Cigarettes have always been the first source to blame for lung disease; however, there’s a new sheriff in town… E-cigarettes. The ongoing national surge of electronic-cigarettes and vaping product use has resulted in lung damage, which led to 2400 hospitalizations and 52 deaths in the US since December 12, 2019. Over the years, there have been debates on whether raising the legal age for the purchase of tobacco products would reduce lung injury-related hospitalizations.
Now, as of December 2019, a new law, according to the FDA, prohibits the sale of tobacco products, including e-cigarettes and vaping products, to individuals under the age of 21. A 2019 study, published in the New England Journal of Medicine, by Benjamin Blount and colleagues, now sheds light on how e-cigarettes and vaping products cause lung damage.
Damaged caused by these smoking products is known as EVALI (e-cigarette or vaping product use associated lung injury). One hundred and fifty individuals participated in the study; 51 were diagnosed with EVALI and 99 had healthy lungs, but may or may not have used cigarettes, e-cigarettes of vaping products. Each of the subjects underwent bronchoalveolar-lavage (BAL), a process during which a bronchoscope is inserted into the lungs, through the mouth or nose, and fluid is withdrawn for testing. BAL fluids were analyzed by the Center for Disease Control (CDC) in search of toxins that might be related to lung disease. Specifically, the researchers looked for known toxic agents including vitamin E acetate, coconut oil, other plant oils, products of petroleum distillation, and terpenes, which are essential oils found in some plants, such as citrus trees. Although coconut oil and a terpene were found in the BAL fluid from one EVALI subject, vitamin E acetate was found in 48 of 51 BAL fluid samples from subjects with lung injuries. No toxins were found in the BAL fluid samples form healthy subjects.
According to Blount, insufficient clinical data was available to estimate the time between the last use of an e-cigarette product and BAL fluid collection. Nevertheless, vitamin E seems to be the “smoking gun.” The evidence suggests that e-cigarette or vaping products can deliver vitamin E acetate to the lung and cause injury. Originally marketed as a safer alternative for cigarettes, there are, indeed, health risks that are associated with long-term use of e-cigarettes or vaping products.