Relevant Vapes – What is E-Cigarette-Associated Lung Injury (EVALI)?

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Vaping involves inhaling nicotine and other chemicals into your lungs. It’s not healthier than smoking cigarettes.

EVALI (e-cigarette or vaping product use associated lung injury) is a serious lung condition that can cause permanent scarring and make it harder to breathe. Diacetyl, a chemical found in some flavored relevant vapes, can also cause a serious lung disease called bronchiolitis obliterans or popcorn lung.


Nicotine stimulates the adrenal glands to release epinephrine and increases levels of a chemical messenger called dopamine, which creates feelings of pleasure. It is highly addictive and can cause withdrawal symptoms when it is stopped. While less harmful than combusted tobacco, the use of nicotine in any form is unsafe for youth and can lead to problems such as addiction, lung damage and risk of using other drugs.

Even if a device is labeled as nicotine free, most vapor products contain some amount of nicotine. The FDA recommends that youth not use e-cigarettes or any product that contains nicotine.

The longer ENDS are on the market, the more we learn about their impacts on health. These include the high rates of cigarette initiation among youth, which has led to new public education efforts to prevent this behavior.

There is also growing evidence of other health hazards from vaping, including exposure to secondhand smoke and the potential for toxicity from the chemicals in some e-liquids. In addition, recent reports of serious lung illnesses have prompted health agencies to take action.

In a study published in Nicotine & Tobacco Research, researchers found that compared to unexposed participants, those who were exposed to secondhand nicotine vapor experienced more wheeze, bronchitic symptoms and shortness of breath. These associations were still observed after controlling for age, sex, race/ethnicity and parental education.


Aerosols are suspensions of solid and liquid particles in a gas, usually air. They are also called clouds because they can appear to be visible, especially when light is passing through them. The particles in an aerosol are shaped differently from one another, varying from jagged volcanic ash to nearly spherical liquid droplets. This shape difference influences how the aerosol moves and behaves.

The particles in an aerosol also have different properties and a range of sizes. The size of the particles, measured by their radius, is a key property used to characterize an aerosol. These particles can be removed from the atmosphere by wet deposition, as in the case of precipitation, or dry deposition by settling on or diffusing into soil, plants or the like.

These chemicals can be toxic to humans, damaging the cells in lungs and other organs, and causing DNA damage. This can lead to a host of health problems, including the development of atherosclerosis, the build-up of fatty material on arteries and veins.

Traditional aerosols are packaged in flammable propellant containers that can explode if they are pierced or otherwise compromised. These traditional packaging methods are a threat to the environment because they can wash away into natural water bodies and soil, where they can contaminate plantation and aquatic ecosystems. The bag on valve filling technology of the EVALI device prevents environmental contamination because it uses non-flammable, high-grade ingredients for the aerosols.


As EVALI outbreaks have occurred, the medical community has learned more about the disease. Initially referred to as VAPI (vaping associated pulmonary illness), the 2019 EVALI outbreak was linked to vitamin E acetate, an additive in THC-based e-liquids that is added to help vaping devices perform better. The outbreak also sparked the renaming of EVALI as “e-cigarette-associated lung injury.”

The diagnosis begins with a physical exam and a history of vaping. Doctors ask patients about their use of THC- and nicotine-based e-liquids, and what types of devices they have used. They also conduct a pulse oximetry test, which measures how well oxygen is carried to the body’s farthest tissues. Patients with low oxygen levels require a chest x-ray and may need to be hospitalized.

Histologically, EVALI resembles other inhalational lung injuries, such as those seen with amiodarone toxicity or exposure to noxious chemical fumes. Histologic findings include a swollen alveolus with bronchiolitis, cytoplasmic vacuolization of pneumocytes, and increased surfactant turnover due to epithelial injury.

EVALI is challenging for physicians to diagnose since the symptoms often develop slowly, over days or weeks. The e-liquid solution in vapes may contain harmful chemicals, including antifreeze made from propylene glycol or ethylene glycol and aldehydes, such as formaldehyde. Secondhand smoke from e-cigarettes is also dangerous to lungs, and many vaporizers have burst into flames or burned the user’s hands. The e-liquids may also contain volatile organic compounds and heavy metals that can be inhaled into the lungs.