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In late 2019, deaths caused by vaping struck fear into policymakers nationwide. E-cigarette or vaping produced use-associated lung injury (EVAILI) was officially labeled in June 2019, and cases peaked in September that year. Despite sweeping bans, March 2020 report showed 2800 US cases and 68 deaths attributed to EVAILI. Why are cases so high with Vitamin E Acetate bans so prevalent? A recent study found evidence to suggest that Vitamin E Acetate may not be the cause of EVAILI. Instead, a heating element, specifically a nickel‐chromium alloy (nichrome) heating element at high power, caused and continues to cause vaping injury and death.

Study Design

When critically examining the results of any study, it is important to start with the study design. Researchers in this study initially intended to examine the effect of E-cig use on the cardiovascular system in rats. They turned their attention to lung damage when they anecdotally noticed “an E‐cigarette or vaping product use–associated lung injury‐like condition that occurred acutely after use of a nichrome heating element at high power, without the use of tetrahydrocannabinol, vitamin E, or nicotine.”

In the study, 18 rats were exposed to E-cig use for two hours via the nose at 60 or 70 W. It is important to note here that most E-cig users agree on settings between 10-50W, 50 being the high end. An additional 5 rats were exposed to vapor from a stainless steel heating element, and 7 were exposed to air.

“None of the 5 rats exposed using SS heating elements developed respiratory distress, whereas 14 of 18 rats exposed using NC heating units developed clinical acute respiratory distress (all of these rats had been exposed to the 70‐W power setting; P<0.05 Fisher’s exact test)”. The rats displayed labored mouth breathing (highly unusual in rats, which are obligatory nose breathers), fatigue, and in some cases, audible wheezing. Tragically, one rat became so sick it had to be euthanized prematurely.

Other Evidence Against Vitamin E Acetate

Researchers noted that prior to September 2019, they were studying E-cig vapor using a Stainless Steel heating element and a common E-cig juice. In these studies, none of these rats (>30 experiments) developed respiratory distress. 

Still, although these findings suggest that the heating element is responsible for lung injury and not Vitamin E Acetate, they are not definitive. Researchers note that they have been approved for human trials. It is not time to draw conclusions.

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