From the Guidelines
E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) is a serious respiratory condition that can develop rapidly, with symptoms appearing anywhere from a few days to several weeks after using e-cigarettes or vaping products. The condition is characterized by respiratory symptoms including shortness of breath, chest pain, and cough, often accompanied by gastrointestinal symptoms like nausea, vomiting, and abdominal pain, as well as constitutional symptoms such as fever and weight loss. EVALI has been strongly associated with vitamin E acetate, an additive found primarily in THC-containing vaping products, though other chemicals in vaping products may also contribute to lung damage 1.
Key Characteristics of EVALI
- Respiratory symptoms: shortness of breath, chest pain, cough
- Gastrointestinal symptoms: nausea, vomiting, abdominal pain
- Constitutional symptoms: fever, weight loss
- Associated with vitamin E acetate and other chemicals in vaping products
Development and Onset of EVALI
EVALI can develop rapidly after the use of e-cigarettes or vaping products, with some cases reported to occur within a few days of use 1. The exact timeline for the development of EVALI can vary, but it is crucial for individuals to seek medical attention immediately if they experience any symptoms after vaping.
Importance of Prompt Medical Attention
Prompt diagnosis and cessation of vaping are crucial for recovery from EVALI. Treatment typically involves supportive care, possible corticosteroids, and most importantly, complete cessation of all vaping products 1. It is also essential for healthcare professionals to provide guidance on reducing the risk of rehospitalization and death following hospital discharge, including recommendations for postdischarge follow-up and care coordination 1.
Recommendations for Healthcare Professionals
- Advise discontinuation of all e-cigarette, or vaping, products
- Consider corticosteroid use with caution in outpatients because of the risk for worsening of respiratory infections
- Ensure outpatient primary care or pulmonary specialist follow-up, optimally within 48 hours of discharge
- Plan for discharge care, early follow-up, and management of any comorbidities
- Arrange for posthospitalization specialty care and ensure social support and access to mental and behavioral health and substance use disorder services.
From the Research
Definition and Overview of EVALI
- E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) is a serious pulmonary disease associated with the use of e-cigarettes or vaping products 2, 3, 4.
- It is characterized by a constellation of constitutional, pulmonary, and gastrointestinal symptoms, including dyspnea, cough, fever, and emesis 2, 5.
- The exact pathophysiology of EVALI is unknown, but it is thought to be related to the contamination of e-liquids with vitamin E acetate, which can lead to pulmonary lipid accumulation and/or interfere with surfactant functioning 2.
Development and Onset of EVALI
- EVALI can develop within 90 days of vaping or dabbing, with some cases reported to occur within hours of switching to e-cigarettes 3.
- The timeline for the development of symptoms or notable structural changes is not well established, but most patients require management in the intensive care unit and steroid therapy 5.
- Patients may present with life-threatening hypoxemia, requiring admission to the intensive care unit, but most improve within 1-2 weeks of initial presentation after vaping cessation and administration of systemic corticosteroids 5.
Risk Factors and Diagnosis
- The leading risk factor for EVALI is the use of e-cigarettes or vaping products in the preceding 90 days, particularly those containing tetrahydrocannabinol (THC) oil 2, 5.
- Diagnosis of EVALI requires a high degree of suspicion and exclusion of other possible causes of lung disease, with radiographical findings of nonspecific bilateral ground-glass infiltrates on computed tomography 2, 6.
- A clinical algorithm has been developed to guide the evaluation and management of EVALI, focusing on the key signs and symptoms and the importance of ruling out infection and other cardiopulmonary conditions 5.