Vaping-associated pulmonary injury

See also: Health effects of electronic cigarettes
Vaping-associated pulmonary injury
Other namesVaping-associated lung injury,[1] e-cigarette, or vaping, product use associated lung injury (EVALI)[2]
CT scan of the chest showing diffuse lung infiltrates found in three cases of vaping-associated pulmonary injury
SpecialtyPulmonology, Intensive care medicine
SymptomsShortness of breath, hypoxia, fever, cough, diarrhea
CausesE-liquid carrying agents, flavoring, metals from e-liquid vape coils, virus contamination, heat
Diagnostic methodChest X-ray, CT Scan
TreatmentCorticosteroids, Oxygen therapy
Deaths68 U.S. (2,758 cases U.S.)[3]

Vaping-associated pulmonary injury (VAPI),[4] also known as vaping-associated lung injury (VALI)[1] or e-cigarette, or vaping, product use associated lung injury (E/VALI),[2][a] is an umbrella term,[15][16] used to describe lung diseases associated with the use of vaping products that can be severe and life-threatening.[3] Symptoms can initially mimic common pulmonary diagnoses, such as pneumonia, but sufferers typically do not respond to antibiotic therapy.[4] Differential diagnoses have overlapping features with VAPI, including COVID-19.[17][18][19] 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."[20] 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."[21]

Sufferers usually present for care within a few days to weeks of symptom onset.[4] 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,[22] or the process of inhaling aerosolized substances with battery-operated electronic cigarettes (e-cigarettes),[23] ciga-likes, or vape mods.[8]

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.[3] CDC data show that the outbreak peaked in September 2019, and declined steadily to a low level through January 2020.[24] 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."[25][24] 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."[26] 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."[27]

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.[28] Several organizations, including Purdue University and Public Health England (PHE), strongly advise against sharing vapes.[29][30] The CDC has stated that the THC cutting agent vitamin E acetate is very strongly implicated in VAPI,[31] but evidence was not sufficient to rule out a contribution from other chemicals of concern to VAPI as of January 2020.[3][32]

