Ever since last year’s national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI), researchers have sought to uncover the cause of the mysterious illness that has sickened thousands of e-cigarette users and resulted in dozens of deaths. Reports of vaping illnesses are ongoing in the United States and in a new study published in the New England Journal of Medicine on February 20, researchers linked the EVALI to the presence of vitamin E acetate additives in e-cigarette liquids. If you or a loved one has been diagnosed with a severe lung illness allegedly caused by e-cigarette use, contact an experienced e-cigarette injury attorney today to discuss your legal options.
Vitamin E oil, found naturally in some foods and commonly used in skin creams and supplements, doesn’t appear to cause harm when ingested or applied to the skin. However, the substance that is commonly used as an additive in the production of certain e-cigarette products and as a thickener in some THC products is vitamin E acetate, a synthetic form of vitamin E oil that is heated and inhaled by e-cigarette users. Lipids (i.e. oils) in the lungs have been associated with lung injury for years and experts say that the oil-like chemicals in e-cigarettes have the potential to severely impair lung function. Says Dr. Sven-Eric Jordt of the Duke University School of Medicine, “Just the lack of toxicity data for inhaled Vitamin E acetate should raise red flags.”
The researchers involved in this new NEJM study report that the presence of vitamin E acetate was associated with EVALI in a sample of 51 patients from 16 states across the United States. The researchers reached this conclusion by looking at samples of bronchoalveolar-lavage (BAL) fluids from 51 patients with EVALI and from 99 healthy participants of an ongoing study involving nonsmokers, individuals who use e-cigarettes or vaping products exclusively and individuals who smoke combustible cigarettes exclusively. Using the BAL fluids, the researchers conducted tests to measure levels of vitamin E acetate and other toxins commonly found in e-cigarette liquids.
According to the researchers’ findings, vitamin E acetate was found in BAL fluid obtained from 48 out of 51 EVALI patients (94%) but not in BAL fluid obtained from the healthy group. Among the patients for whom laboratory or epidemiologic data were available, the researchers found that 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping with THC products in the 90 days before the onset of the lung illness. The researchers also detected nicotine or its metabolites in 30 of 47 of the EVALI patients (64%). The fact that vitamin E acetate additives were found in the BAL fluid samples of patients who experienced a lung illness linked to vaping means the additive could be the underlying cause of the ongoing outbreak, the researchers say.
The vaping-related lung illnesses were first identified by health officials in Wisconsin and Illinois in early August, after several cases of severe lung injury were reported and e-cigarette use was found to be the only common factor. In September 2019, in the midst of a nationwide investigation into the EVALI outbreak, the New York State Department of Health identified vitamin E acetate as a possible cause of the vaping-related lung illness. Two months later, after federal health officials found vitamin E acetate in every sample of lung fluid collected from 29 patients with EVALI across 10 states, the CDC issued a report identifying the chemical as a “potential toxin of concern” in the lung illness outbreak.
As of February 2020, the ongoing outbreak of vaping-related lung illness has resulted in more than 2,700 hospitalizations across all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. In addition, 64 deaths have been reported in connection with the lung injury outbreak. Since identifying vitamin E acetate as the potential culprit in the EVALI outbreak, officials from the FDA and CDC have collected product samples from a number of states and are testing the samples for the presence of additives, cutting agents, heavy metals, toxins and chemicals. According to the FDA, “Vitamin E acetate has been found in product samples tested by FDA and state laboratory and in patient lung fluid samples tested by CDC from geographically diverse states. Vitamin E acetate has not been found in the lung fluid of people that do not have EVALI.” Based on these findings, the FDA has determined that “Vitamin E acetate is strongly linked to the EVALI outbreak.”