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

EVALI is the acronym of E-cigarette or Vaping-use Associated Lung Injury. It is a serious inflammatory condition that damages your lungs. It develops as a result of vaping, the use an electronic cigarette (e-cigarette) that heats a liquid into an aerosol that is inhaled (breathed in) into the lungs. You inhale liquid nicotine, propylene glycol, vegetable glycerine, and flavouring.

EVALI is a relatively new condition with the first reported case in 2019. As a result, healthcare providers and medical researchers aren’t sure of EVALI’s long-term effects or outlook. EVALI can develop suddenly and last only a little while (acute) or progress gradually and steadily over a longer period (subacute). Severe cases can be fatal. The symptoms can affect people who’ve used vaping products up to 90 days before symptoms started.

Yes, EVALI is serious. About 90% of reported EVALI cases require hospitalization. As of early 2020, EVALI was responsible for nearly 3,000 hospitalizations and almost 70 deaths.

EVALI symptoms include chest pain, cough, shortness of breath (dyspnea), accelerated heartbeat (tachycardia), abdominal pain, nausea and vomiting, diarrhea, fever, chills, unexplained weight loss, irriversable lung damage, and death. Some chemicals in vaping products can also cause cardiovascular disease and biological changes that are associated with cancer development.

There may be a link between EVALI and vitamin E acetate[1]. Vitamin E acetate is a synthetic form of vitamin E. While vitamin E acetate is safe to ingest, but it may cause lung damage when you heat it and inhale it as a vapour. Other components, propylene glycol and glycerol significantly damage human small airway epithelial cells (SAECs)[2].

Because EVALI shares many of the same symptoms as lung infections, your doctor may initially treat you with antibiotics or antivirals to rule out an infection. Your treatment may also include corticosteroids, drugs that help reduce inflammation.

[1] Boudi et al: Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness in Cureus – 2019. See here.
[2] Kumura et al: Propylene glycol, a component of electronic cigarette liquid, damages epithelial cells in human small airways in Respiratory Research – 2022. See here.