Despite a global decline in tobacco use,smoking remains a leading cause of preventable death,with rising vaping rates among adolescents and young adults further complicating nicotine cessation efforts.Digital interven...Despite a global decline in tobacco use,smoking remains a leading cause of preventable death,with rising vaping rates among adolescents and young adults further complicating nicotine cessation efforts.Digital interventions,particularly chatbots,have gained attention for their potential to support tobacco and vaping cessation by simulating human-like conversations and providing instant feedback.However,evidence of their effectiveness is limited.The emergence of generative artificial intelligence(AI)chatbots,such as ChatGPT,offers a promising avenue for more personalised and effective cessation support.This article reviews existing literature on traditional chatbot interventions for cessation services,explores the potential of AI chatbots,namely ChatGPT,in continuing to support tobacco and vaping cessation efforts,and identifies areas for future research.It highlights the need to further monitor the reliability and accuracy of AI-generated content and to develop frameworks ensuring healthcare professionals receive adequate training in using these new tools effectively to support patients in quitting smoking and/or vaping.展开更多
Recent studies have suggested an evolving understanding of the association be-tween vaping,specifically electronic cigarette(e-cigarette)use,and the progre-ssion of atherosclerosis,a significant contributor to cardiov...Recent studies have suggested an evolving understanding of the association be-tween vaping,specifically electronic cigarette(e-cigarette)use,and the progre-ssion of atherosclerosis,a significant contributor to cardiovascular disease.Des-pite the prevailing perception of vaping as a safer alternative to traditional toba-cco smoking,accumulating evidence suggests that the aerosols emitted by e-cigarettes contain harmful constituents that may promote endothelial dysfunction,oxidative stress,inflammation,and dyslipidemia—key mechanisms implicated in atherosclerosis pathogenesis.While past research,including experimental studies and clinical investigations,has shed light on the potential cardiovascular risks associated with vaping,gaps in knowledge persist.Future research endeavors should focus on interpreting the long-term effects of vaping on atherosclerosis development and progression,exploring the impact of different e-cigarette formu-lations and user demographics,and identifying effective strategies for mitigating the cardiovascular consequences of vaping.By identifying and addressing these research gaps,we can enhance our understanding of the cardiovascular implica-tions of vaping and inform evidence-based interventions and policies to safe-guard public health.Core Tip:E-cigarette use has been linked to various cardiovascular risks,including the progression of atherosclerosis.Despite the perception of vaping as a safer alternative to smoking,evidence suggests that e-cigarette aerosols contain harmful substances that contribute to endothelial dysfunction,oxidative stress,inflammation,and dyslipidemia.These mechanisms are crucial in the development and progression of atherosclerosis.This review explores multiple facets of e-cigarettes and arterial health,focusing on the connection between vaping and atherosclerosis progression.It presents up-to-date evidence on pathophysiology and significant clinical implications,the impact of various constituents,and discusses contemporary public health strategies.展开更多
Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping pr...Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI).Methods:Retrospective review of clinical characteristics,radiographs,and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio,Texas from 9/2019 to 6/2020 was performed.Results:We report 16 cases(15 men;median age,30 years[range 19-75])of EVALI with a history of vaping Tetrahydrocannabinol(THC),nicotine,or both.The most common presenting symptoms were tachycardia,dyspnea,cough,and fever.All patients required supplemental oxygen,including two who required noninvasive positive pressure ventilation,and five who required mechanical ventilation.All 16 patients had bilateral ground-glass opacities(GGO)with peripheral sparing on chest computerized tomography(CT).Cultures were negative,except for one patient who tested positive for rhinovirus.COVID-19 PCR was done in one individual which was negative.Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh(i.e.,without fixative)BAL in the majority of patients(N=12)with a mean lipid-saturation percentage of 78%[range,44%-100%]and the mean Colombo count of 194[range,101-359].Fifteen patients were treated with systemic corticosteroids.The median length of hospital stay was 10 days.At discharge,three patients required supplemental oxygen.Eight of those who had follow-up imaging showed resolution of GGO.One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate,with resolution of symptoms.Fourteen patients who were evaluated after discharge denied vaping post-discharge(two patients were not able to be contacted and did not keep follow-up appointments).Conclusions:Successful diagnosis and management of EVALI requires a high clinical suspicion,thorough evaluation to rule out infectious etiologies,and aggressive treatment with systemic corticosteroids,along with sustained abstinence from vaping.展开更多
The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational pu...The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes.The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials.Daily use of ECs has implications in myocardial infarction(MI)with an odds ratio of 1.70 compared to healthy,nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62.Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions.Platelet aggregation,endothelial function,and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure.Though more studies need to be done on the topic of EC use and cardiovascular disease,the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes.ECs are toxic to human beings and their harmful effects cannot be overlooked.There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use.It will take decades to collect data for chronic EC use on long term sequelae,such as lung cancer.Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported.Due to undergoing investigations of possible harm and life threatening complications of EC use,we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies.A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage,frequency of use,and contents of ECliquid are just some of the vast complicating factors that limit the ability to effectively compare data.展开更多
