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Chemical constituents involved in e-cigarette, or vaping product use-associated lung injury (EVALI)
Open accessAbstract
Background: The Centers for Disease Control (CDC) declared e-cigarette (e-cig), or vaping product use-associated lung injury (EVALI) a national outbreak due to the high incidence of emergency department admissions and deaths. Investigators have identified vitamin E acetate (VEA) as the plausible cause for EVALI, based on compounds found in bronchoalveolar lavage fluid. Objectives: We defined the chemical constituents present in e-cig cartridges associated with EVALI and compared constituents to medical-grade and cannabidiol (CBD) containing cartridges. Methods: We measured chemicals and elemental metals in e-liquid and vapor phases of e-cig counterfeit cartridges by Gas Chromatography (GC) and Mass Spectrometry (MS), EPA method TO-15 by GCMS, and ICP-MS analysis. Results: We have identified chemical constituents in e-cig vaping tetrahydrocannabinol (THC)-containing counterfeit cartridges compared to medical-grade and cannabidiol (CBD) containing cartridges. Apart from VEA and THC, other potential toxicants correlated with EVALI included solvent-derived hydrocarbons, silicon conjugated compounds, various terpenes, pesticides/plasticizers/polycaprolactones, and metals. These chemicals are known to cause symptoms, such as cough, shortness of breath or chest pain, nausea, vomiting or diarrhea, fatigue, fever, or weight loss, all symptoms presenting in patients with EVALI. Conclusion: This study provides insights into understanding the chemical-induced disease mechanism of acute lung injury.
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Not all vapes contain Vitamin E acetate (VEA), but VEA has been commonly found in illicit THC vape products and is strongly linked to EVALI due to its toxic effects when inhaled.
“Despite the fact that not all vapes contain Vitamin E acetate (VEA), it has been commonly found in illicit THC vape products and is strongly linked to EVALI due to its toxic effects when inhaled [18,19,20].”
From Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign (2025) · cites this paper as [18]
The Introduction identifies VEA as a cutting agent in counterfeit street cartridges, and the Discussion reports finding it in many, but not all, EVALI-associated e-liquids. The Discussion also says VEA is the agent most consistently linked to EVALI cases. However, the Introduction explicitly says VEA inhalation is not a proven cause of lung damage, so the claim that the link is due to its toxic effects when inhaled goes beyond this paper's evidence. (LLM, conf=0.90)
Experimental — accuracy not yet measuredVEA and vaping oils disrupt lung surfactants.
“while a 2020 MDPI review and a report of Centers for Disease Control and Prevention (CDC) describe how VEA and vaping oils disrupt lung surfactants [18,21,22].”
From Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign (2025) · cites this paper as [18]
The Discussion says hydrocarbon solvents found in vaping cartridges may alter lung surfactant production and function, which supports part of the claim. It does not say that VEA or vaping oils themselves disrupt surfactants; the Introduction also cautions that VEA inhalation is not a proven cause of lung damage. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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Cited by
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Mobilizing for Health: A Case Study of Kazakhstan’s Vaping Ban Advocacy Campaign
Sadykova, J., Ayaganova, A., & Yergaliyev, K. A. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22071102 · Cited by 1
Metadata
- Authors
- Muthumalage, T., Friedman, M. R., McGraw, M. D., Friedman, A. E., & Rahman, I.
- Affiliations
- University of Rochester Medicine (US)
- SUNY Brockport (US)
- University at Buffalo, State University of New York (US)
- Corresponding author
- Rahman, Irfan
- Venue
- Toxics
- Publisher
- openRxiv
- Published
- 2020-01-15
- Volume
- 8
- Issue
- 2
- Pages
- 25-25
- ISSN
- 2305-6304 (ISSN-L)
- PMC
- PMC7355865
- OpenAlex
- W3015182621
- Cited by
- 82
- References
- 0
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 8 · 2023: 8 · 2022: 18 · 2021: 20 · 2020: 11
- FWCI
- 8.57
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Toxics (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- New York State Department of Health
- University of Rochester
- Strong
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Keywords
- EVALI, alpha-tocopherol acetate, tetrahydrocannabinol, CBD, terpenes, silicon compounds, pesticides, plasticizers, polycaprolactone, metals, acute lung injury, toxicants
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