Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI

Details

• Personal Author:
  Baldwin GT ; Barr JR ; Blount BC ; Braselton M ; Briss P ; Brosius CR ; Caron KT ; Chambers D ; Corstvet J ; Cowan E ; De Jesús VR ; Delaney, Lisa J. ; Espinosa P ; Fernandez C ; Gardner M ; Ghinai I ; Heitkemper DT ; Holder C ; Jones CM ; Karwowski MP ; King BA ; Krishnasamy V ; Kuklenyik Z ; Kusovschi JD ; Layden J ; Lung Injury Response Laboratory Working Group ; Meaney-Delman D ; Morel-Espinosa M ; Newman C ; Patel A ; Pirkle JL ; Rees J ; Reese C ; Reis GB ; Rose D ; Seyler T ; Shields PG ; Silva L ; Song MA ; Sosnoff C ; Spitzer CR ; Tevis D ; Thomas J ; Valentin-Blasini L ; Wang L ; Watson C ; Wewers MD ; Xia B
• Description:
  BACKGROUND: The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. METHODS: BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. RESULTS: State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). CONCLUSIONS: Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. [Description provided by NIOSH]
• Subjects:
  Acetates Electrical Equipment And Supplies Hazardous Substances Lung Lung Diseases Occupational Health Respiratory System Respiratory Tract Diseases Safety Smokers Solvents Tobacco Products

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• Keywords:
  Cigarette Smoking Electronic Devices Lung Disorders Respiratory System Disorders Toxins Vapors
• ISSN:
  0028-4793
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  California ; District of Columbia ; Georgia ; Maryland ; North Carolina ; Ohio ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  EPRO - Emergency Preparedness and Response Office
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  382
• Issue:
  8
• NIOSHTIC Number:
  nn:20058606
• Citation:
  N Engl J Med 2020 Feb; 382(8):697-705
• Contact Point Address:
  Dr. Blount, Centers for Disease Control and Prevention, Mailstop F47, 4770 Buford Hwy. NE, Atlanta, GA 30341
• Email:
  bkb3@cdc.gov
• CAS Registry Number:
  2H-1-Benzopyran-6-ol, 3,4-dihydro-2,5,7,8-tetramethyl-2-(4,8,12-trimethyltridecyl)-, 6-acetate (CAS RN 7695-91-2)
• Federal Fiscal Year:
  2020
• Performing Organization:
  Public Health Institute
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  New England Journal of Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:40018e5fb85517be8dcf9094487bbb8203424dd27ffb3979e83442f7910a9f45e8ef29b04a570b9231c9e18d6a436808e96a3dc6bc5b2f40773c4b11dcad5694
• Download URL:
  https://stacks.cdc.gov/view/cdc/221651/cdc_221651_DS1.pdf
• File Type:
  [PDF - 173.08 KB ]