Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — 10 States, August–October 2019

• Published in: MMWR. Morbidity and mortality weekly report Vol. 68; no. 45; pp. 1040 - 1041
• Main Authors: Blount, Benjamin C., Karwowski, Mateusz P., Morel-Espinosa, Maria, Rees, Jon, Sosnoff, Connie, Cowan, Elizabeth, Gardner, Michael, Wang, Lanqing, Valentin-Blasini, Liza, Silva, Lalith, De Jesús, Víctor R., Kuklenyik, Zsuzsanna, Watson, Cliff, Seyler, Tiffany, Xia, Baoyun, Chambers, David, Briss, Peter, King, Brian A., Delaney, Lisa, Jones, Christopher M., Baldwin, Grant T., Barr, John R., Thomas, Jerry, Pirkle, James L.
• Format: Journal Article Newsletter
• Language: English
• Published: United States Centers for Disease Control & Prevention (CDC) 15.11.2019; U.S. Government Printing Office; Centers for Disease Control and Prevention
• Subjects: Adolescent; Adult; Aged; Bronchoalveolar Lavage Fluid - chemistry; Disease Outbreaks; Electronic cigarettes; Female; Full Report; Humans; Lung diseases; Lung Injury - epidemiology; Male; Middle Aged; United States - epidemiology; Vaping - adverse effects; Vaping-related lung injury; Young Adult; United States
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/mmwr.mm6845e2

CDC, the Food and Drug Administration (FDA), state and local health departments, and multiple public health and clinical partners are investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). Based on data collected as of October 15, 2019, 86% of 867 EVALI patients reported using tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset (1). Analyses of THC-containing product samples by FDA and state public health laboratories have identified potentially harmful constituents in these products, such as vitamin E acetate, medium chain triglyceride oil (MCT oil), and other lipids (2,3) (personal communication, D.T. Heitkemper, FDA Forensic Chemistry Center, November 2019). Vitamin E acetate, in particular, might be used as an additive in the production of e-cigarette, or vaping, products; it also can be used as a thickening agent in THC products (4). Inhalation of vitamin E acetate might impair lung function (5-7).