From the Guidelines
Vape-induced injury is called EVALI, which stands for E-cigarette or Vaping product use-Associated Lung Injury. This condition emerged in 2019 when numerous cases of severe respiratory illness were linked to vaping products 1. EVALI typically presents with respiratory symptoms such as shortness of breath, cough, and chest pain, often accompanied by gastrointestinal symptoms like nausea, vomiting, and abdominal pain. Fever and fatigue are also common. The condition is believed to be caused by chemical exposure from vaping products, particularly those containing vitamin E acetate, which was found in many THC-containing vaping products associated with EVALI cases 1. The injury occurs when these chemicals are inhaled and damage the delicate tissues of the lungs, causing inflammation and sometimes severe respiratory compromise.
Key Points
- EVALI is a serious condition that can progress rapidly and become life-threatening
- Symptoms of EVALI include cough, shortness of breath, chest pain, nausea, vomiting, stomach pain, diarrhea, fever, chills, and weight loss 1
- Treatment typically involves supportive care, cessation of vaping, and in some cases, corticosteroids to reduce inflammation
- Anyone experiencing symptoms after vaping should seek immediate medical attention
- The use of vitamin E acetate in THC-containing e-cigarettes has been strongly linked to EVALI 1
Management
- Outpatient follow-up with primary care providers or pulmonology specialists within 48 hours after hospital discharge for EVALI might provide an opportunity to prevent adverse outcomes, including rehospitalization or death 1
- Patients should be supported in their efforts to discontinue e-cigarette, or vaping, product use and should be educated that resuming use of e-cigarette, or vaping, products might result in recurrence of lung injury symptoms 1
- Ongoing engagement with addiction medicine and mental health services should be considered 1
From the Research
Vape Induced Injury
- Vape induced injury is also known as E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) 2, 3, 4, 5, 6
Characteristics of EVALI
- EVALI is a severe pulmonary illness associated with the use of e-cigarettes or vaping products 2, 5
- It is characterized by respiratory, gastrointestinal, and systemic symptoms, including dyspnea, cough, fever, and hypoxemia 4, 6
- Imaging tests typically show bilateral airspace opacities on chest radiographs and ground-glass opacities on computed tomography scans 4, 6
Diagnosis and Treatment of EVALI
- EVALI is a diagnosis of exclusion, with no specific diagnostic test 3, 6
- Diagnosis requires a high degree of suspicion and exclusion of other possible causes of lung disease 2
- Treatment is centered around removing the offending substance and providing supportive care, including systemic glucocorticosteroids and oxygen therapy 2, 3, 4, 6
Epidemiology of EVALI
- The outbreak of EVALI cases in 2019 was strongly linked to vitamin E acetate in vaping products 3, 4
- The majority of patients with EVALI reported using e-cigarette cartridges containing tetrahydrocannabinol (THC) oil 6
- The disease has been reported in almost all age groups, with the worst prognosis in patients over 35 years of age with accompanying diseases 4