UMEM Educational Pearls

Title: E-cigarette, or vaping, product use-associated lung injury (EVALI) update from CDC

Keywords: EVALI, e-cigarette, vaping, lung injury (PubMed Search)

Posted: 11/22/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

As of November 20, 2019:

2290 cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) from 49 states (except Alaska), District of Columbia and 2 U.S. territories.

Largest number of cases (150-199) reported from CA, TX and IL
47 deaths

Analysis of 29 bronchoalveolar lavage (BAL) fluid samples from EVALI patients submitted to CDC from 10 states showed:

Vitamin E acetate in all samples
THC: 82%
Nicotine: 62%
No other chemicals of concern were identified (e.g. plant oil, mineral oil, terpenes, etc.)

*** Vitamin E acetate appears to be associated with EVALI but the investigation is continuing.***

Oral ingestion of vitamin E acetate does not cause harm.
High dose vitamin E supplementation (>2000 IU/day [2000 mg/day]) can cause GI symptoms: nausea, vomiting, diarrhea and abdominal pain.

Some research has suggested that oral vitamin E use has potential beneficial effects (i.e. anti-inflammatory/antioxidant) in the lung (e.g. asthma and allergic lung disease), cardiovascular disease and prostate cancer (Cook-Mills JM et al. 2013; Jiang Q et al. 2001)

Common uses of vitamin E

Topical cosmetic skin products (skin cream) for antioxidant effect.
Essential dietary vitamin (fat soluble) found in many food items and as dietary supplement.
In vaping products: vitamin E is used as an additive/thickening agent in THC containing e-cigarette, or vaping products.

There is limited to no data on pulmonary effect of vitamin E from inhalation in the scientific literature.

Stay tuned for additional updates from CDC.

References

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
Cook-Mills J et al. Two vaces of vitmain E in the lung. Am J Respir Crit Care Med. 2013;188:279-284.
Jiang Q et al. gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention. Am J Clin Nutr. 2001;74:714-722.