EVALI

What is EVALI?

E-cigarette- or vaping-use-associated lung injury (EVALI) is a serious inflammatory condition that damages your lungs. It develops as a result of vaping, which is when you use a small, electronic device to breathe in tiny particles of liquid nicotine and flavoring. EVALI can affect people who’ve used vaping products up to 90 days before symptoms started.

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.

How serious is EVALI?

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.

Is EVALI long-term?

EVALI is a relatively new condition — the first reported case in the United States was in 2019. As a result, healthcare providers and medical researchers aren’t sure of EVALI’s long-term effects or outlook.

What are the symptoms of EVALI?

EVALI symptoms include:

• Chest pain.
• Cough.
• Shortness of breath (dyspnea).
• Accelerated heartbeat (tachycardia).
• Abdominal pain.
• Nausea and vomiting.
• Diarrhea.
• Fever.
• Chills.
• Unexplained weight loss.

In some cases, EVALI may cause death.

What causes EVALI?

Using e-cigarettes and vaping cause EVALI. Healthcare experts aren’t sure which components of e-liquids (e-juice or vape juice) directly leads to inflammation. However, there may be a link between EVALI and vitamin E acetate. Vitamin E acetate is a synthetic form of vitamin E. Manufacturers may add it to e-liquids that contain THC (tetrahydrocannabinol). THC is the primary chemical in marijuana that causes you to feel high. Vitamin E acetate is safe to ingest or apply to your skin as a lotion or cream, but it may cause lung damage when you heat it and inhale it as a vapor.

Is EVALI reversible?

Medical professionals aren’t entirely sure if EVALI is reversible. However, as they collect more information, it seems like EVALI damage may be reversible if you stop vaping and get treatment from a healthcare provider.

Who does EVALI affect?

EVALI can affect anyone who vapes. However, you may be at a greater risk of hospitalization from EVALI if you:

• Are younger than 35.
• Vape THC.
• Use THC-containing vapes from informal sources (online, family or friends).

How is EVALI diagnosed?

EVALI can be challenging to diagnose because it has the same symptoms as many other lung conditions. A healthcare provider will review your medical history and perform a physical exam. During the exam, they’ll listen to your lungs with a stethoscope (auscultation). They’ll also ask you questions, such as:

• What are your symptoms?
• Do you vape?
• Have you vaped in the last three months?
• Do you vape nicotine, THC or both?
• Where did you get the e-liquid for your vape?

Your provider will also order tests to help confirm their diagnosis.

What tests will be done to diagnose EVALI?

To help confirm EVALI, a healthcare provider may order:

• Blood oxygen level test. A blood oxygen test measures how much oxygen you have in your blood. Low blood oxygen levels indicate lung damage. The provider may draw a blood sample or pulse oximetry to measure your blood oxygen levels.
• Imaging tests. Imaging tests are painless, noninvasive tests that help the provider look for lung damage. They may order a chest X-ray or a computed tomography (CT) scan.
• Pulmonary function tests (PFTs). PFTs help determine how well your lungs work.

How is EVALI treated?

Because EVALI shares many of the same symptoms as lung infections, a healthcare provider may initially treat you with antibiotics or antivirals to rule out an infection. Your treatment may also include:

• Corticosteroids. Corticosteroids are drugs that help reduce inflammation. Your provider might prescribe you an inhaler or a nebulizer to breathe corticosteroids directly into your lungs.
• Oxygen therapy. Oxygen therapy is “extra” (supplemental) oxygen. You receive supplemental oxygen through a flexible plastic tube with two prongs that go into your nostrils (a nasal cannula). The nasal cannula connects to an oxygen tank.
• Mechanical ventilation. A ventilator is a machine that either partially or entirely breathes for you. Severe cases of EVALI may require mechanical ventilation.

How soon after treatment will I feel better?

Most people start to feel better a few days after beginning EVALI treatment. However, it may take longer to return to your usual activities after treatment. A healthcare provider will tell you what to expect.

Can EVALI be prevented?

You can prevent EVALI by avoiding vaping products, especially those containing THC or vitamin E acetate. If you vape, make sure you buy vaping products from a licensed seller.

What can I expect if I have EVALI?

EVALI is a relatively new condition and healthcare experts aren’t sure of its long-term effects. Some people develop symptoms again after they finish treatment, so it’s important to schedule follow-up appointments with a healthcare provider. Your provider may refer you to a pulmonologist. Pulmonologists are doctors who specialize in diagnosing and treating conditions that affect your lungs and other parts of your respiratory system.

How do I take care of myself if I have EVALI?

If you have EVALI, your healthcare provider will work with you to develop a treatment plan. Be sure to take all your prescribed medications.

Your provider will also help you quit vaping. Many tips that help people quit smoking can also help you quit vaping.

When should I see a healthcare provider?

See a healthcare provider if you vape and have symptoms of EVALI. Call your provider immediately if your symptoms come back after treatment. Schedule follow-up appointments to test how well your lungs work and determine your blood oxygen levels.

When should I go to the ER?

Call 911 (or your local emergency number) or go to the emergency room immediately if you feel like you can’t get enough air into your lungs.

What questions should I ask a healthcare provider?

• How do you know I have EVALI?
• Is there permanent damage to my lungs?
• When should I start to feel better?
• What do I do if my symptoms come back?
• How often should I schedule follow-up appointments?
• Can you recommend a vaping cessation program or a vaping support group?

How do you tell if vaping is affecting your lungs?

You may have lung damage if you vape and have symptoms that affect your breathing. Vaping can also make the symptoms of any other lung conditions you have (like asthma) worse.

How many years does it take for vaping to affect your lungs?

Some studies suggest that vaping can cause lung damage after only three days of use.

A note from Cleveland Clinic

E-cigarette- or vaping-use-associated lung injury (EVALI) causes inflammation in your lung tissues. If you vape — even rarely — and develop symptoms of EVALI, see a healthcare provider or go to the ER. Treatment helps most people feel better within several days.

If you don’t vape, it’s a good idea not to start. If you do, healthcare providers are available to help you quit.