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

What Is EVALI?

E-cigarette or vaping product use-associated lung injury, or EVALI, was first identified in 2019. It is sometimes referred to as vaping-associated pulmonary injury (VAPI) or vaping-associated lung injury (VALI). EVALI is an acute or subacute respiratory illness and can be fatal. More than 50% of patients with EVALI require admission to an intensive care unit. These terms describe any lung disease that can be caused using e-cigarettes, including:

• Acute respiratory distress syndrome (ARDS)
• Hypersensitivity pneumonitis
• Bronchiolitis obliterans, more commonly known as popcorn lung

What are the symptoms of EVALI?

Common symptoms include shortness of breath, fever, cough, vomiting, diarrhea, headache, dizziness, rapid heart rate and chest pain.

How Is EVALI Diagnosed?

There is no single diagnostic test to define EVALI as it is an umbrella term for several diseases that can be caused by e-cigarette use. An elevated white blood cell count is often identified in lab tests. Diagnosis is mostly a process of ruling out other diseases with similar symptoms such as pneumonia, influenza or COVID-19. The most widely used guidance on defined cases is the onset of pulmonary infiltrates on chest x-ray or computed tomography (CT) that occur within 90 days of e-cigarette use, with no alternative case found after medical assessment. 

What Is the Treatment for EVALI?

Treatment is based on expert recommendations and depends on the severity of the illness. Treatment may include supportive oxygenation, medication such as antibiotics or antivirals to fight infection and corticosteroids to help reduce inflammation in the lungs.

Once hospitalized and ventilated patients have regained the ability to breathe on their own, they may be allowed to go home. Doctors recommend that all patients, regardless of the severity of their illness, schedule follow-up appointments with a pulmonologist within 48 hours after being discharged.

Guidance for Healthcare Providers

The American Lung Association has a large collection of information on e-cigarettes and lung health. Healthcare providers can share this information with patients who use e-cigarettes, parents, teens and anyone else who may benefit from education about the dangers of e-cigarette use.

E-cigarettes entered the market about twenty years ago, we are still learning the long-term effects. Research indicates that there is an ongoing epidemic of EVALI across the United States and it is recommended by the CDC to report all cases of EVALI to your state or local health department. Researchers continue to learn as much as possible about EVALI, its causes, and the most effective treatments.