Nearly four years ago, federal health officials reported a dire new epidemic linked to vaping use that causes life-threatening and potentially irreversible lung disease. The condition, known as vaping or vaping product use-associated lung injury (EVALI), is primarily associated with the presence of vitamin E acetate (VEA) in the e-liquid used in vaping cartridges. It is mostly found in unregulated marijuana vaping products.
Jason Rose, MD, MBA, Associate Professor of Medicine and Associate Dean for Innovation and Physician Science Development at the University of Maryland School of Medicine (UMSOM), co-chaired a workshop through the American Thoracic Society that brought together public health experts from around the world to discuss EVALI findings and research, and draft recommendations to help prevent future epidemics.Their analysis is published in a new report in the January 2023 issue of Annals of the American Thoracic Society.
We are working hard to raise awareness of this growing public health problem. We have identified and resolved the VEA problem, but new substances and contaminants may be emerging in e-liquid formulations that may cause lung damage in the future. “
Jason Rose, MD, MBA, Associate Professor of Medicine and Associate Dean for Innovation and Physician Science Development, University of Maryland School of Medicine
E-cigarette use has increased over the years as some adults use these nicotine products to help them quit smoking. Worryingly, however, vaping is increasing among teens and young adults who use these products recreationally. In a 2019 survey funded by the federal government, 22 percent of college students said they had vaped nicotine in the past month, more than double the number who reported vaping in a 2017 survey. According to the National Institute on Drug Abuse, the percentage of college students who said they had smoked marijuana in the past 30 days rose from 5 percent in 2017 to 14 percent in 2019. Similar rates and similar increases in rates were seen among young adults who did not attend college.
Before VEA was identified and removed from vaping products, the 2019 EVALI epidemic caused 2,807 hospitalizations and 68 deaths in the United States, according to a new analysis. Symptoms of EVALI are similar to acute respiratory illness and include cough, shortness of breath, chest pain and, in some cases, coughing up blood. Gastrointestinal symptoms, fever, fatigue, or rapid weight loss have also been associated with EVALI.
At its heart, EVALI is a serious disease that primarily affects the lungs and has resulted in massive hospitalizations and deaths in a relatively young and otherwise healthy population in the United States. The epidemic, driven in large part by the unregulated and rapidly evolving nature of the vaping industry, certainly underscores the need for continued action by researchers and government agencies. “
Dr. Meghan Rebuli, Study Co-Leader, Assistant Professor, Department of Pediatrics, UNC School of Medicine
Early in the outbreak, the U.S. Centers for Disease Control and Prevention (CDC) collected e-cigarette samples to determine what EVALI patients were inhaling into their respiratory systems. Tetrahydrocannabinol (THC) — the psychoactive ingredient in marijuana — and vitamin E acetate were found in most of the samples; this led the CDC to conclude that vitamin E acetate may be responsible for EVALI. According to Dr. Rose, however, vitamin E acetate was not found in all vaping products linked to the EVALI cases, raising the question of whether other ingredients may also contribute to the lung disease.
The workshop team issued several public health recommendations to prevent future outbreaks of this kind. First, the group emphasizes the need for scientists to gain a more complete understanding of EVALI’s mechanisms. For example, more research is needed to assess the role of various compounds in vaping products on the development of lung disease. This step will require more research and testing of e-liquid formulations to determine their toxicity (based on dose and inhalation delivery), with the goal of classifying ingredients for safety standards. The workshop panel recommended reducing restrictive regulations on research on marijuana — currently considered a controlled substance by the federal government — in favor of more robust research on THC in vaping products.
Healthcare providers need a better understanding of the signs and symptoms of EVALI to quickly identify the condition and identify new outbreaks. Equally important, though, is the need to inform consumers through public health messaging of the potential dangers of vaping products, which are largely unregulated and have unknown health risks. “
Mark T. Gladwin, MD, Dean, Vice Chancellor for Medical Affairs, and John Z. and Akiko K. Bowers Distinguished Professor, UMSOM University of Maryland, Baltimore
source:
University of Maryland School of Medicine
