Abstract
CDC, the 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). Based on data collected as of October 15, 2019, 86% of 867 EVALI patients reported using tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset (1). Analyses of THC-containing product samples by FDA and state public health laboratories have identified potentially harmful constituents in these products, such as vitamin E acetate, medium chain triglyceride oil (MCT oil), and other lipids (2,3) (personal communication, D.T. Heitkemper, FDA Forensic Chemistry Center, November 2019). Vitamin E acetate, in particular, might be used as an additive in the production of e-cigarette, or vaping, products; it also can be used as a thickening agent in THC products (4). Inhalation of vitamin E acetate might impair lung function (5-7).
Highlights
Bronchoscopy and bronchoalveolar lavage† (BAL) can be part of the clinical and diagnostic workup of EVALI patients
Results for plant oils, medium chain triglyceride oil (MCT oil), petroleum distillates, and diluent terpenes were all below analyte-specific levels of detection
These findings provide direct evidence of vitamin E acetate at the primary site of injury among EVALI
Summary
Bronchoscopy and bronchoalveolar lavage† (BAL) can be part of the clinical and diagnostic workup of EVALI patients. Methods to analyze specific toxicants of concern and active compounds in case-associated BAL fluid.§ These CDC analytic 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. Among the 27 BAL fluid specimens with sufficient volume for testing, all had measurable levels of DPPC.
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