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LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 16
| Issue : 2 | Page : 219-220 |
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| E-cigarettes in the COVID-19 era |
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Gabriela Gama Freire Alberca, Ricardo Wesley Alberca
Department of Dermatology, Faculty of Medicine FMUSP, Laboratory of Dermatology and Immunodeficiencies (LIM - 56), University of Sao Paulo, Sao Paulo, Brazil
| Date of Submission | 03-Feb-2021 |
| Date of Acceptance | 08-Feb-2021 |
| Date of Web Publication | 17-Apr-2021 |
Correspondence Address:
Ricardo Wesley Alberca
Department of Dermatology, Faculty of Medicine FMUSP, Laboratory of Dermatology and Immunodeficiencies (LIM - 56), University of Sao Paulo, Sao Paulo
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/atm.atm_62_21
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How to cite this article:
Alberca GG, Alberca RW. E-cigarettes in the COVID-19 era. Ann Thorac Med 2021;16:219-20 |
Sir,
We read with great interest the article entitled “E-cigarettes: A novel therapy or a looming catastrophe” by Hussain et al. that was published in Annals of Thoracic Medicine.[1] The manuscript highlights the impact of e-cigarettes on the respiratory and cardiovascular system in active and passive smokers and their impact on young adults. Nevertheless, due to the current coronavirus disease-2019 (COVID-19) pandemic situation, we would like to raise some questions.
COVID-19 systemic and respiratory disease is generated by infection with severe acute respiratory syndrome coronavirus-2 that infects cells via the angiotensin-converting enzyme 2 (ACE2) receptor. It is clear that tobacco smoking is a risk factor for severe COVID-19,[2] but the exact mechanism is not clear. Some shreds of evidence support that smoking increases the expression of the ACE2 receptor in the lungs[3] and also increases the systemic inflammation in COVID-19 patients.[2]
Hussain et al. highlighted that e-cigarettes may be used with a wide range of substances from nicotine, common in tobacco cigarettes, to butane hash oils and cannabidiol.[1] In addition, the amount of each toxic compound may vary between products, which could impact the immune response differently. Since it is not established which compounds present in the tobacco cigarettes modulate the ACE2 receptor in the lungs, it is possible that e-cigarettes smoking also increases ACE2 expression in the lungs.
In addition, a recent report identified the risk for the development of severe lung injury due to e-cigarette smoking,[4] a syndrome described as vaping use-associated acute lung injury (EVALI).[5] EVALI contributes to the compromise of the lung capacity due to remodeling and inflammation, further increasing the risk for respiratory disorders and/or compromising established ones.
Hussain et al. presented evidence that vaping can increase the airway inflammation and type-2 cytokines in the lungs of mice submitted to an allergic lung inflammation protocol.[1] Moreover, a recent report identified a lethal case of influenza in a patient with EVALI,[5] indicating a possible link between e-cigarettes and severe response to respiratory viral infections.
Due to the lack of current information, we believe that e-cigarettes could represent an important risk factor for COVID-19, especially for young adults. However, the impact of vaping on respiratory viral infections and COVID-19 still needs to be further discussed and explored.
Financial support and sponsorship
RWA has a fellowship from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) grant: 19/02679-7.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Hussain S, Shahid Z, Foroozesh M, Sofi U. E-cigarettes: A novel therapy or a looming catastrophe. Ann Thorac Med 2021;16:73-80. [doi: 10.4103/atm.atm_190_20]  |
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| 3. | Jacobs M, Van Eeckhoutte HP, Wijnant SR, Janssens W, Joos GF, Brusselle GG, et al. Increased expression of ACE2, the SARS-CoV-2 entry receptor, in alveolar and bronchial epithelium of smokers and COPD subjects. Eur Respir J 2020;56:2002378 |
| 4. | Layden JE, Ghinai I, Pray I, Kimball A, Layer M, Tenforde MW, et al. Pulmonary illness related to E-cigarette use in illinois and wisconsin – Final report. N Engl J Med 2020;382:903-16 |
| 5. | Akkanti BH, Hussain R, Patel MK, Patel JA, Dinh K, Zhao B, et al. Deadly combination of vaping-lnduced lung injury and Influenza: Case report. Diagn Pathol 2020;15:83. |
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