E-cigarette or Vaping Use-Associated Lung Injury (EVALI)

In the last decade, e-cigarettes and vaping devices have surged in popularity, particularly among teens and young adults. Marketed as a safer alternative to traditional cigarettes, these products were initially seen as a tool to help smokers quit or reduce their tobacco use.

However, the rise of vaping has brought with it a new and alarming health concern: e-cigarette or vaping use-associated lung injury (EVALI). First identified in 2019, EVALI has since become a major focus of public health efforts, raising questions about the safety of vaping and the long-term effects of these products.

In this article, we’ll explore what EVALI is, what causes it, how it’s diagnosed and treated, and why it’s such a critical issue in public health today

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What Is EVALI?

EVALI stands for e-cigarette or vaping use-associated lung injury. Originally referred to as VAPI (vaping associated pulmonary illness), the name was updated in 2019 to better reflect the growing number of cases linked to vaping.

The condition came to light when a surge of severe lung illnesses was reported among individuals who used e-cigarettes or vaping products. Many of these cases involved otherwise healthy young adults who suddenly developed severe respiratory symptoms, leading to hospitalizations and, in some cases, death.

EVALI is a serious condition that causes inflammation and damage to the lungs. Symptoms can range from mild to life-threatening, and the disease has been linked to both nicotine and THC-containing vaping products. Because EVALI is still relatively new, researchers are working hard to understand its full scope, and the terminology and understanding of the disease may continue to evolve as more information becomes available.

What Causes EVALI?

The exact causes of EVALI are still under investigation, but health officials have identified a key suspect: vitamin E acetate. This substance, often used as a thickening agent in THC-containing vaping products, has been found in the lung fluid of many EVALI patients.

THC, or tetrahydrocannabinol, is the psychoactive compound in cannabis, and many of the affected individuals reported using vaping products that contained THC, often obtained from informal sources like friends or unlicensed dealers.

The Role of Vitamin E Acetate

A groundbreaking report from the Centers for Disease Control and Prevention (CDC) analyzed lung fluid samples from EVALI patients across 16 states. The study found vitamin E acetate in 48 out of 51 patients, while none was detected in healthy individuals. This strong correlation pointed to vitamin E acetate as a primary culprit.

However, it’s important to note that it may not be the only cause. Researchers are also examining other substances in vaping products, such as flavoring agents, heavy metals, and other chemicals, to determine if they contribute to the development of EVALI.

The Problem with Unregulated Products

One of the biggest challenges in understanding EVALI is the lack of regulation in the vaping industry. Unlike traditional cigarettes, which are subject to strict regulations, vaping products vary widely in their ingredients and quality.

Many of the products linked to EVALI were obtained from informal sources, and their ingredients are often unknown or untested. This lack of oversight makes it difficult to pinpoint exactly what’s causing the problem, and it underscores the need for more research and regulation in this area.

Symptoms of EVALI

One of the challenges in diagnosing EVALI is that its symptoms overlap with many other respiratory illnesses. Patients with EVALI often experience symptoms like:

• Shortness of breath

• Coughing

• Chest pain

• Fever and chills

• Rapid heart rate

• Headache

• Dizziness

• Vomiting

• Diarrhea

Because these symptoms can mimic those of the flu, pneumonia, or even COVID-19, diagnosing EVALI requires a thorough evaluation of the patient’s history and symptoms. If you’ve been vaping and start experiencing these symptoms, it’s crucial to seek medical attention right away.

Note: Be sure to tell your healthcare provider about your vaping habits, as this information can help guide the diagnostic process. Early detection and treatment are key to managing EVALI and preventing complications.

How Is EVALI Diagnosed?

Diagnosing EVALI isn’t straightforward because there’s no single test for the condition. Instead, doctors rely on a process of elimination. They’ll start by evaluating your symptoms and medical history, paying close attention to your use of e-cigarettes or vaping products.

If EVALI is suspected, your doctor may order imaging tests like a chest X-ray or CT scan. These tests can reveal hazy spots on the lungs, known as opacities, which are a common sign of tissue damage in EVALI patients.

Advanced Diagnostic Tools

In some cases, doctors may also perform a bronchoalveolar lavage (BAL), a procedure that involves collecting fluid from the lungs for analysis. This can help identify the presence of substances like vitamin E acetate, which is strongly associated with EVALI. However, this procedure is typically reserved for more severe cases or when the diagnosis is unclear.

Because EVALI shares symptoms with so many other conditions, ruling out other possibilities is a critical part of the diagnostic process.

This might involve testing for infections, such as pneumonia or influenza, or evaluating for other lung diseases. It’s a complex process, but it’s necessary to ensure an accurate diagnosis and appropriate treatment.

