EVALI

EVALI stands for E-cigarette or Vaping product use-Associated Lung Injury. It is an acute, sometimes severe illness in which the lungs become inflamed after vaping, causing cough, shortness of breath, chest pain, fever and gastrointestinal symptoms over days. The term came to prominence during a 2019 outbreak in the United States.

Investigation of that outbreak pointed strongly to vitamin E acetate, an oily additive used to thicken some illicit THC-containing vaping liquids, as a key culprit; it appears to disrupt the surfactant lining of the alveoli. EVALI is therefore not a single disease but a label for vaping-associated lung injury, most cases of which were linked to informally sourced cannabis products rather than to commercial nicotine devices.

It is a diagnosis of exclusion: clinicians confirm recent vaping, find diffuse lung infiltrates (often patchy ground-glass opacities) on CT, and rule out infection and other causes. Treatment is supportive — stopping vaping, oxygen, and corticosteroids in many cases — and most patients recover, though some need intensive care and a minority have lasting impairment or die. Cases fell sharply once vitamin E acetate was identified and removed.