What Is EVALI?

In 2019, reports of a mysterious lung condition were documented in Illinois and Wisconsin. The patients, primarily young adults, experienced difficulty breathing, coughing fits, chest pain, nausea, and developed pneumonia-like symptoms. Soon, the illness spread across the United States, becoming a bona fide health crisis. Over 2,000 confirmed cases resulted in hospitalization, and 68 of those cases proved to be fatal. 

Despite the initial difficulty in diagnosing the emerging disease, the Centers for Disease Control eventually linked the condition to illegal black market vape cartridges. The disease hit its peak in September of 2019 before steadily declining into relative obscurity. 

What Does EVALI Stand For?

Originally, the CDC named the novel condition VAPI (vaping associated pulmonary illness) but eventually changed the name to EVALI, which stands for e-cigarette or vaping use-associated lung injury.

What Is EVALI Lung Disease?

In many ways, EVALI remains somewhat mysterious to medical professionals. Essentially, EVALI is an inflammatory response to certain additives in e-juice or cannabis vape oil. These additives are primarily found in illicit THC cartridges. 

EVALI may present as the inflammatory reaction fibrinous pneumonitis, typical pneumonia, or as damage to the small air sacs in the lungs called alveoli. 

The health complications associated with EVALI are worsened by the degree of difficulty healthcare providers have diagnosing it. There is no one simple test that can confirm a patient has EVALI, which means physicians must diagnose by eliminating all other potential lung illnesses with similar symptoms first. 

What Are The EVALI Symptoms 

Symptoms of EVALI include shortness of breath, fever and chills, cough, vomiting, diarrhea, headache, dizziness, rapid heart rate, and chest pain. If you are a habitual vaper experiencing these symptoms, it’s advised you see a healthcare provider as soon as possible—especially if you use illicit carts. 

What Is The Treatment For EVALI?

The appropriate treatment for EVALI will vary depending on severity. Data indicates that over 90% of patients will require hospitalization due to a need for supplemental oxygen. Standard treatment includes a combination of antibiotics to prevent infections and corticosteroids to help the lungs fight off inflammation. 

Typically, once the patient has regained the ability to breathe on their own, they can be safely discharged from the hospital. However, due to the risks of relapse, it’s recommended patients schedule a follow-up appointment with a pulmonologist within 48 hours of discharge. 

What Causes EVALI?

EVALI has been strongly associated with the chemical vitamin e acetate, which can be used to increase the viscosity of e-juice or cannabis vape oil. 

When vitamin e is topically applied to the skin or consumed orally, either in capsule form or in food products, it’s a perfectly safe compound, and may in fact have some health benefits. However, when the chemical is consumed via inhalation, research suggests it can cause severe damage to the lungs and respiratory system. 

While the evidence suggests that vitamin e acetate is the likely culprit behind EVALI, the CDC has been unable to confirm whether other chemicals found in vape products also contribute to the onset of the condition. 

Is EVALI Still A Threat To The Vape Community? 

Confirmed cases of EVALI have dropped substantially since 2019, becoming so rare that CDC no longer tracks EVALI cases or collects reports on the condition from individual states. 

The extreme decrease in case numbers likely has to do with the identification of vitamin e acetate as the likely cause of EVALI. The lion’s share of both legal and illegal vape manufacturers now no longer include vitamin e acetate in their products and have shifted into other thickening agents.

However, because the e-cigarette and cannabis industries are highly unregulated, it’s possible to still find tainted products, especially on the black market.  

Are There Other Health Concerns With Vaping? 

Aside from EVALI, there are other potential health concerns associated with vaping. 

Bronchiolitis obliterans, also known as “popcorn lung,” is a disease that causes obstructions in the bronchioles. It’s caused by inhaling a chemical compound called diacetyl, which had previously been used as an artificial flavoring agent in microwave popcorn and certain e-cigarettes. 

Additionally, new research suggests that metal heating elements in vaporizers can leach toxic heavy metals, like lead, which vape users will eventually inhale. 

How To Minimize The Dangers Of Vaping

Vape products exist to be a healthier alternative to smoking that still offers the same level of enjoyment and bioavailability. Research suggests that by circumventing the combustion process, vaporizers expose users to less toxic particulates than smokeables. However, this doesn’t mean that vapes aren’t without health risks. 

Users who want to minimize the health risks associated with vaping should start by choosing legal products that have undergone thorough third-party lab testing. This will help eliminate the potential to consume vape products manufactured with dangerous ingredients like vitamin e acetate and diacetyl. Also, by using ceramic coils in vaporizer mods or using ceramic cannabis vape cartridges, consumers can avoid the potential of heavy metal leaching. 

So while there are still some potential risks to vaping, consumers and manufacturers can take steps to reduce these risks significantly.