E-Cigarette, or Vaping, Associated Lung injury: the Maryland Poison Center

Source: 

https://www.mdpoison.com/media/SOP/mdpoisoncom/ToxTidbits/2019/October%202019%20ToxTidbits.pdf

E-Cigarette, or Vaping, Associated Lung injury

The CDC, the FDA, state and local health departments, poison centers and others are investigating a multi-state outbreak of lung injury associated with use of e-cigarettes or vaping products. As of October 8, 2019, there have been 1,299 cases in the U.S. (29 in Maryland) with 26 deaths reported from 21 states. Approximately 80% of pa ents are <35 years old; 15% are <18 years old and 21% are 18-20 years old.

E-cigare es were introduced into the U.S. market in 2007. E-cigarettes differ from traditional cigarettes in that they are tobacco-less and heat up a solution cartridge which volatilizes the liquid into a vapor form. This process of heating a re-fillable solution into a vapor brings about various possible mechanisms as to the cause of this sudden increase in e-cigarette, or vaping, associated lung injury (EVALI). The first theory relates to the newer e-cigarette devices that have the ability to heat the solution to a higher temperature, volatilizing substances in greater quantity that was not achievable with the lower temperatures (Sleiman M. Envir Sci Tech 50.17; 2016:9644-9651). Another possible mechanism would be vaping of substances previously not available in the market such as THC. Among reported cases, 76% of patients recount vaping of THC creating a possible association of THC products and EVALI (Layden JE. N Engl J Med Sep 6 2019). However, THC has been available as a vaping solution for many years in some states, and does not fully explain the sudden increase nationwide. The prevailing theory has been adulteration of off market vaping solutions.