Treatment for EVALI

Treating EVALI can be challenging because the disease is so new, and its course can be unpredictable. What we do know is that EVALI can be severe—96% of reported cases required hospitalization, and some patients have died from the condition.

Treatment typically depends on the severity of the illness and may involve a combination of medications and supportive care.

Medications

In many cases, doctors will start by prescribing antibiotics or antivirals to rule out or treat any potential infections. Once infection is ruled out, corticosteroids are often used to reduce inflammation in the lungs. These medications can be highly effective in helping patients recover, but they must be used carefully, as they can have side effects.

Hospitalization and Supportive Care

For patients with more severe cases, hospitalization is often necessary. Some patients may require supplemental oxygen to help them breathe, while others may need to be placed on a ventilator if they’re unable to breathe on their own.

Note: The road to recovery can be long and difficult, and even after leaving the hospital, patients need close follow-up care.

The Importance of Follow-Up Care

One of the most concerning aspects of EVALI is that some patients have relapsed or even died shortly after being discharged from the hospital. This highlights the importance of follow-up care.

Doctors recommend that all EVALI patients, regardless of the severity of their illness, schedule an appointment with a pulmonologist (a lung specialist) within 48 hours of being discharged. Regular check-ups are essential to monitor recovery and catch any potential complications early.

Pulmonary Rehabilitation

Follow-up care may also involve pulmonary rehabilitation, which includes exercises and therapies designed to improve lung function and overall health. For patients who have experienced severe lung damage, this can be a critical part of the recovery process.

The Bigger Picture: What We Still Don’t Know

While we’ve made significant progress in understanding EVALI, there’s still a lot we don’t know. For example:

• Why do some people develop EVALI while others who use similar vaping products do not?

• Are there genetic or environmental factors that increase the risk?

• What are the long-term effects of EVALI on lung health?

These are just a few of the questions researchers are working to answer. Another major concern is the lack of regulation in the vaping industry. Many of the products linked to EVALI were obtained from informal sources, and their ingredients are often unknown or untested.

This highlights the need for stricter regulations and better oversight to ensure the safety of vaping products. Until then, the best way to protect yourself from EVALI is to avoid using e-cigarettes and vaping products altogether.

Guidance for Healthcare Providers

Healthcare providers play a critical role in identifying and treating EVALI. The CDC has issued guidance to help providers recognize the signs and symptoms of the condition and understand how to diagnose and treat it.

This includes recommendations for evaluating patients with respiratory symptoms, conducting imaging tests, and using corticosteroids as part of treatment.

Providers are also encouraged to educate their patients about the risks of vaping and to monitor for any new developments in the field. As research continues, staying informed is key to providing the best possible care for patients.

A Word of Caution

E-cigarettes and vaping products have only been on the market for about a decade, and we’re still learning about their long-term effects. The outbreak of EVALI has shown that these products are not without risks, and the consequences can be severe.

If you or someone you know uses e-cigarettes or vaping products, it’s important to be aware of the potential dangers and to seek medical attention if you experience any concerning symptoms.

For those who are using vaping as a way to quit smoking, it’s worth exploring other options, such as FDA-approved nicotine replacement therapies or counseling. While vaping may seem like a safer alternative, the risks associated with EVALI and other potential health concerns make it a less-than-ideal choice.

Key Takeaways

• EVALI is a serious lung condition linked to vaping, first identified in 2019.

• Vitamin E acetate, found in some THC-containing vaping products, is a primary cause.

• Symptoms include shortness of breath, coughing, chest pain, and fever.

• Diagnosis involves imaging tests and ruling out other conditions.

• Treatment may include antibiotics, antivirals, and corticosteroids, with severe cases requiring hospitalization.

• Follow-up care is critical to monitor recovery and prevent relapse.

• The lack of regulation in the vaping industry poses significant risks.

• Avoiding vaping is the best way to protect yourself from EVALI.

Note: By understanding the risks and staying informed, we can make better choices for our health and advocate for safer, more regulated vaping products. EVALI is a wake-up call—one that reminds us of the importance of caution and the need for continued research in the ever-evolving world of vaping.

Final Thoughts

EVALI is a stark reminder that the safety of e-cigarettes and vaping products is far from guaranteed. While vitamin E acetate has been identified as a primary cause, there’s still much we don’t know about this condition. What we do know is that EVALI can cause serious lung damage, and in some cases, it can be fatal.

If you’re a vaper, it’s crucial to be aware of the risks and to seek medical help if you experience symptoms like shortness of breath, coughing, or chest pain. And if you’re considering vaping, it’s worth thinking twice—there are safer, more proven methods for quitting smoking.

As researchers continue to study EVALI, we can hope for better diagnostic tools, more effective treatments, and stricter regulations to protect public health. In the meantime, staying informed and making smart choices is the best way to protect yourself and your loved ones from this potentially devastating condition.