Is EVALI Reversible?
Yes, EVALI is generally reversible with appropriate treatment, particularly with systemic corticosteroids and cessation of vaping products, though some patients may have persistent pulmonary function abnormalities in the short-term follow-up period. 1, 2
Clinical Course and Recovery
The evidence demonstrates that EVALI patients typically show dramatic clinical improvement with treatment:
- Most patients can be discharged on room air after receiving systemic glucocorticoid therapy, indicating substantial reversal of acute lung injury 2
- Clinical stability is typically achieved within 24-48 hours before discharge in appropriately managed cases 3, 1
- Patients report resolved or improved symptoms at short-term outpatient follow-up (mean 4.5 weeks post-discharge) 2
Persistent Abnormalities Despite Clinical Improvement
However, complete reversibility is not universal in the short term:
- Approximately 64% of adolescent patients (7/11) demonstrated abnormalities on pulmonary function testing at follow-up despite reporting symptom resolution 2
- Residual airway reactivity or diffusion abnormalities persisted when patients were re-evaluated in the short-term period 2
- CDC guidelines recommend follow-up testing at 1-2 months post-discharge, including spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), and chest x-ray to assess for persistent lung capacity reduction 3, 4
Treatment Requirements for Reversibility
The key factors enabling reversibility include:
- Immediate discontinuation of all e-cigarette and vaping products is essential 3, 1
- Systemic corticosteroids show clear benefit, with an observed association between clinical improvement and corticosteroid treatment 1, 5, 2
- Some patients require ongoing inhaled corticosteroids (5/11 in one cohort) and continued systemic corticosteroid weaning (4/11) at outpatient follow-up 2
Risk Factors for Incomplete Recovery
Certain populations face higher risks:
- Patients with cardiac disease, chronic pulmonary disease, diabetes, and older age have higher risk for rehospitalization and death, suggesting potentially less complete recovery 1
- Comorbidities that compromise cardiopulmonary reserve increase risk for severe disease 4
Long-Term Prognosis Considerations
While acute reversibility is common, the long-term trajectory requires monitoring:
- Pulmonary specialist follow-up within 2-4 weeks is recommended to assess pulmonary function and resolution of radiographic findings 3, 1
- The need for ongoing inhaled corticosteroids in some patients suggests that complete functional recovery may take longer than the acute hospitalization period 2
Common Pitfalls
- Do not assume complete recovery based solely on symptom resolution—objective pulmonary function testing is necessary as abnormalities persist despite subjective improvement 2
- Ensure adherence to corticosteroid tapers, as non-adherence has been reported among rehospitalized patients 3
- Screen for secondary adrenal insufficiency in patients who received prolonged corticosteroid courses 3, 1