People hospitalized with e-cigarette and vaping-associated lung injury in rural areas are more at risk for severe respiratory failure compared to people in urban regions, new research found.

“Rural populations, such as states in the Midwest and Appalachian region of the U.S., are of particular concern since adult and youth tobacco use remains among the highest in the [United States], and there is evidence that West Virginia youth vaping rates are rising faster compared to any other states in the U.S.,”Rahul Sangani,MD, assistant professor division of pulmonary, critical care and sleep medicine at West Virginia University School of Medicine, and colleagues wrote in Hospital Practice.

“Despite such concerns, the reported prevalence of hospitalized [e-cigarette and vaping-associated lung injury] cases or death in Appalachian region remains low.”

Researchers conducted a consecutive case series of 17 patients (mean age, 37 years; 59% men) with e-cigarette and vaping-associated lung injury (EVALI) admitted to West Virginia University Hospital from August 2019 to March 2020. Researchers collected demographics, baseline characteristics, comorbidities, vaping behavior and hospital course data. Patient-volunteered e-liquid materials and vapors were analyzed and bronchoalveolar lavage specimens were assessed for lipid-laden macrophages staining for oil red O (n = 15) and hemosiderin-laden macrophages staining for Prussian blue (n = 14).

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