EVALI (e-cigarette or vaping product use-associated lung injury) has been a public health priority since August 2019, when the CDC declared the situation an emergency. The CDC advised people not to use THC containing e-cigarettes and vaping products, because the CDC pinpointed THC as a suspected reason for EVALI.
Of the EVALI patients, 82% used any THC and 33% used only THC, and 57% used any nicotine and 14% used only nicotine.
In addition, the CDC also recommended that people do not get these products from informal sources, such as:
Watch this 1:23 minute video by Fight For Flavors: “Industry Insider: What is EVALI?”
Further to these cautions, the CDC also established an association of Vitamin E acetate with EVALI, especially in connection with THC containing products. As such, they issued a statement that people should not add to e-cigarettes or vaping products:
Watch this 5:03 minute video by MedCram: “Vaping / E-Cigarette Associated Lung Injury: CDC Update & Vitamin E Acetate”
Since mid-January 2020, doctors in 50 US states and territories reported altogether 2,668 cases of EVALI hospitalizations to the CDC: three quarters were non-Hispanic white, two thirds were men, and the average age was 24 years. Having said that, the typical profile of EVALI victims was young white men.
As the figure shows, the number of reported cases were the highest in September 2019, after which the numbers started to fall. The reason for the decrease is public awareness and related informed behavior of customers.
Watch this 1:58 minute video by WJBF: “EVALI – new type of lung injury”
Besides Vitamin E acetate, we know little about what other chemicals and/or components might also attribute to lung damage due to vaping and e-cigarettes. This raises a lot of questions, especially because 14% of EVALI cases used products that had only nicotine and no Vitamin E acetate. (One study actually tested these patients for THC, and some tested negative. Those who tested positive had said they used THC some way other than e-cigarettes or vaping.)
Is it possible that these patients simply forgot to mention these risk factors? Or is it that they were unaware that the products also contained THC and/or Vitamin E acetate? Or maybe the evaluating health care professional failed to accurately record these patients’ records?
Another interesting aspect is that several cases of EVALI had occurred even before this outbreak. In those cases, it was nicotine products associated with e-cigarettes. As such, the presence of patients who smoked only nicotine products, might reflect this background incidence.
Still, the question arises, why do those patients that vape products that contain only nicotine get EVALI? This is an open question that the CDC is trying to answer.
Ellington S, Salvatore PP, Ko J, Danielson M, Kim L, Cyrus A, Wallace M, Board A, Krishnasamy V, King BA, Rose D, Jones CM, Pollack LA; Lung Injury Response Epidemiology/Surveillance Task Force. Update: Product, Substance-Use, and Demographic Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury – United States, August 2019-January 2020. MMWR Morb Mortal Wkly Rep. 2020 Jan 17;69(2):44-49.
Ghinai I, Navon L, Gunn JK, et al. Characteristics of Persons Who Report Using Only Nicotine-Containing Products Among Interviewed Patients with E-cigarette, or Vaping, Product Use–Associated Lung Injury — Illinois, August–December 2019. MMWR Morb Mortal Wkly Rep. ePub: 17 January 2020.