From the Guidelines
EVALI stands for E-cigarette or Vaping product use-Associated Lung Injury, a serious respiratory condition first identified in 2019 that is directly caused by vaping or e-cigarette use. The condition typically presents with respiratory symptoms including shortness of breath, chest pain, and cough, often accompanied by gastrointestinal symptoms like nausea, vomiting, and abdominal pain, as well as fever and chills. EVALI has been strongly linked to vitamin E acetate, an additive found primarily in THC-containing vaping products, though other chemicals in vaping products may also contribute to lung damage, as reported in a study published in 2021 1.
Key Characteristics of EVALI
- Respiratory symptoms: shortness of breath, chest pain, cough
- Gastrointestinal symptoms: nausea, vomiting, abdominal pain
- Fever and chills
- Strongly linked to vitamin E acetate in THC-containing vaping products
- Can be severe and fatal, requiring hospitalization and intensive respiratory support
Diagnosis and Treatment
Healthcare providers diagnose EVALI by evaluating symptoms, confirming vaping history, performing imaging studies that show lung inflammation or damage, and ruling out other potential causes of respiratory illness. Treatment generally involves corticosteroids to reduce inflammation, respiratory support ranging from supplemental oxygen to mechanical ventilation in severe cases, and complete cessation of all vaping products, as recommended in guidelines published in 2020 1.
Management and Follow-up
Patients with EVALI should be managed with careful discharge planning, including confirmation of clinical stability, assurance of social support and access to mental health and substance use disorder services, and follow-up with primary care providers or pulmonology specialists within 48 hours after hospital discharge. Ongoing engagement with addiction medicine and mental health services should be considered, and patients who have experienced prolonged immobilization during hospitalization may benefit from physical therapy, as suggested in a study published in 2020 1.
Prevention
The best way to prevent EVALI is to avoid using e-cigarette or vaping products, especially those containing THC or vitamin E acetate. Healthcare providers should advise patients to discontinue all e-cigarette or vaping product use and offer cessation services to those who need them, as recommended in guidelines published in 2020 1.
From the Research
Definition and Overview of EVALI
- EVALI stands for e-cigarette or vaping product use-associated lung injury, a lung disease that can be severe and life-threatening 2, 3.
- It is not a clinical diagnosis, but rather a surveillance case definition 2.
- EVALI is characterized by respiratory, gastrointestinal, and systemic symptoms, with typical imaging features including opacities on chest radiograms and ground-glass clouds on computed tomography scans 2, 4.
Causes and Risk Factors
- The exact causes of EVALI are not completely understood, but it has been linked to the use of tetrahydrocannabinol (THC) and vitamin E acetate 2, 3, 5.
- The use of e-cigarette or vaping products, particularly those containing THC, is a significant risk factor for developing EVALI 2, 3, 4.
- Other substances used in e-liquids may also be causative factors, but more research is needed to understand their role in EVALI 2, 6.
Diagnosis and Treatment
- Diagnosis of EVALI requires a high degree of suspicion and exclusion of other possible causes of lung disease 3, 4.
- Treatment is centered around removing the offending substance and providing supportive care, with systemic glucocorticosteroids considered the best treatment option 2, 4.
- Patients with EVALI often require hospitalization and oxygen substitution, with a mortality rate of around 2.42% reported in one study 2.
Epidemiology and Implications
- EVALI has been linked to a significant outbreak of lung injury cases in the United States, with over 2600 cases reported to the CDC as of February 2020 3.
- The use of e-cigarettes and vaping products is increasingly popular among teenagers and young adults, making them a key demographic for EVALI prevention and education efforts 5.
- The COVID-19 pandemic has presented challenges in diagnosing and treating EVALI, with some patients initially misdiagnosed with COVID-19 or community-acquired pneumonia 5.