EVALI: Current Understanding of Its Pathophysiology, Diagnosis, and Management

Abstract

Background: E-cigarette, or Vaping, product use-Associated Lung Injury (EVALI) emerged in 2019 as a novel clinical syndrome, posing a significant public health challenge linked to the inhalation of aerosols from e-cigarette or vaping products, particularly those containing tetrahydrocannabinol (THC) and vitamin E acetate (VEA).

Aim: This narrative review synthesizes the current understanding of EVALI's pathophysiology, diagnostic approach, and management principles, drawing upon evidence published from 2017 to 2024.

Material and Methods: We conducted a comprehensive narrative synthesis of literature from 2017–2024, focusing on etiological studies, clinical case series, public health reports, and reviews detailing the mechanisms, clinical presentation, diagnostic criteria, and therapeutic outcomes of EVALI.

Results: The pathophysiology involves a complex interplay of direct chemical pneumonitis, surfactant dysfunction, and acute lung injury patterns triggered primarily by VEA. Clinical presentation includes respiratory, gastrointestinal, and constitutional symptoms. Diagnosis relies on a meticulous history of vaping, consistent radiological findings (typically bilateral ground-glass opacities on CT), and exclusion of infection. Management is primarily supportive, with systemic glucocorticoids showing efficacy in reducing inflammation and improving outcomes in moderate to severe cases.

Conclusions: EVALI represents a severe form of inhalational lung injury directly attributable to toxic substances like VEA in vaping aerosols. While the peak incidence has subsided, it underscores the ongoing risks of unregulated vaping products and highlights critical gaps regarding long-term sequelae. Continued surveillance, public health education, and further research are imperative.