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Understanding EVALI: E-Cigarette or Vaping Product Use-Associated Lung Injury
What is EVALI?
EVALI stands for E-Cigarette or Vaping Product Use-Associated Lung Injury. It is a severe pulmonary illness linked to the use of e-cigarettes or vaping products. EVALI was officially identified and named in 2019 following a surge in cases primarily in the United States 23.
Pathogenesis and Risk Factors
EVALI is an acute inflammatory disease triggered by lung cell injury due to electronic cigarettes and vaping devices. Common additives in these devices, such as Vitamin E Acetate and tetrahydrocannabinol (THC), are frequently implicated in the development of EVALI 1. The disease can mimic respiratory viral illnesses and may progress to acute respiratory failure and acute respiratory distress syndrome (ARDS), potentially affecting other organs beyond the lungs 16.
Clinical Presentation and Diagnosis
Patients with EVALI typically present with a range of nonspecific symptoms, including respiratory issues (dyspnea, cough), gastrointestinal symptoms (nausea, vomiting), and constitutional symptoms (fever, fatigue) 67. Diagnosis is primarily one of exclusion, requiring a history of recent vaping, abnormal chest imaging, and the elimination of other potential causes 26. Imaging often reveals patterns of acute lung injury, such as organizing pneumonia and diffuse alveolar damage 6.
Management and Treatment
The management of EVALI is largely supportive, with many patients requiring intensive care and steroid therapy. Cessation of vaping is crucial, and most patients show significant improvement within 1-2 weeks of stopping vaping and receiving appropriate treatment 7. Corticosteroids have been shown to reduce the severity of lung injury in some patients 67.
Challenges and Research Priorities
Despite advancements in understanding EVALI, several challenges remain. There is a need for better identification of triggers and risk factors, understanding the role of specific lung immune and structural cells, and identifying key molecular mediators and therapeutic targets 13. The absence of an established animal model for EVALI is a significant limitation in preclinical research 1.
Public Health and Regulatory Response
The outbreak of EVALI has highlighted the need for a coordinated public health response and stricter regulatory oversight of e-cigarette products. Initiatives such as national case registries, biorepositories, and standardized clinical follow-up assessments are critical for improving the understanding and management of EVALI 34. Regulatory actions, including the enforcement of nicotine e-cigarette standards and the regulation of non-tobacco-derived e-cigarettes, are essential to prevent future outbreaks 3.
Conclusion
EVALI is a serious and potentially life-threatening condition associated with e-cigarette and vaping product use. While significant progress has been made in understanding its pathogenesis, clinical presentation, and management, ongoing research and regulatory efforts are crucial to address the remaining challenges and prevent future cases. Public health initiatives and stricter regulations will play a vital role in mitigating the risks associated with vaping and protecting public health.
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Most relevant research papers on this topic
Pathogenesis of E-Cigarette Vaping Product Use-Associated Lung Injury (EVALI).
E-cigarette vaping product use-associated lung injury (EVALI) is an acute inflammatory disease caused by lung cell injury from electronic cigarettes and vaping devices, often containing Vitamin E Acetate or tetrahydrocannabinol additives.
EVALI (E‐cigarette or vaping product use associated lung injury): First case report of an adolescent in Europe
EVALI is the first case report of an adolescent in Europe with acute dyspnea and hypoxemia due to vaping, highlighting the need for further research and awareness in this area.
Case Report
Rigorous JournalThe E-cigarette or Vaping Product Use–Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An Official American Thoracic Society Workshop Report
Addressing the root causes of e-cigarette or vaping product use-associated lung injury (EVALI) requires an integrated approach from multiple perspectives, including public health, clinical research, regulators, and users.
NIH Workshop Report: E-cigarette or Vaping Product Use Associated Lung Injury (EVALI): Developing a Research Agenda.
E-cigarette and vaping product use-associated lung injury (EVALI) research priorities include creating national and international registries, defining pathogenesis, and addressing disparities in vaping risks compared to smoking.
EVALI: A Mimicker of COVID-19
EVALI diagnosis may be delayed due to anchoring bias when patients present with COVID-19 symptoms, potentially leading to misdiagnosis and delayed treatment.
Case ReportRadiologic, Pathologic, Clinical, and Physiologic Findings of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): Evolving Knowledge and Remaining Questions.
Electronic cigarette or vaping product use-associated lung injury (EVALI) is a diagnosis of exclusion, with chest imaging findings indicating acute lung injury.
Rigorous Journal
Highly CitedE-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach.
E-cigarette use can cause severe lung injury, but most patients recover within 1-2 weeks after quitting and receiving supportive care and steroid therapy.
Case ReportRigorous JournalHighly CitedDiagnosis and Acute Management of E-cigarette or Vaping Product Use- Associated Lung Injury (EVALI) in the Pediatric Population: A Systematic Review.
Pediatric cases of e-cigarette or vaping-associated lung injury (EVALI) present with respiratory, constitutional, abdominal, and cardiovascular symptoms, and treatment varies based on the lung injury pattern.
Systematic ReviewLessons Learned From the E-cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020
The Minnesota Department of Health's EVALI outbreak response highlights the importance of legal authority and partnerships for effective noncommunicable disease investigations.
Observational StudyDiagnosis of EVALI in Adolescents During the COVID-19 Pandemic: A Case Series.
During the COVID-19 pandemic, eliciting a complete psychosocial history for adolescents is crucial for diagnosis of EVALI and ensuring consistent outpatient follow-up and vaping cessation.
Case Report