EVALI (e-cigarette or vaping product use associated lung injury) isn’t the first controversy to hit vaping and e-cigarettes — they’ve been the source of controversy for years. JUUL Labs, the country’s largest e-cig manufacturer, has come under federal investigation for its sales and marketing practices – particularly to young people. The National Youth Tobacco Survey, released in November, found that between 2017 and 2018, e-cig use among high school students spiked 78% and 48% among middle school students. About 1.5 million young people took up e-cigs between 2017 and 2018. More recently, the company said it would suspend online sales of its flavored pods, which are appealing to younger consumers.
Lung Injuries and Deaths, EVALI
The Centers for Disease Control and Prevention (CDC) has been investigating a rash of cases of vaping-related lung illnesses. As of November 5, 2019, 2,051 confirmed and probable lung injury cases an 39 deaths all associated with the use of e-cigarette or vaping products have been reported to the CDC.
As of November 8, 2019, the CDC says it has identified a probable culprit: vitamin e acetate, an oil found in vitamin e, in the lungs of some lung injury patients.
Vitamin e acetate is a nutritional supplement and is used in topical skin products. When inhaled, it can be damaging. CDC officials said that most of the sickened patients used vape products that contained THC, the psychoactive ingredient in marijuana, as well as vitamin e acetate.
Symptoms of EVALI begin with a gradual onset of difficulty breathing, shortness of breath, fatigue or chest pain. Some patients have mild to moderate gastrointestinal illness including vomiting and diarrhea. Doctors could not find an infection causing these symptoms and the patients did not improve with antibiotics. A few have responded positively to steroid therapies.
Michelle R. Peace, PhD, an associate professor in the Department of Forensic Science at Virginia Commonwealth University and an e-cig researcher, recently posted an authoritative video on vaping devices and e-cig liquids that delves into the technical details of why vaping can be so dangerous and addresses some of the concerns associated with the vaping-related illness outbreak.
Key components of e-cig liquids
The liquid in vaping pods consists of several primary ingredients:
- polyethylene glycol (PEG) PEG is used as a food additive and it toothpaste, as well as medical uses such as laxatives and pharmaceutical binders.
- vegetable glycerin (VG) VG is a clear, odorless liquid derived from vegetable fats. Glycerin is widely used for food, cosmetic and pharmaceutical purposes, and is considered safe when ingested orally.
- medium chain triglycerides (MCT) MCTs are oils such as coconut and palm kernel.
Of course, many vape liquids contain nicotine, the same addictive chemical found in traditional cigarettes. Because the nicotine in many e-cig liquids is in the form of nicotine salts, they can contain a higher amount of nicotine. For example, a typical cigarette contains 2 mg of nicotine or 40 mg in a standard 20 cigarette pack. But a single vaping pod, which is equivalent to a pack of cigarettes, contains 55 mg-65 mg of nicotine, according to Peace.
Research conducted by Peace also found that e-cig liquids contain ethanol, which has been used as a recreational drug for its psychoactive effects. Ethanol’s main use, however, is as an engine fuel and fuel additive. Peace’s research also found that some vape liquids contain acetone, isopropanol and methanol.
Vaping devices turn liquid into an aerosol, another name for vapor. In order to do this, the liquid is passed through a heated coil. This creates by-products from the chemicals in the liquids that are dangerous. Some of these by-products include: formaldehyde, acetaldehyde, benzene, heavy metals and dozens of other potential chemical irritants.
Chemical toxicity to cells
Not surprisingly, most of the chemicals in e-cig liquids pose danger to cellular health. Prior research has found that VG and PEG are both cytotoxic, though VG more so. Also, certain flavors tend to be more toxic than others. For example, tobacco, mint and flavors with buttery/creamy characteristics were found to be the most toxic.
A 2018 University of North Carolina study found that when glycerin is inhaled, it led to slowing the growth of cells. Another 2018 study found that flavoring chemicals are toxic to a type of white blood cells known as monocytes.
Complaints from vaping users
Numerous studies have highlighted health issues by those who vape. These include
- nose irritation
- watery, red eyes
- sore throat
- airway irritation
- immune response
In addition, vaping has been linked to a rise in asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis.
A recent study identified acute lipid pneumonia in mice exposed to e-cig vapor. This type of pneumonia is an inflammatory response to the presence of lipids within alveoli – tiny air sacs – in the lungs. Alveoli serve a critical function in the lungs and respiratory system, working to exchange oxygen and carbon dioxide molecules to and from the bloodstream.
This finding is significant considering that in many of the nearly 1,900 lung-related illnesses associated with vaping, lipid-laden macrophages – white blood cells of the immune system – were found in the users’ alveoli.
MedShadow’s Risk-Benefit Conclusion
Some have argued that vaping is a safer alternative to traditional combustible cigarettes, and may even play a role in helping smokers to quit after all. The fact is that there is no safe alternative to smoking. E-cigs contain many of the same dangerous chemicals that are in traditional cigarettes, as well as some other ones that are extremely toxic.