There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted i...There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.展开更多
Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of tox...Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of toxins. However, the scientific evidence and the long-term health effects of e-cigarettes are limited. We describe a case of a 43-year-old man who had been smoking electronic cigarettes excessively for three days and presented with acute dyspnea, increased work of breathing and tachycardia. Subsequent chest x-ray revealed bilateral pleural effusions. In addition, the patient had a new oxygen requirement and was thus admitted with a diagnosis of pneumonia and bilateral pleural effusions. The case and the potential harmful effects of electronic cigarettes are discussed herein.展开更多
The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might pro</span><span style="font-family:Verdana;"&...The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might pro</span><span style="font-family:Verdana;">vide a </span></span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">reverse-gateway” from smoking traditional cigarettes to a less-harmful</span><span style="font-family:Verdana;"> alternative. But are users actually smokers? We developed an electronic on-line survey to gather data regarding e-cigarette usage in a target study population of pharmacy students. The survey was created using Google Forms to collect the responses anonymously. We surveyed medical-savvy healthcare students about their e-cigarette use, and whether or not their healthcare providers were aware of their e-cigarette use. Although nearly one-fourth of a convenience sampling of 134 pharmacy-student respondents (23.9%) reported using e-cigarettes, only 2.0% reported prior regular cigarette use, 28% used cartridges containing nicotine and only 11.2% had tried and wanted to quit. The majority (64.1%) reported that their healthcare providers did not ask about such use, and respondents did not volunteer this information. The results of this pilot survey reveal a significant e-cigarette use among health-aware pharmacy students, and they do not support the notion that the respondents do so to quit smoking. The observation that most of the students’ healthcare providers did not inquire about their e-cigarette use, coupled with the finding that users did not volunteer their vaping behavior</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> suggests that the information should be included when getting a medical history. Further research is needed to determine what behavioral factors may play a role in this type of decision-making among student healthcare professionals.展开更多
文摘Despite a global decline in tobacco use,smoking remains a leading cause of preventable death,with rising vaping rates among adolescents and young adults further complicating nicotine cessation efforts.Digital interventions,particularly chatbots,have gained attention for their potential to support tobacco and vaping cessation by simulating human-like conversations and providing instant feedback.However,evidence of their effectiveness is limited.The emergence of generative artificial intelligence(AI)chatbots,such as ChatGPT,offers a promising avenue for more personalised and effective cessation support.This article reviews existing literature on traditional chatbot interventions for cessation services,explores the potential of AI chatbots,namely ChatGPT,in continuing to support tobacco and vaping cessation efforts,and identifies areas for future research.It highlights the need to further monitor the reliability and accuracy of AI-generated content and to develop frameworks ensuring healthcare professionals receive adequate training in using these new tools effectively to support patients in quitting smoking and/or vaping.
文摘Recent studies have suggested an evolving understanding of the association be-tween vaping,specifically electronic cigarette(e-cigarette)use,and the progre-ssion of atherosclerosis,a significant contributor to cardiovascular disease.Des-pite the prevailing perception of vaping as a safer alternative to traditional toba-cco smoking,accumulating evidence suggests that the aerosols emitted by e-cigarettes contain harmful constituents that may promote endothelial dysfunction,oxidative stress,inflammation,and dyslipidemia—key mechanisms implicated in atherosclerosis pathogenesis.While past research,including experimental studies and clinical investigations,has shed light on the potential cardiovascular risks associated with vaping,gaps in knowledge persist.Future research endeavors should focus on interpreting the long-term effects of vaping on atherosclerosis development and progression,exploring the impact of different e-cigarette formu-lations and user demographics,and identifying effective strategies for mitigating the cardiovascular consequences of vaping.By identifying and addressing these research gaps,we can enhance our understanding of the cardiovascular implica-tions of vaping and inform evidence-based interventions and policies to safe-guard public health.Core Tip:E-cigarette use has been linked to various cardiovascular risks,including the progression of atherosclerosis.Despite the perception of vaping as a safer alternative to smoking,evidence suggests that e-cigarette aerosols contain harmful substances that contribute to endothelial dysfunction,oxidative stress,inflammation,and dyslipidemia.These mechanisms are crucial in the development and progression of atherosclerosis.This review explores multiple facets of e-cigarettes and arterial health,focusing on the connection between vaping and atherosclerosis progression.It presents up-to-date evidence on pathophysiology and significant clinical implications,the impact of various constituents,and discusses contemporary public health strategies.
