Actual questions about the electronic cigarette associated lung injury

The electronic cigarette and vaping associated lung injury (EVALI) syndrome was first described in the United States (US) and was presumably strongly associated with cannabinoid vaping and exposure to vitamin E acetate, an oily additive used to dilute/cut cannabinoids vape liquids. As the case numbers were relatively low (epidemiologically) and the available data was inconsistent, several assumptions were made to explain the phenomenon. The lack of standardization of sampling, the self-reported, inhomogeneous user habits, the huge number of potential etiologies, and certain trade/legal loopholes (such as online distribution, black market penetration, or the inefficient regulatory control regarding the quantity and/or quality of ingredients/cutting agents) might question the validity of the data and the consequent conclusions. Furthermore, an interesting but by no means negligible question is the fact why no EVALI cases have been registered outside the US when electronic cigarettes and vapes have become increasingly popular worldwide. The present review seeks to answer whether vitamin E acetate is indeed the cause of this complex syndrome, what potentially non-healthcare related factors might have contributed to the rapid increase and decline in EVALI cases, and last but not least the minimum standards of safe vaping (as potential for drug delivery route for cannbinoids). Orv Hetil. 2020; 161(31): 1281-1285.