  1. ^ a b c "Vaping-Associated Lung Injuries". Minnesota Department of Health. September 24, 2019.
  2. ^ a b c Cite error: The named reference SiegelJatlaoui2019 was invoked but never defined (see the help page).
  3. ^ a b c d Outbreak of lung injury associated with e-cigarette use, or 'vaping' (Report). Centers for Disease Control and Prevention (CDC). February 11, 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  4. ^ a b c d CDPH Health Alert: Vaping-Associated Pulmonary Injury (PDF). California Tobacco Control Program (Report). California Department of Public Health. August 28, 2019. pp. 1–5. Public Domain This article incorporates text from this source, which is in the public domain.
  5. ^ Henry TS, Kanne JP, Kligerman SJ (October 2019). "Imaging of Vaping-Associated Lung Disease". The New England Journal of Medicine. 381 (15): 1486–87. doi:10.1056/NEJMc1911995. PMID 31491070.
  6. ^ Christiani DC (March 2020). "Vaping-Induced Acute Lung Injury". The New England Journal of Medicine. 382 (10): 960–62. doi:10.1056/NEJMe1912032. PMID 31491071.
  7. ^ Hswen Y, Brownstein JS (October 2019). "Real-Time Digital Surveillance of Vaping-Induced Pulmonary Disease". The New England Journal of Medicine. 381 (18): 1778–80. doi:10.1056/NEJMc1912818. PMC 11342631. PMID 31539466.
  8. ^ a b Gotts JE, Jordt SE, McConnell R, Tarran R (September 2019). "What are the respiratory effects of e-cigarettes?". BMJ. 366: l5275. doi:10.1136/bmj.l5275. PMC 7850161. PMID 31570493.
  9. ^ Fentem S (October 4, 2019). "As more people die after using vaping products, St. Louis doctor warns of the risks". KWMU.
  10. ^ Naftulin J (September 6, 2019). "A number of vape-related lung illnesses are linked to 'Dank Vapes', a mysterious black market brand selling THC products". Insider.
  11. ^ Bentley J (October 7, 2019). "First Massachusetts vape-related death confirmed". Patch Media.
  12. ^ Kapnick I (October 25, 2019). "Vaping companies brace for wave of lawsuits over lung illness". Courthouse News Service.
  13. ^ Mole B (September 12, 2019). "Black-market THC-vape operation busted in Wisconsin, police say". Ars Technica.
  14. ^ Carlos WG, Crotty Alexander LE, Gross JE, Dela Cruz CS, Keller JM, Pasnick S, Jamil S (October 2019). "ATS Health Alert-Vaping-associated Pulmonary Illness (VAPI)". American Journal of Respiratory and Critical Care Medicine. 200 (7): P15–P16. doi:10.1164/rccm.2007P15. hdl:1805/24237. PMID 31532698.
  15. ^ Chen, J; English, S; Ogilvie, JA; Siu, MKM; Tammara, A; Haas, CJ (October 29, 2020). "All up in smoke: vaping-associated lung injury". Journal of Community Hospital Internal Medicine Perspectives. 10 (6): 571–78. doi:10.1080/20009666.2020.1800978. PMC 7599004. PMID 33194132.
  16. ^ Agudelo, CW; Samaha, G; Garcia-Arcos, I (June 3, 2020). "Alveolar lipids in pulmonary disease. A review". Lipids in Health and Disease. 19 (1): 122. doi:10.1186/s12944-020-01278-8. PMC 7268969. PMID 32493486.
  17. ^ Cite error: The named reference pmid=34055688 was invoked but never defined (see the help page).
  18. ^ Cite error: The named reference pmid=33483200 was invoked but never defined (see the help page).
  19. ^ Cite error: The named reference pmid=33817560 was invoked but never defined (see the help page).
  20. ^ Jonas, Andrea M; Raj, Rishi (May 18, 2020). "Vaping-Related Acute Parenchymal Lung Injury: A Systematic Review". Chest. 158 (4): 1555–65. doi:10.1016/j.chest.2020.03.085. PMID 32442559. S2CID 218857503.
  21. ^ "Differentiating EVALI from COVID-19 on Imaging Proves Challenging Similar symptoms make radiology a key factor in diagnosis". Radiological Society of North America. March 10, 2022. Retrieved July 6, 2022.
  22. ^ Carlos WG, Crotty Alexander LE, Gross JE, Dela Cruz CS, Keller JM, Pasnick S, Jamil S (October 2019). "Vaping-associated Pulmonary Illness (VAPI)". American Journal of Respiratory and Critical Care Medicine. 200 (7): P13–P14. doi:10.1164/rccm.2007P13. hdl:1805/24236. PMID 31532695.
  23. ^ Triantafyllou GA, Tiberio PJ, Zou RH, Lamberty PE, Lynch MJ, Kreit JW, et al. (December 2019). "Vaping-associated Acute Lung Injury: A Case Series". American Journal of Respiratory and Critical Care Medicine. 200 (11): 1430–31. doi:10.1164/rccm.201909-1809LE. PMID 31574235. S2CID 203639820.
  24. ^ a b "Most EVALI Patients Used THC-Containing Products as New Cases Continue To Decline | CDC Online Newsroom | CDC". www.cdc.gov. January 17, 2020. Retrieved June 19, 2020.
  25. ^ King BA, Jones CM, Baldwin GT, Briss PA (February 2020). "The EVALI and Youth Vaping Epidemics - Implications for Public Health". The New England Journal of Medicine. 382 (8): 689–91. doi:10.1056/NEJMp1916171. PMC 7122126. PMID 31951683.
  26. ^ "Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products". CDC. February 25, 2020. Retrieved July 6, 2022.
  27. ^ "Johns Hopkins Finds Thousands of Unknown Chemicals in E-Cigarettes". Johns Hopkins. October 6, 2021. Retrieved April 13, 2022.
  28. ^ "Purdue students sharing vaping devices spread COVID-19". WLFI News. Archived from the original on November 22, 2021. Retrieved July 5, 2021.
  29. ^ "COVID-19: advice for smokers and vapers". GOV.UK. March 10, 2022.
  30. ^ "Important reminder: Don't share vaping devices". Protect Purdue. September 3, 2020.
  31. ^ Cite error: The named reference CDC2019_11 was invoked but never defined (see the help page).
  32. ^ Chand HS, Muthumalage T, Maziak W, Rahman I (2019). "Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury". Frontiers in Pharmacology. 10: 1619. doi:10.3389/fphar.2019.01619. PMC 6971159. PMID 31992985.


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