An overview of Vaping Associated Lung Injury (VALI)
Hosts:
Audrey Bree Tse, MD
Larissa Laskowski, DO
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Vaping_Associated_Lung_Injury.mp3



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Tags: Pulmonary, Toxicology





Show Notes
Why this matters

As of Oct 15, vaping has been associated with acute lung injury in over 1400 people
33 deaths have been confirmed in 24 states
70+% of those with VALI are young men
A large number of patients are requiring ICU/ intubation/ ECMO

4 main ingredients in solvent

+/- Flavor additives
+/- Nicotine or THC (Tetrahydrocannabinol)
Propylene Glycol (PG)
Vegetable Glycerin (VG)

CDC definition of VALI (Vaping Associated Lung Injury)

Using an e-cigarette (“vaping”) or dabbing* in 90 days prior to symptom onset AND
Pulmonary infiltrate, such as opacities, on plain film chest radiograph or ground-glass opacities on chest CT AND
Absence of pulmonary infection on initial work-up. 
No evidence in the medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process).

*Dabbing allows the user to ingest a high concentration of THC.  Butane Hash Oil (BHO), an oil or wax-like substance extracted from the marijuana plant, is placed on a “nail” attached to a specialized glass bong called a “rig.” A blow torch is used to heat the wax, which produces a vapor that can then be inhaled to supposedly produce an instantaneous effect.
Pathophysiology

At present, no single compound or ingredient has emerged as the cause, and there may be more than one cause
The only common thread among the cases is that ALL patients reported using e-cig or vaping products
Leading potential toxins:

Vaping products containing THC concentrates: most cases are linked to THC concentrates that were either purchased on the street or from other informal sources (meaning not from a dispensary)
Vitamin E acetate: nutritional supplement safe when ingested or applied to the skin (but likely not when inhaled) has been found in nearly all product samples of NY state cases of suspected VALI

vitamin E acetate is NOT an approved additive at least by NYS Medical Marijuana program

Other potential toxins:

IT CANNOT BE UNDERSTATED that a small percentage of persons w/ VALI have reported exclusive use of nicotine-containing vape products, such as JUUL; as such, we must consider the potential toxicity of standard e-liquid or vape juice
Flavor additives, that exists as chemical aldehydes: irritating and potentially damaging to lung tissue
PG/VG: shown not only to break down to formaldehyde which is a known carcinogen,