Potential of Ethenone (Ketene) to Contribute to Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury

Details

• Personal Author:
  Attfield KR ; Chen W ; Cummings, Kristin J. ; Fowles J ; Jacob P III ; O'Shea DF ; Wagner J ; Wang P
• Description:
  In 2019, the United States experienced an unprecedented outbreak of electronic cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI). Although reports of lipid-laden macrophages in BAL fluid raised the possibility that EVALI represented exogenous lipoid pneumonia, case series that focused on histopathology found patterns of acute lung injury, including diffuse alveolar damage and organizing pneumonia, often with bronchiolitis. Thus, the available evidence to date suggests the outbreak is characterized by an airway-centered chemical pneumonitis rather than acute exogenous lipoid pneumonia. ... Understanding the mechanism by which VEA might cause EVALI has preventive and prognostic implications. Acetate moieties capable of generating ethenone may be present in other compounds within nicotine- or cannabis-based e-liquids, especially in the unregulated market, such as other diluents and solvents or novel additives, including flavorings, herbal extracts, essential oils, homeopathic remedies, and probiotics. Testing of newer vaping devices may also help shed light on the poorly characterized additional impacts of heat, hydrophobic conditions, and catalytic materials on known or newly identified starting ingredients. Furthermore, mechanistic insights could inform the understanding of long-term health effects to patients with EVALI, including potential DNA damage and carcinogenicity from exposures to low concentrations of an acylating agent. Animal models, such as one that was recently reported, have the potential to address these issues and may benefit from delivery methods that allow reactive compounds to reach deep lung tissue, such as intratracheal or direct, nose-only delivery. We hope that this discussion will stimulate further scientific inquiry into the mechanism of lung damage in EVALI and, ultimately, preventive measures to address potential harm from vaping and e-cigarette use. [Description provided by NIOSH]
• Subjects:
  Electrical Equipment And Supplies Lung Diseases Nicotine Occupational Health Respiratory System Respiratory Tract Diseases Safety Smokers Solvents
• Keywords:
  Electronic Devices Ketene Lung Disease Respiratory Irritants Smoking Vapors
• ISSN:
  1073-449X
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  California ; Georgia ; Maryland ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  202
• Issue:
  8
• NIOSHTIC Number:
  nn:20066531
• Citation:
  Am J Respir Crit Care Med 2020 Oct; 202(8):1187-1189
• Email:
  kristin.cummings@cdph.ca.gov
• CAS Registry Number:
  (-)-Nicotine (CAS RN 54-11-5) ; Ketene (CAS RN 463-51-4)
• Federal Fiscal Year:
  2021
• Performing Organization:
  Public Health Institute
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  American Journal of Respiratory and Critical Care Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:8baa6c180173932ead4d07e405c6fc7f10d8b40e0f61e95406c34fcc120e3f211bd1dd3a98e3b755f09212f9eb88f49fc32ab022091c9611463d3c12147b2814
• Download URL:
  https://stacks.cdc.gov/view/cdc/231109/cdc_231109_DS1.pdf
• File Type:
  [PDF - 699.05 KB ]