EVALI Research: Lung Injury Update

As of January 21, 2020, 2,711 cases of electronic cigarette or vaping product use-associated lung injury (EVALI) have resulted in hospitalization or death. The CDC reports these are in all 50 states, the District of Columbia, and Puerto Rico and the US Virgin Islands. Of those thousands of cases, 60 deaths were confirmed as of that date.

However, rates of new EVALI cases, not an illness but a syndrome of vaping-related lung injuries, are finally slower. This week, new research in the journal Radiology describes how EVALI changes the lungs.

The article also analyzes 25 patient lung scans to identify two major patterns of lung damage EVALI causes. Ideally, if medical professionals begin to recognize these imaging patterns in hospitals and other clinical settings, they can help sick vapers sooner.

EVALI is currently a diagnosis of exclusion, meaning doctors must first rule out various other diagnoses to arrive at EVALI. EVALI symptoms are similar to flu, too, and include chest pain, shortness of breath, and coughing. Some patients also experience abdominal pain, diarrhea, nausea, and/or vomiting.

The EVALI research

The report indicates that pulmonary imaging is important to diagnosing EVALI. The study also details current knowns and unknowns surrounding EVALI and poses outstanding questions.

A single cause of EVALI remains elusive. Here are the current knowns: most EVALI patients are young men and youth males, and more than 80 percent of patients vaped THC- or CBD-containing compounds.

The report also lists several hallmark signs of EVALI. The first and most common is organizing pneumonia. Found in 19 of 25 patients in the analysis, this kind of lung inflammation eventually causes scarring, and even more labored breathing.

The second notable sign the authors describe is widespread alveolar damage. Alveoli, small sacs in the lungs that remove carbon dioxide and import oxygen, sustain similar damage in patients with acute respiratory distress syndrome. In scans of lungs in both patient groups, doctors can see many white and gray areas of the lungs troubled by inflammation and fluids instead of healthy black lung tissue regions.

Neither sign on its own is enough for a diagnosis of EVALI. EVALI patients also usually experience fatigue, fever, and both gastrointestinal and respiratory symptoms. They also must have the abnormal lung images signaling damage, and have vaped within the past 90 days.

EVALI and vitamin E acetate

Public health officials in New York State were among the first to focus on vitamin E acetate. This thickening agent, sometimes called “honey cut,” is often used to stretch product further on the black market.

Right now, vitamin E acetate is the leading suspect for what is causing EVALI—although officials point out that it is not in fact linked to all cases. In addition, the data simply reveals a correlation between the EVALI and vitamin E acetate, not causality—at least not yet.

However, experts suggest that vitamin E may damage the lungs directly when it is broken down in the vaping process, and indirectly and the vaper’s immune system is taxed over and over again. The researchers confirm that major questions about this and other EVALI issues remain. For example, the scientists are concerned that other combinations of temperatures, metals, flavors, and other vaping constituents might cause injuries.

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