Expanding Knowledge, Awareness of Vaping-Related Lung Injury

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February 2, 2023

4 minute read



Interviews at Healio

Rebuli does not report relevant financial disclosures.

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Since the CDC declared e-cigarette/vaping-associated lung injury, or EVALI, an epidemic in 2019, researchers have been working to understand its causes and harms, and how to stop the rise of this disease.

One such effort took place in 2021 through a virtual workshop comprised of pulmonologists, public health officials, epidemiologists, and toxicologists. Together, 26 experts discussed the public health and regulatory response to EVALI, the clinical care of EVALI, the mechanisms that contribute to EVALI, and the actions needed that address the health effects of EVALI.

Quote from Meghan E. Rebuli, PhD
Source: Healio Interviews

These discussions and recommendations have been published as a report in Annals of the American Thoracic Society.

Healio spoke with Megan ME. Rebuli, PhD, lead author of the report, assistant professor of pediatrics and member of the Center for Environmental Medicine, Asthma and Pulmonary Biology at the University of North Carolina, for more information on the rationale for the workshop, the challenges that need to be overcome to better address EVALI, and what Efforts can be undertaken to prevent future EVALI outbreaks.

healthy: What were the reasons for convening this virtual workshop on EVALI?

rebulli: The workshop was initially proposed in 2020, shortly after the peak of the EVALI epidemic in 2019. Researchers and clinicians were concerned about the epidemic, both because of the seemingly rapid onset and the number of people affected across the country, and they wanted to establish a panel of experts to examine the factors that contributed to the epidemic and identify ways we could improve research strategies and infrastructure to prevent such a large event in the future. The workshop proposal was approved in early 2021 by the American Thoracic Society and was held a few months after approval.

Healio: What are some of the challenges related to EVALI that addressed/discussed in the workshop?

Rebuli: The first major challenge we tackled as a group was how to run such a workshop in a virtual environment. Historically, major workshops like this one were held in person to allow for dynamic discussion and interaction among workshop participants. So we had to come up with a way to work with everyone’s schedule across the country and make the workshop as interactive and informative as possible.

  • how to study EVALI incidents now that the CDC no longer collects nationally representative data;
  • increase physician education on how to ask patients about e-cigarette use or secondhand exposure;
  • the challenges around continually adapting research strategies to keep up with the rapidly evolving e-cigarette market;
  • the need for more regulatory and manufacturing standards around e-cigarettes to facilitate safety testing and ensure public health; Y
  • the continued need to invest in EVALI research as cases continue to be documented across the country, although not at peak epidemic rates.

Healio: According to a Press release from UNC HealthCare, talked about the chemical components of electronic cigarettes and the role that vitamin E plays in the development of EVALI. What were the key points of this conversation?

Rebuli: First, we wanted to clarify that while most EVALI cases were associated with THC-based products containing Vitamin E Acetate, there were a few cases that were associated with nicotine-based products only. This leads us to believe that there may be other potential components in some e-cigarettes that contribute to the development of EVALI. This argument is bolstered by the fact that cases of EVALI are still being documented in hospital systems across the country and, to the best of our knowledge, vitamin E acetate has been removed from products on the market.

This led us to discuss the potential for further regulation of the compounds that can be allowed in e-cigarettes and the development of manufacturing standards by the FDA, similar to what has been done with cigarettes. In addition, the need for comprehensive safety testing of products before they are available on the market was discussed, which has not historically been the case with e-cigarettes, especially prior to the EVALI epidemic.

Since most vitamin E acetate-containing products also contained THC, we discussed the need to better understand what inhaling THC-containing products does to the lungs. Currently, our biological understanding of the effects of THC is limited, as there are strong federal restrictions around its use in federally funded laboratories under the Controlled Substances Act. Declassification of marijuana as a Schedule I substance or an exemption from the requirements on the use of Schedule I substances for research purposes would help scientists more easily study its health effects.

Healio: What critical needs and areas of additional work did you identify at the workshop as necessary to prevent and address future EVALI outbreaks?

rebulli: Critical needs to prevent future EVALI events include increased regulation of e-cigarettes, including manufacturing standards and limited marketing to youth and young adults. Additional research work needed includes development of a national case registry and biorepository, ongoing safety and toxicity assessments as products on the market change, investment in research on long-term health effects of EVALI and the identification of other potentially harmful chemical additives in electronic cigarettes

Healio: How can doctors, healthcare workers and the public help in the fight against EVALI?

rebulli: Physicians and healthcare workers can help combat EVALI by seeking training in assessing patient exposure and making sure they are testing patients for e-cigarette use. They can also propose and participate in clinical studies with identified EVALI patients, ensuring consistent follow-up evaluations with other investigators across the country for a useful nationally representative data set.

The public, as well as healthcare workers, can continue to seek and disseminate knowledge about the known health effects of e-cigarette use, especially among youth and young adults. Everyone can also advocate with government legislators and the NIH for dedicated resources, such as a national biorepository and case registry, as well as grant funding, to prevent future outbreaks of EVALI or EVALI-like outbreaks from the use of inhaled products. new and emerging.

For more information:

Megan ME. Rebuli, PhD, can be reached at meradfor@email.unc.edu.


Rebuli ME. Ann Am Thorac Soc.. 2022;doi:10.1513/AnnalsATS.202209-796ST.

UNC researchers address the epidemic of lung injury associated with the use of e-cigarettes or vaping products (EVALI). https://news.unchealthcare.org/2023/01/unc-researchers-tackle-the-e-cigarette-or-vaping-product-use-associated-lung-injury-evali-epidemic/. Published January 3, 2023. Accessed January 4, 2023.

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