Vaping related lung injury: What you need to know

Experts know that e-cigarette aerosol can contain harmful and potentially harmful ingredients.

Some evidence of the health risks showed up in 2019, when more than 2,500 people got sick after using vaping products. The illness is called EVALI. That stands for e-cigarette or vaping product use associated lung injury.

EVALI describes severe lung problems that resemble pneumonia in some cases, and chemical burns in others. Some people with EVALI suffer total lung failure. More than 60 people have died.

What causes EVALI?

It’s still not clear which e-cigarette ingredients cause these bad reactions, but most experts agree that vitamin E played a part in the recent incidences.

Vitamin E is approved for use in vitamin supplements and cosmetics, but has not been tested for inhalation. It was used in vaping fluids to reduce production costs.

Most of those who became ill also had vaped tetrahydrocannabinol or THC. THC is the active ingredient in marijuana.

But staying away from these two ingredients may not protect you from vaping related lung injuries. Health problems could be caused by other ingredients.

“Vape companies make new products and new flavors all the time,” says Jason Robinson, Ph.D., associate professor in MD Anderson’s department of Behavioral Science. “Until there is comprehensive regulation, yes, it’s likely something like this will happen again with other untested ingredients.”

What does EVALI do to the lungs?

In the most serious cases, EVALI causes extensive damage to vapers’ lungs. Doctors call it acute lung injury because of the massive destruction to the lung tissue.

“On a microscopic level, the lungs get so inflamed that the small sacs that collect air get clogged with blood, pus and other fluids,” says Chad Strange, M.D., assistant professor in MD Anderson’s department of Thoracic Imaging.

When that happens, your lungs cannot send oxygen around your body. You suffer the same fate as someone who dies from smoke inhalation.

“You literally starve of oxygen,” says Strange. “You can’t breathe because your lungs are so full of this debris and inflammation.”

Symptoms of EVALI

The signs of vaping related lung injury can be vague. Some people do not start with symptoms relating to their lungs.

“They may not have a cough or shortness of breath,” says Yuqi Wang an MD Anderson resident physician who studies EVALI cases. “They often come in with nausea or vomiting or abdominal pain and a fever.”

EVALI's symptoms can extend beyond the lungs, because the lungs transmit toxins throughout your system.

“Diagnosis relies on the doctor eliminating other illnesses and then asking questions about your lifestyle, like whether you vape,” says Wang.

What can you do to avoid EVALI?

The most important thing you can do to avoid all health problems related to vaping is to not use e-cigarettes or other vaping products.

If you are a smoker who is trying to quit, use proven methods like medications and counseling to help you. E-cigarettes have not been shown to successfully help you stop smoking.

People who have never smoked should not use e-cigarettes. This is especially true for young people. E-cigarettes have nicotine, which is harmful to people under age 26 because it damages developing brains. It affects the part of the brain that controls mood and attention.

And the long term safety of e-cigarettes is unknown.

“It’s certainly the case that e-cigarettes could be causing permanent damage to the lungs of users, especially those who start young,” says Robinson.