文摘Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI).Methods:Retrospective review of clinical characteristics,radiographs,and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio,Texas from 9/2019 to 6/2020 was performed.Results:We report 16 cases(15 men;median age,30 years[range 19-75])of EVALI with a history of vaping Tetrahydrocannabinol(THC),nicotine,or both.The most common presenting symptoms were tachycardia,dyspnea,cough,and fever.All patients required supplemental oxygen,including two who required noninvasive positive pressure ventilation,and five who required mechanical ventilation.All 16 patients had bilateral ground-glass opacities(GGO)with peripheral sparing on chest computerized tomography(CT).Cultures were negative,except for one patient who tested positive for rhinovirus.COVID-19 PCR was done in one individual which was negative.Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh(i.e.,without fixative)BAL in the majority of patients(N=12)with a mean lipid-saturation percentage of 78%[range,44%-100%]and the mean Colombo count of 194[range,101-359].Fifteen patients were treated with systemic corticosteroids.The median length of hospital stay was 10 days.At discharge,three patients required supplemental oxygen.Eight of those who had follow-up imaging showed resolution of GGO.One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate,with resolution of symptoms.Fourteen patients who were evaluated after discharge denied vaping post-discharge(two patients were not able to be contacted and did not keep follow-up appointments).Conclusions:Successful diagnosis and management of EVALI requires a high clinical suspicion,thorough evaluation to rule out infectious etiologies,and aggressive treatment with systemic corticosteroids,along with sustained abstinence from vaping.
文摘The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes.The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials.Daily use of ECs has implications in myocardial infarction(MI)with an odds ratio of 1.70 compared to healthy,nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62.Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions.Platelet aggregation,endothelial function,and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure.Though more studies need to be done on the topic of EC use and cardiovascular disease,the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes.ECs are toxic to human beings and their harmful effects cannot be overlooked.There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use.It will take decades to collect data for chronic EC use on long term sequelae,such as lung cancer.Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported.Due to undergoing investigations of possible harm and life threatening complications of EC use,we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies.A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage,frequency of use,and contents of ECliquid are just some of the vast complicating factors that limit the ability to effectively compare data.
文摘There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.
文摘Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of toxins. However, the scientific evidence and the long-term health effects of e-cigarettes are limited. We describe a case of a 43-year-old man who had been smoking electronic cigarettes excessively for three days and presented with acute dyspnea, increased work of breathing and tachycardia. Subsequent chest x-ray revealed bilateral pleural effusions. In addition, the patient had a new oxygen requirement and was thus admitted with a diagnosis of pneumonia and bilateral pleural effusions. The case and the potential harmful effects of electronic cigarettes are discussed herein.
文摘The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might pro</span><span style="font-family:Verdana;">vide a </span></span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">reverse-gateway” from smoking traditional cigarettes to a less-harmful</span><span style="font-family:Verdana;"> alternative. But are users actually smokers? We developed an electronic on-line survey to gather data regarding e-cigarette usage in a target study population of pharmacy students. The survey was created using Google Forms to collect the responses anonymously. We surveyed medical-savvy healthcare students about their e-cigarette use, and whether or not their healthcare providers were aware of their e-cigarette use. Although nearly one-fourth of a convenience sampling of 134 pharmacy-student respondents (23.9%) reported using e-cigarettes, only 2.0% reported prior regular cigarette use, 28% used cartridges containing nicotine and only 11.2% had tried and wanted to quit. The majority (64.1%) reported that their healthcare providers did not ask about such use, and respondents did not volunteer this information. The results of this pilot survey reveal a significant e-cigarette use among health-aware pharmacy students, and they do not support the notion that the respondents do so to quit smoking. The observation that most of the students’ healthcare providers did not inquire about their e-cigarette use, coupled with the finding that users did not volunteer their vaping behavior</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> suggests that the information should be included when getting a medical history. Further research is needed to determine what behavioral factors may play a role in this type of decision-making among student healthcare professionals.
