DOH urged to monitor vaping ailments

CHIANG MAI, Thailand, Philippines — A group actively campaigning against tobacco use said it is pushing for the inclusion of E-cigarette or Vaping Use-Associated Lung Injury (EVALI) in the regular disease surveillance report of the Department of Health (DOH).

Southeast Asia Tobacco Control Alliance (SEATCA) executive director Dr. Ulysses Dorotheo said that monitoring and documenting EVALI is necessary, similar to how illnesses like lung cancer and other respiratory diseases caused by smoking are being reported and recorded.

According to the Centers for Disease Control and Prevention criteria, EVALI is a clinical diagnosis that requires the use of an e-cigarette in the 90 days preceding the appearance of initial symptoms; pulmonary infiltrates on a plain chest radiograph or chest CT and the absence of any other possible etiology, such as infection.

“DOH does not have an official mechanism yet (on EVALI) unlike with the infectious diseases, there is a protocol on that. The World Health Organization actually requires reporting cases of diseases such as tuberculosis, malaria, among others,” said Dorotheo during an ongoing SEATCA workshop in Thailand.

He added, “For EVALI, there isn’t such a protocol since doctors are also busy. There is the problem of underreporting. They also don’t write case reports and submit it to scientific journals.”SEATCA cited one reported case of EVALI, a 16-year-old girl from Cebu.“The problem is that there is no way to determine if it’s through vape use so that is why in the US in the beginning, they don’t know what they are dealing with, so initially at face value, it looked like pneumonia so they were treating it with antibiotics,” said Dorotheo. However, Dorotheo added, it was not working so they thought it was resistant to infection and from history, they realized it was from vaping “and that is EVALI.”“If you look at the lung scans, one can observe that it is pneumonia that is inflammatory, not necessarily due to infection but through inhaling lipids, oils through the lungs,” he noted.The SEATCA official added, “Nicotine actually is an oily kind of liquid, that is why history taking (of the person) is important than just simply asking about vaping. If that is the case, the treatment is not antibiotics but steroids and anti-inflammatory drugs.”“So we haven’t really documented many cases (of EVALI), and I’ve heard in other countries, they’ve seen more cases of lung injury, cardiac cases related to e-cigarettes,” said Dorotheo.“There are reports of EVALI from Europe, South America. But in Asia, I’ve only seen reports from Japan as to heated tobacco products. There are also reports from Malaysia, not many from Asia,” he said.“In the beginning, we never thought that smoking was harmful... Historically, lung cancer was rare about 100 years ago but because widespread smoking is now very common, maybe 70 to 80 percent of lung cancer is due to smoking,” Dorotheo said, adding that with EVALI, the same ratio is likely.