EVALI, AN EMERGING RISK FOR BRAZIL: A LITERATURE REVISION.
KEY WORDS: “EVALI”, “E-Cigarettes”, “Lung Injury”, “Electronic Cigarette or Vaping-associated Lung Injury”.
ABSTRACT
In 2019, the Centers for Disease Control exposed a rise in cases of acute pulmonary dysfunctions related to the use of electronic cigarettes. The nominated “Electronic Cigarette or Vaping-associated Lung Injury (EVALI)”, once considered it’s novelty, lacked an effective knowledge about it’s identification and diagnosis. This scenario rebounded in the medical community as the beginning of new discussions related to the pathology. Once determined the significance of the context, this study aimed to evoke a debate that supported Brazil’s involvement in the described circumstances, as it would promote the reflection about the brazilian health situation to the management of a possible epidemic outbreak.Thus, it was promoted a search in the theme’s current literature in Pubmed and Google Scholar. A screening for the keywords “EVALI”, “lung injury” and “e-cigarette”, written in portuguese and english and published in the last decade took place. The critical analysis of titles and abstracts was done, excluding the publications which did not added to the discussion or the ones that were pointed in both research platforms. At last, the screened articles were read. From the initial 66 found papers, 21 were excluded for it’s non-addition to the discussion and 7 of them based on it’s duplicity. 38 publications composed the study’s outcomes.The main findings in literature pointed towards an epidemiologic profile for EVALI of individuals aged between 18 and 24 years old, mainly males, of whom used e-cigarettes daily. Bibliography also highlighted a preference for inhalation of Tetracanabidiol, followed by it’s association with nicotine and the isolated use of nicotine for smoking. EVALI’s pathophysiology is still uncertain. However, the analysis of findings directs to the hypothesis of Vitamin-E Acetate’s participation in EVALI’s pathogenesis. Other theories point to the aerosolization of heavy metals, product of the thermal decomposition of the e-cigarettes material that become susceptible to inhalation. The analysis of the EVALI’s manifestations revealed a predominance of respiratory (cough, dyspnea and thoracic oppression), gastrointestinal (abdominal pain, nausea, vomiting and diarrhea) and constitutional (fever, chills and weight-loss) symptoms, with an acute behavior, progressing to more dramatic stages in one to two weeks. Tachycardia and tachypnea associated with oximetry levels lower than 95% are frequent. Regarding the radiologic findings, irregular infiltrates in both lungs was more frequently found. Several patterns were observed in computed tomography, the most common being bilateral consolidation in the lung bases and ground-glass opacities. The diagnosis is based on the exclusion of other causes, associated with suggestive radiologic findings and a e-cigarette use in the last trimester. Treating the illness is mainly based on corticotherapy and invasive and non-invasive ventilathory methods. At last, considering the study’s main objective, the review could show the absence of brazilian scientific productions that analysed EVALI or the national prevalence of electronic cigarette use. This lack of studies became an indicative of vulnerability of brazilian medicine towards the growing usage of those devices worldwide and the possibility of an epidemic outbreak, similar to what was known in other countries, despite the fact that the marketing of e-cygarettes isn’t legalized in Brazil and their impact on the development of other diseases is still unknown. These conclusions, therefore, only highlight the urgency of the debate in the country.
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