found 62% of those patients in the study continued to vape or smoke.
Blagev said the findings are alarming on multiple levels.
“These are not minor complications,” Blagev said. “And they are happening even in patients whose injuries were not severe enough to require ICU care. These long-term issues are also happening in relatively young people who could face a long life of continuing complications.”
Immediate impacts of EVALI include trouble breathing, chest pain, nausea, fever and chills.
According to health.utah.gov, in 2021, 9.7% of Utah high school students reported using vape products or e-cigarettes in the past 30 days. Over 70,000 Utah teens have admitted trying e-cigarettes and 38,000 have tried vaping. Teens in the Weber-Morgan health district have the highest percentage (13.2%) of e-cigarette use among eighth, 10th and 12th graders.
The U.S. Centers for Disease Control and Prevention released preliminary data from the National Youth Tobacco Survey showing e-cigarette use among U.S. teens continues to rise, with roughly 5 million reporting vaping in the past month, including 11.3% of high school students and 2.8% of middle school students. This data was released just as the results from the Intermountain study were published.
“It’s not for a lack of motivation or a lack of understanding how severe this could still be, especially for patients that have depression, anxiety and PTSD and who might be reaching for those vaping behaviors to cope,” Blagev said. “That doesn’t mean clinicians should give up.”
In fact, she said, discovering younger patients who did quit points to the importance of targeted outreach, especially considering young people are still vaping.
“The big intervention here is going to be trying to raise awareness and implement policies that we know work to reduce vaping among young people,” she said. “And we need to better address mental health issues among young people, so that they have more help than self-medicating with vaping and marijuana use.”
That includes public awareness campaigns directed at the dangers of vaping, tobacco use and EVALI and the fact that it continues to be a problem despite the removal of vitamin-E acetate, an additive tied to lung injuries, from vaping products.
Over the past year, Provo, Ogden, Davis and Box Elder school districts have filed lawsuits against e-cigarette market leader Juul Labs and other manufacturers for allegedly hooking thousands of teenagers on their products.