Public health experts draft recommendations to help prevent lung injury associated with vaping product use

About four years ago, federal health officials reported a frightening new epidemic linked to e-cigarette use, which caused a life-threatening and potentially irreversible lung condition. The condition — called e-cigarette or vaping product use-associated lung injury (EVALI) — was primarily linked to the addition of vitamin E acetate (VEA) to e-liquids used in vape cartridges. It was primarily found in marijuana vape products that were unregulated.

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-led a workshop through the American Thoracic Society that brought together public health experts brought together. countries to discuss the findings and research of the investigation on EVALI and draft recommendations to help prevent future pandemics. Their analysis was published in a new report in the January 2023 issue of Annals of the American Thoracic Society,

We are trying to raise awareness of this as a growing public health concern. We have identified and managed the VEA problem, but new substances and contaminants are likely to be present in e-liquid formulations that could induce lung injuries in the future.”

Jason Rose, MD, MBA, Associate Professor of Medicine and Associate Dean of Innovation and Physician Science Development at the University of Maryland School of Medicine

The use of e-cigarettes has increased over the years as some adults use these nicotine products to help them quit smoking. However, the increase in vaping among teens and young adults using these products for recreational purposes is worrying. In a federally funded 2019 survey, 22 percent of college students said they had used nicotine in the past month, double the percentage who reported vaping in the 2017 survey. According to the National Institute on Drug Abuse, the percentage of college students who have used marijuana in the past 30 days increased from 5 percent in 2017 to 14 percent in 2019. Similar rates and similar rate increases were also observed among young adults who were not attending college.

The 2019 EVALI epidemic caused 2,807 hospitalizations and 68 deaths in the US before VEA was identified and removed from e-cigarette products, according to the new analysis. The symptoms of EVALI mimic those of an acute respiratory illness with symptoms such as cough, shortness of breath, chest pain and in some cases coughing up blood. Gastrointestinal symptoms, fever, fatigue or rapid weight loss were also associated with EVALI.

At its core, EVALI is a serious disease that primarily affects the lungs and causes a substantial number of hospitalizations and deaths in relatively young and otherwise healthy populations across the United States. This epidemic has been caused largely by the unregulated and rapidly evolving nature of the e-cigarette industry and certainly highlights the need for continued action by both researchers and government agencies.”

Meghan Rebuli, PhD, Study Co-Leader, Assistant Professor, Department of Pediatrics, UNC School of Medicine

At the beginning of the epidemic, the Centers for Disease Control and Prevention (CDC) sampled e-cigarettes to identify what EVALI patients were breathing into their respiratory tracts. Tetrahydrocannabinol (THC) – the psychoactive component in marijuana – and vitamin E acetate were found in most samples; This prompted the CDC to conclude that vitamin E acetate was possibly responsible for causing EVALI. However, vitamin E acetate was not found in all vaping products linked to EVALI cases, which Dr. That raises the question of whether other components could be causing the lung condition, according to Rose.

The workshop panel issued a number of public health recommendations to prevent such outbreaks in the future. First and foremost, the panel underscored the need for scientists to more fully understand the mechanisms of EVALI. More studies are needed, for example, to assess the role played by different compounds in vaping products on the development of lung disease. The move will require more research and testing of e-liquid formulations to determine their toxicity (based on dose and delivery via inhalation) with the goal of classifying ingredients to create safety standards. The workshop panel recommended less restrictive regulations on the study of marijuana — currently considered a controlled substance by the federal government — to allow for more robust studies of THC in vaping products.

Healthcare providers need to be better educated about the signs and symptoms of EVALI in order to quickly recognize the condition and identify new outbreaks. However, equally important, consumers need to be informed through public health messaging about the potential dangers of vaping products that are largely unregulated and have unknown health risks.”

Mark T. Gladwin, MD, UMSOM Dean, Vice President for Medical Affairs, University of Maryland, Baltimore, and John Z. and Akiko K. Bowers Distinguished Professor


University of Maryland School of Medicine


Leave a Comment