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Vaping-associated lung injury—VALI facts, assumptions and opportunities: review of the present situation
  1. Gabor Zoltan Xantus
  1. Alumni, Cardiff University, Cardiff CF10 3XQ, UK
  1. Correspondence to Dr Gabor Zoltan Xantus, Alumni, Cardiff University, Cardiff CF10 3XQ, UK; gabor.xantus{at}gmail.com

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Background

More than 1400 respiratory cases have been linked to vaping at the Center for Disease Control and Prevention (CDC), one of the most prestigious epidemiological organisation in the world. So far, 33 patients succumbed to vaping-associated lung injury (VALI), a new syndrome characterised by respiratory distress with bilateral (sometimes haemorrhagic) infiltrates within 3 months of using e-cigarettes. VALI patients (mostly male young college or high school students) predominantly have presented with shortness of breath and gastrointestinal symptoms: majority needed hospital, often critical care admission.1 Vapes are battery-operated devices that work by heating certain liquid compounds to produce vapours. Nicotine-containing liquids are mostly based on glycerine and/or propylene glycol to create dense fumes resembling cigarette smoke; however, cannabinoids are vaped in oil form (no fumes produced). The vapours are delivered to the lungs by inhalation, similar to smoking cigarette. Vaping devices are very different in terms of material of the coils, voltage used to heat the liquids, temperature of the inhaled aerosols and so far, no single culprit product has been identified. Until quite recently, e-cigarettes have been welcomed by most public health authorities and medical organisations all over the world,2–4 as they seemed to be a safer alternative to cigarette smoking. In countries where cannabis has been legalised vaporising cannabinoid oils became increasingly popular form of administration. However, the safety of vaping either nicotine-containing liquids or cannabinoid oils is yet unknown.

Is VALI a completely new disease, or a syndrome which has not yet reached critical mass to be recognised prior to the present surge of cases? To understand the background and to have a clear picture of the illness itself, we aim to report the facts in chronological order in broader perspective differentiating vaping nicotine and cannabinoid products, reviewing the safety and ethical aspects of both and …

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