Vaping-associated pulmonary injury (VAPI), also known as vaping-associated lung injury (VALI) or e-cigarette, or vaping, product use associated lung injury (E/VALI), is an umbrella term, used to describe lung diseases associated with the use of vaping products that can be severe and life-threatening. Symptoms can initially mimic common pulmonary diagnoses, such as pneumonia, but sufferers typically do not respond to antibiotic therapy. Differential diagnoses have overlapping features with VAPI, including COVID-19. According to an article in the Radiological Society of North America news published in March 2022, EVALI cases continue to be diagnosed. “EVALI has by no means disappeared,” Dr. Kligerman said. “We continue to see numerous cases, even during the pandemic, many of which are initially misdiagnosed as COVID-19.”
Sufferers usually present for care within a few days to weeks of symptom onset. Starting, in September 2019, the US Centers for Disease Control and Prevention (CDC) reported on a nation-wide outbreak of severe lung disease linked to vaping, or the process of inhaling aerosolized substances with battery-operated electronic cigarettes (e-cigarettes), ciga-likes, or vape mods.
According to a systematic review article,"Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019..."<
All CDC-reported cases of VAPI involved a history of using e-cigarette, or vaping, products, with most samples having tested positive for tetrahydrocannabinol (THC) by the US FDA and most patients reporting a history of using a THC-containing product. CDC data show that the outbreak peaked in September 2019, and declined steadily to a low level through January 2020. In late February 2020, a CDC-authored article in the NEJM stated that the VAPI outbreak was "driven by the use of THC-containing products from informal and illicit sources." However, the CDC also stated, "Evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products, in some of the reported EVALI cases." In 2021, researchers at Johns Hopkins University analyzed the vape aerosols of popular brands such as Juul and Vuse, and found "nearly 2,000 chemicals, the vast majority of which are unidentified."
Due to the COVID-19 pandemic, that exceeded 1 million worldwide deaths in October 2020, it is now possible that shared vaping devices spread COVID-19. Several organizations, including the Purdue University, and Public Health England (PHE) strongly advises against sharing vapes.
The CDC has stated that the THC cutting agent vitamin E acetate is very strongly implicated in VAPI, but evidence was not sufficient to rule out a contribution from other chemicals of concern to VAPI as of January 2020.
Signs and symptoms
Commonly reported symptoms include shortness of breath, cough, fatigue, body aches, dizziness, fever, nausea, vomiting, and diarrhea. Additional symptoms may include chest pain, abdominal pain, chills, or weight loss. Symptoms can initially mimic common pulmonary diagnoses like pneumonia, but individuals typically do not respond to antibiotic therapy. In some patients, gastrointestinal symptoms can precede respiratory symptoms. Individuals typically present for care within a few days to weeks of symptom onset.
At the time of hospital presentation, the individual is often hypoxic and meets systemic inflammatory response syndrome (SIRS) criteria, including fever. Physical exam can reveal rapid heart rate or rapid breathing. Auscultation of the lungs tends to be unremarkable, even in patients with severe lung disease. In some cases, the affected individuals have progressive respiratory failure, leading to intubation. Several affected individuals have needed to be placed in the intensive care unit (ICU) and on mechanical ventilation. Time to recovery for hospital discharge has ranged from days to weeks.
Possible causes
No single cause of these illnesses has been established . Many different substances and product sources continued to be under investigation.