Understanding EVALI: The 2019 Vaping-Related Illness
The 2019 outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) was the first time these products were linked to such a severe public health crisis. Although cases have decreased since peaking in 2019, instances of vaping-related lung injuries are still diagnosed. The initial outbreak resulted in thousands of hospitalizations and numerous deaths, mainly among young adults using THC-containing vaping products.
What caused the EVALI outbreak?
Investigators quickly linked vitamin E acetate, used as a thickening agent in some illicit THC vaping products, as a primary cause of the EVALI outbreak. This substance is safe when ingested but hazardous when heated and inhaled, damaging the lungs. However, other chemicals in both THC and nicotine vaping products, especially from unregulated sources, may also contribute to lung injury.
Symptoms of EVALI and other vaping-related illnesses
Identifying symptoms is vital for prompt medical attention. While symptoms can resemble common respiratory infections, they do not improve with typical antibiotic treatments. Common symptoms can include:
- Respiratory issues such as shortness of breath, cough, and chest pain.
- Gastrointestinal symptoms like nausea, vomiting, and abdominal pain.
- Systemic symptoms including fever, chills, and fatigue.
Symptom severity varies, from mild, flu-like signs to severe respiratory distress requiring hospitalization.
The broader health risks of vaping
Beyond EVALI, vaping poses other health risks. Since e-cigarettes are relatively new, long-term effects are still being studied.
Risk factors for lung disease
- Popcorn Lung (Bronchiolitis Obliterans): Linked to diacetyl, a flavoring in some e-liquids.
- Collapsed Lung (Spontaneous Pneumothorax): Vaping may increase this risk by damaging lung tissue.
- Asthma Exacerbation: Vaping can worsen asthma symptoms and potentially increase the risk of developing asthma.
Harmful chemicals and heavy metals
E-cigarette aerosol contains harmful substances, not just water vapor. These include:
- Cancer-causing chemicals and volatile organic compounds.
- Heavy metals like nickel, tin, and lead.
- Toxic flavorings that become dangerous when heated and inhaled.
Comparing risks: Regulated vs. unregulated products
The EVALI outbreak highlighted the significant difference in risk between commercially produced and black market products. The outbreak was most strongly associated with illicit THC vape cartridges lacking safety standards and often containing vitamin E acetate. While commercially produced nicotine vapes have some regulation, they are not entirely risk-free. Informal products present a much higher risk due to unknown and potentially toxic contents.
| Feature | Regulated Commercial Products | Unregulated/Black Market Products |
|---|---|---|
| Regulation | Subject to some FDA oversight, but not all components are tested for inhalation safety. | No oversight; contents are unknown and can be modified by users or dealers. |
| Content | Ingredients often listed, but accuracy can vary. | Can contain toxic additives like vitamin E acetate, THC, or other harmful substances. |
| Manufacturing | Produced in commercial facilities, though quality control can vary. | Made with no quality control standards, often with unknown or impure ingredients. |
| Risk of EVALI | Lower, but not zero. Some EVALI cases involved only nicotine products. | Much higher, especially when using THC products from informal sources. |
Taking action: What to do if you vape or know someone who does
Given the documented health risks, quitting vaping is the recommended course of action. Resources are available to help those who are struggling.
- Seek professional help, such as from a healthcare provider or cessation coach, to develop a quit plan.
- Use nicotine replacement therapy (NRT) like patches, gum, or lozenges to manage withdrawal symptoms.
- Find support through text programs, online communities, or helplines.
- Identify and manage triggers by finding healthy alternatives and using stress management techniques.
- Set a quit date and inform supportive friends or family.
The American Lung Association offers resources for quitting vaping and improving respiratory health {Link: American Lung Association https://www.lung.org/}.
Conclusion: The continued importance of awareness
While the 2019 EVALI crisis raised public awareness, the health risks of vaping are ongoing. The CDC monitors vaping-related illnesses, and research continues to uncover potential long-term effects on the heart, lungs, and brain. EVALI underscores that vaping is not harmless, particularly with unregulated products. Increased awareness, regulation, and access to cessation resources are crucial.
