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

What Is EVALI?

EVALI stands for e-cigarette or vaping use-associated lung injury. It was originally known as VAPI (vaping associated pulmonary illness). The new name is in response to a growing number of severe lung illness cases related to using e-cigarette and vaping products, the first being identified during 2019. We are still learning about this disease, so changes may continue to be made to the terminology.

What Causes EVALI?

Health officials point to vitamin E acetate (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. The CDC and lung health researchers around the country are continuing to investigate. Learn more about what we know and don’t know and new developments on the CDC website.

How Is EVALI Diagnosed?

There is no single test for EVALI. Diagnosis is mostly a process of elimination because 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. Your doctor will evaluate your history of e-cigarette use and other vaping devices, and may take a chest X-ray or CT scan to see if there are hazy spots on your lungs (called opacities) that indicate tissue damage.

What Is the Treatment for EVALI?

Because the disease is so new, the course of the illness is unpredictable. Among the cases reported, 96% of patients required hospitalization, including some who died. Treatment is based on expert recommendations and depends on the severity of the illness. Primary medication treatments include antibiotics and/or antivirals until infection is ruled out as well as corticosteroids to help fight inflammation in the lungs. Patients with more severe cases will need hospitalization and, because they may be unable to breathe on their own, could be placed on a ventilator. Even patients who have less severe symptoms may need supplemental oxygen.

Guidance for Healthcare Providers
This guidance is intended to support healthcare providers in their understanding and tracking of -cigarette and vaping product use. Learn more.

Once patients have regained the ability to breathe on their own, they may be allowed to go home. However, because researchers have found that some patients are relapsing and even dying soon after discharge from the hospital, doctors recommend that all patients regardless of severity schedule follow-up appointments with a pulmonologist within 48 hours after being discharged.

E-cigarettes only entered the market about a decade ago, and we are still learning the long-term effects. With this recent breakout of EVALI, researchers are working hard to learn as much as possible about the illness, its causes, and the most effective treatments.

Current information and advisories are available from the Centers for Disease Control and Prevention.

For more information about vaping and how it effects your body, visit our e-cigarette section.

Knowing and reducing your risk

Learn More

To learn more about programs available to help tobacco users, including e-cigarettes and vaping products, to quit, contact the Lung HelpLine at 1-800-LUNG-USA.

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