'How E-cigarettes cause lung diseases decoded'

Vitamin E acetate, a chemical used in many E-cigarettes, may be the causative agent for vaping related respiratory diseases, according to a study that strengthens the link between the compound and lung injury.

Researchers, including those from the US Centers for Disease Control and Prevention (CDC), and The Ohio State University in the US, analysed lung fluid from 51 EVALI (E-cigarette or vaping product use-associated lung injury) patients from 16 states, and compared it to those from 99 healthy individuals.

The study, published in the New England Journal of Medicine, found vitamin E acetate in the bronchoalveolar-lavage (BAL) lung fluid from 48 of 51 EVALI patients, but not in those from healthy people.

According to the researchers, no other toxic chemical was found in the fluid from either group, except coconut oil and limonene (one EVALI patient each).

"These findings support the conclusion that vitamin E acetate is a potential causative agent of EVALI, and that is an important discovery as decisions are made about how to best regulate the rapidly evolving e-cig industry," said study co-author Peter Shields from The Ohio State University.

The study also said the absence of other toxicants including plant oils, coconut oil, petroleum distillates, in EVALI patient lung fluids could be evidence against the role of any of these chemicals as a primary cause of the disease.

"In our study, the detection of vitamin E acetate in BAL fluid in most of the patients with EVALI provides evidence that e-cigarette, or vaping, products can deliver vitamin E acetate to respiratory epithelial-lining fluid, the presumed site of injury in the lung," the researchers wrote in the study.

The scientists said further research in animals can provide information on whether exposure to vitamin E acetate alone can directly cause the lung injury seen in patients with EVALI.