Evaluation of Bronchoalveolar Lavage Fluid Samples from Patients with E-cigarette, or Vaping, Product Use Associated Lung Injury (EVALI)

 

CDC, the U.S. 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). CDC developed laboratory methods to analyze chemicals of concern and active compounds in case-associated bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs).

CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Vitamin E acetate might be used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.

Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. CDC a nalytic methods can identify vitamin E acetate, MCT oil (medium chain triglycerides), plant oils (long chain triglycerides), petroleum distillates (including mineral oil), diluent terpenes, cannabinoids, and nicotine in BAL fluid. For more information, visit 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.

This is the first time we have detected a chemical of concern (vitamin E acetate) in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs. These findings complement the ongoing work of FDA and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.

While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI. Many different substances and product sources are still under investigation, and it may be that there is more than one cause of this outbreak. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.

For more information, read the full MMWR.

 

The Emergency Risk Communication Branch in the Division of Emergency Operations, Center for Preparedness and Response is responsible for the management of all COCA products.
  
For information about this update or other clinical issues, or to send your feedback, please contact us at coca@cdc.gov

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