Vaping-Related Lung Injury (EVALI): Symptoms, Causes, and Treatment

EVALI is a lung condition caused by vaping. The most common symptoms are trouble breathing, cough, chest pain, fever, and stomach problems. If you vape and develop these symptoms, see a doctor right away. Treatment often requires hospital care. The best way to prevent EVALI is to stop vaping.

In plain words

EVALI is a serious lung problem caused by vaping. It happens when the lungs get hurt from chemicals in vaping products. Symptoms include trouble breathing, cough, chest pain, fever, nausea, and tiredness. Many cases were linked to vaping THC, especially products bought off the street. Most people need to go to the hospital for treatment. The main medicine doctors use is steroids to calm the swelling in the lungs. The most important thing is to stop vaping right away. Some people get better completely, but others may have lasting lung damage.

What is Vaping-Related Lung Injury (EVALI): Symptoms, Causes, and Treatment?

Symptoms

Early symptoms

Shortness of breath: Difficulty breathing or feeling like you can't get enough air, often worsening over days or weeks. (1) (2)
Cough: Persistent cough that doesn't go away, sometimes bringing up mucus. (1) (2)
Chest pain: Discomfort or sharp pains in the chest, especially when breathing in or coughing. (1) (2)
Fever or chills: Elevated body temperature or feeling unusually cold with shivering. (1)
Nausea or vomiting: Feeling sick to your stomach or actually throwing up, sometimes with loss of appetite. (1)
Diarrhea: Loose, watery stools occurring more frequently than usual. (1)

Serious or emergency symptoms

Severe breathing difficulty: Struggling for breath even when resting, gasping, or being unable to speak full sentences. Call emergency services immediately if breathing becomes very difficult. (3)
High fever (over 103°F/39.4°C): Very high temperature that doesn't improve with medication or lasts more than 3 days. Seek emergency care for a high fever along with breathing trouble. (3)
Confusion or extreme fatigue: Mental confusion, extreme tiredness, or trouble staying awake can signal low oxygen. Get emergency help for these symptoms along with breathing problems. (3)

Causes

Primary causes

Vaping THC-containing products: Products containing THC (the psychoactive compound in marijuana), especially those bought from informal sources, were strongly linked to EVALI cases. Many contained vitamin E acetate, which may damage lungs. (1)
Chemical exposure from vaping: Heating and inhaling chemicals in vaping liquids can irritate and injure lung tissue. The exact harmful substances may vary between products. (1)

Risk factors

GAP: Risk factors not covered in evidence dossier

Diagnosis

Doctors diagnose EVALI based on: 1) A history of vaping within the past 90 days; 2) Lung abnormalities seen on imaging tests like chest X-rays or CT scans; 3) No evidence of infection after testing; and 4) No other clear explanation for the symptoms. Tests may include imaging, blood work, and sometimes a bronchoscopy (examining lung airways with a small camera).

Chest X-ray or CT scan

To check for lung abnormalities like hazy white patches (ground-glass opacities) that suggest inflammation. (2) (4) (5)

Infection testing

To rule out pneumonia or other infections that could cause similar symptoms. May include nasal swabs, blood cultures, or urine tests. (4) (6)

Pulse oximetry

Measure oxygen levels in blood to check if lungs are working properly. Low levels suggest severe lung involvement. (3)

Bronchoscopy (in some cases)

A procedure where a thin tube with a camera is passed into the lungs to look for inflammation and collect samples. (6)

Treatment

Medication options

Corticosteroids

These powerful anti-inflammatory medicines help reduce lung swelling and inflammation. They are given orally or through an IV for hospitalized patients. (2) (3)

Oxygen therapy

Given through nasal tubes or masks to help patients breathe when lung function is impaired. The amount needed depends on severity. (3)

Lifestyle and self-care

Stop all vaping immediately: The most critical step - continuing to vape will likely worsen lung damage. Talk to your doctor about safe ways to quit if you're having trouble stopping. (7)
Follow-up care: Attend all scheduled medical appointments after leaving the hospital. Lung recovery takes time and your doctor will monitor your progress. (7)
Avoid lung irritants: Stay away from smoke, dust, strong fumes, or other substances that could further irritate your lungs during recovery. (7)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

GAP: Complications not covered in evidence dossier: GAP: Complications not covered in evidence dossier

When to see a doctor

Routine follow-up

See a doctor promptly if you vape and develop any breathing problems, cough lasting more than a few days, fever, or stomach symptoms that don't go away. (3) (7)

Seek emergency care

Go to the emergency room or call 911 if you have severe trouble breathing, high fever with confusion, or lips/fingers turning blue. (3)

Frequently asked questions

What is Vaping-Related Lung Injury?

EVALI is a serious lung condition linked to using e-cigarettes or vaping products. It causes inflammation and damage to lung tissue, often requiring hospital treatment. Symptoms include trouble breathing, cough, chest pain, fever, and stomach problems. (1) (5)

What are the first signs of Vaping-Related Lung Injury?

Early symptoms often include shortness of breath, cough, chest pain, fever, nausea, vomiting, diarrhea, and tiredness. These usually develop over days to weeks of vaping. If you vape and notice these symptoms, see a doctor. (1) (2)

What causes Vaping-Related Lung Injury?

EVALI is caused by breathing in harmful substances from vaping products, especially those containing THC bought from informal sources. Vitamin E acetate, sometimes added to THC oils, was found in many patients' lungs but other chemicals may also play a role. (1)

How is Vaping-Related Lung Injury treated?

Severe cases need hospital care with oxygen support. Doctors often prescribe corticosteroids to reduce lung inflammation. The most important part of treatment is stopping all vaping immediately. Recovery can take weeks to months. (2) (3)

Can Vaping-Related Lung Injury be cured?

Many people recover with proper medical care, but some may have lasting lung damage. Full recovery depends on how severe the lung injury is and how quickly treatment begins. Stopping all vaping gives the best chance for healing. (7) (5)