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expert reaction to study of lung biopsies of patients with lung injury due to vaping

Research, published in The New England Journal of Medicine (NEJM), reports that lung injuries from vaping are most likely connected to direct toxicity or tissue damage from noxious chemical fumes.


Prof Linda Bauld, Professor of Public Health at the University of Edinburgh, said:

“This study provides new information about some of the cases of severe respiratory illnesses among people using vaping products in the USA. While there is still much we do not know, the study confirms that acute lung injuries have occurred.  What the researchers found were not chronic adverse effects  – i.e. those that have built up over a long period and cause disease – but instead evidence of an outbreak that is similar to poisoning. 

“This provides further evidence that it is extremely unlikely, if not impossible, that flavoured nicotine e-liquids of the type that have been used by millions of people around the world for up to a decade (including in the UK) are causing these injuries. Instead contaminants look like they are to blame. Most of the evidence points to adulterants in cannabis vaping but other products may be involved. 

“Recent bans in the USA of all flavoured vaping products are not going to prevent further cases like these if the culprit is contaminated products bought on the black market. Indeed bans may make the problem worse by restricting access and driving people to illicit sources.”


Prof John Britton, Director of the UK Centre for Tobacco & Alcohol Studies and Consultant in Respiratory Medicine, University of Nottingham, said:

“This helpful study of samples of lung tissue from people affected by vaping show signs of acute damage, suggesting that the vapour they are inhaling includes something causing direct irritation and inflammation of the lung. That these samples do not show evidence of lipid accumulation indicates that the cause is not lipid per se, but something else in the vapour. This is a small number of cases so we don’t know how representative it is, but the findings are helpful.

“As in all disease outbreaks, it takes time to narrow down on the underlying cause: and in this example it is clearly something to do with vaping, something that often – but not exclusively – occurs in people who vape THC or other oils, and something that isn’t occurring in countries outside the USA.

“So it is something in US vape fluids, or something about the particular e-cigarettes used by those affected, but remains something separate from vaping more generally and particularly from vaping nicotine.”


‘Pathology of Vaping-Associated Lung Injury’ by Yasmeen M. Butt et al. was published in NEJM at 10pm UK time on Wednesday 2 October 2019


Declared interests

Prof Britton: No interests to declare

None others received 

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