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

What Is EVALI?

EVALI stands for e-cigarette or vaping product use-associated lung injury. EVALI was first identified in 2019 and was closely monitored by the CDC and FDA due to the rapid-onset of the severe pulmonary illness. After a sharp peak in cases in the fall of 2019, cases steadily declined due to effective public health messaging.

What Causes EVALI?

Health officials point to vitamin E acetate (VEA), which is an additive in some THC-containing e-cigarettes, as the primary, but not the only, cause of EVALI.

A CDC report analyzed bronchoalveolar lavage (BAL) fluid from a larger number of EVALI patients from 16 states and compared them to BAL fluid from healthy people. They identified Vitamin E acetate, also found in product samples tested by the FDA and state laboratories, in BAL fluid from 48 of 51 EVALI patients, Vitamin E acetate was not found in any of the BAL fluids of healthy people.

In addition to vitamin E acetate, there are many other substances and product sources in vaping materials that are being examined as possible causes. Learn more.

How Is EVALI Diagnosed?

There is no single diagnostic test to define EVALI. Diagnosis is mostly a process of elimination as symptoms can be similar to many other respiratory diseases. These include shortness of breath, fever and chills, cough, vomiting, diarrhea, headache, dizziness, rapid heartrate and chest pain. The most widely used guidance on defined cases are defined as 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. Treatments are mainly supportive oxygenation through supplemental oxygen noninvasive ventilation, mechanical ventilation and sometimes extracorporeal membrane oxygenation. Primary medication treatments include antibiotics and/or antivirals until infection is ruled out, as well as corticosteroids to help fight inflammation in the lungs. Learn more.

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

Guidance for Healthcare Providers

The American Lung Association maintains a large collection of information on e-cigarettes and lung health. Healthcare providers can share this information with patients who use e-cigarettes, parents and teens, and anyone else to help educate about the potential dangers of e-cigarette use. Learn more.

Even with e-cigarettes entering the market about a decade ago, we are still learning the long-term effects. With the breakout of EVALI, researchers continue  to learn as much as possible about the illness, its causes, and the most effective treatments. For more information about vaping and how it effects your body, visit our e-cigarette section.