open access

Vol 88, No 2 (2020)
REVIEWS
Published online: 2020-04-30
Submitted: 2020-01-15
Accepted: 2020-03-04
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Acute eosinophilic pneumonia associated with non-cigarette smoking products: a systematic review

Toufic Chaaban
DOI: 10.5603/ARM.2020.0088
·
Pubmed: 32383466
·
Adv Respir Med 2020;88(2):142-146.

open access

Vol 88, No 2 (2020)
REVIEWS
Published online: 2020-04-30
Submitted: 2020-01-15
Accepted: 2020-03-04

Abstract

Acute eosinophilic pneumonia (AEP) is characterized by an acute onset respiratory illness with bilateral chest infiltrates and evidence of pulmonary eosinophilia. Cigarette smoking is the main risk factor, but drugs and other inhalational exposures have also been reported. Herein, the association between AEP and smoking devices other than cigarettes is reviewed The PubMed database was searched using terms such as ”smoking”, ”vaping”, ”e-cigarette”, ”waterpipe”, and ”marijuana”, along with other commonly used synonyms for these terms. In addition, eosinophilic lung diseases were also searched for using the same database. All cases of AEP were identified using the modified Philit criteria in association with the use of marijuana, waterpipe, e-cigarettes or heat-not-burn cigarettes. Cases associated with illicit drug use were excluded.
Twelve cases were included with a median age of 20 (15–60). 75% of patients studied were male. Exposures included marijuana smoking (n = 5), waterpipe usage (n = 2), heat-not-burn cigarette use (n = 2), e-cigarette use (n = 2) and synthetic cannabinoid use (n = 1). A recent change in smoking habits was reported in 50% of patients. Presenting symptoms were dyspnea (91.6%), cough (66.6%), fever (66.6%) and chest pain (25%). 90% of patients had leukocytosis on presentation, but only 16.6% had peri-pheral eosinophilia. The median eosinophil percentage in bronchoalveolar lavage was 67.5% (0 to 78). Two patients had a lung biopsy performed. Bilateral involvement on chest imaging was reported in all patients. Five patients (41.6%) required invasive mechanical ventilation and ten patients (83.3%) were treated in an intensive care unit. All patients responded to corticosteroid therapy with no relapses reported.  
Acute eosinophilic pneumonia is reported with smoking that does not include traditional cigarette smoking such as waterpipes, e-cigarettes, heat-not-burn cigarettes, and marijuana and can have a similar presentation and clinical course.

Abstract

Acute eosinophilic pneumonia (AEP) is characterized by an acute onset respiratory illness with bilateral chest infiltrates and evidence of pulmonary eosinophilia. Cigarette smoking is the main risk factor, but drugs and other inhalational exposures have also been reported. Herein, the association between AEP and smoking devices other than cigarettes is reviewed The PubMed database was searched using terms such as ”smoking”, ”vaping”, ”e-cigarette”, ”waterpipe”, and ”marijuana”, along with other commonly used synonyms for these terms. In addition, eosinophilic lung diseases were also searched for using the same database. All cases of AEP were identified using the modified Philit criteria in association with the use of marijuana, waterpipe, e-cigarettes or heat-not-burn cigarettes. Cases associated with illicit drug use were excluded.
Twelve cases were included with a median age of 20 (15–60). 75% of patients studied were male. Exposures included marijuana smoking (n = 5), waterpipe usage (n = 2), heat-not-burn cigarette use (n = 2), e-cigarette use (n = 2) and synthetic cannabinoid use (n = 1). A recent change in smoking habits was reported in 50% of patients. Presenting symptoms were dyspnea (91.6%), cough (66.6%), fever (66.6%) and chest pain (25%). 90% of patients had leukocytosis on presentation, but only 16.6% had peri-pheral eosinophilia. The median eosinophil percentage in bronchoalveolar lavage was 67.5% (0 to 78). Two patients had a lung biopsy performed. Bilateral involvement on chest imaging was reported in all patients. Five patients (41.6%) required invasive mechanical ventilation and ten patients (83.3%) were treated in an intensive care unit. All patients responded to corticosteroid therapy with no relapses reported.  
Acute eosinophilic pneumonia is reported with smoking that does not include traditional cigarette smoking such as waterpipes, e-cigarettes, heat-not-burn cigarettes, and marijuana and can have a similar presentation and clinical course.

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Keywords

dosinophilic pneumonia; smoking; e-cigarette; waterpipe; vaping; marijuana; cannabis

About this article
Title

Acute eosinophilic pneumonia associated with non-cigarette smoking products: a systematic review

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 2 (2020)

Pages

142-146

Published online

2020-04-30

DOI

10.5603/ARM.2020.0088

Pubmed

32383466

Bibliographic record

Adv Respir Med 2020;88(2):142-146.

Keywords

dosinophilic pneumonia
smoking
e-cigarette
waterpipe
vaping
marijuana
cannabis

Authors

Toufic Chaaban

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