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Vaping-associated pulmonary injury

Vaping-associated pulmonary injury (VAPI)[notes 1] is a lung disease associated with the use of vaping products.[4]

Vaping-associated pulmonary injury
Other namesVaping-associated lung injury,[1] e-cigarette, or vaping, product use associated lung injury (EVALI)[2]
E cig tomography of chests mm6836e1-F1.gif
CT scan of the chest showing vaping-associated lung injury
SymptomsShortness of breath, hypoxic, fever, cough, diarrhea
Diagnostic methodOpacities on chest radiograph
TreatmentHigh-flow oxygen therapy
Deaths26 (1,299 cases U.S.)[3]

Signs and symptomsEdit

In September 2019, the Centers for Disease Control and Prevention (CDC) reported an outbreak of severe lung disease linked to vaping.[13] The cases of lung injury date back to at least April 2019.[14] The clinical presentation of VAPI can initially mimic common pulmonary diagnoses like pneumonia, but individuals typically do not respond to antibiotic therapy.[4] High clinical suspicion is necessary to make the diagnosis of VAPI.[4] In some cases, individuals seek care at outpatient clinics in the days prior to hospital presentation and received antibiotics for presumed pneumonia or bronchitis, which did not improve their symptoms.[4] Affected individuals typically present for care within a few days to weeks of symptom onset.[4] At the time of hospital presentation, the affected individual is often hypoxic and meets systemic inflammatory response syndrome (SIRS) criteria, including high fever.[4] In some cases, they have progressive respiratory failure following admission, leading to intubation.[4] Several affected individuals have needed to be placed in the ICU while being hooked up to a ventilator.[13] Time to recovery for hospital discharge has been from days to weeks.[4] Commonly reported symptoms include shortness of breath, cough, fatigue, body aches, fever, vomiting, and diarrhea.[4] Non-specific laboratory abnormalities have been reported, including elevation in white blood cell count, transaminases, procalcitonin, and inflammatory markers.[4] Negative infectious disease testing (influenza, respiratory viral panel, cultures, etc.).[4] Imaging abnormalities are typically bilateral and may be described as: Chest x-ray: pulmonary infiltrates or opacities.[4] Chest CT: ground-glass opacities.[4] Bronchoalveolar lavage specimens may exhibit an increased level of neutrophils and sparse to moderate amounts of lipid-laden alveolar macrophages.[13]


Vaping refers to the increasingly popular practice of inhaling aerosol (vapor) from an electronic cigarette device, which works by heating a liquid that can contain nicotine, cannabis, or other drugs.[4] The long-term health impacts of vaping are unknown.[4] Some individuals also use a different type of device to heat and extract cannabinoids for inhalation in a process called "dabbing."[4] Both vaping and dabbing have been associated with VAPI.[4] Most individuals report vaping the cannabis compounds THC and/or CBD, and some also report vaping nicotine products.[4] A smaller group reported using nicotine alone.[15] On October 4, 2019, the CDC reported that the cause of the lung illnesses is unknown but it might be related to prefilled THC cartridges.[16]


VAPI is a clinical diagnosis of exclusion when infectious, rheumatologic, neoplastic, cardiac, or other processes cannot explain an acute pulmonary illness in a person known to vape cannabinoids and/or nicotine.[4] The diagnosis is commonly suspected when the person does not respond to antibiotic therapy, and testing does not reveal an alternative diagnosis.[4] Common documented hospital diagnoses for these people have included: acute respiratory distress syndrome (ARDS), sepsis, acute hypoxic respiratory failure, pneumonitis, and pneumonia.[4]

Case definitionEdit

A case of VAPI meets the following criteria: Respiratory illness requiring hospital admission; history of vaping or dabbing within 90 days of symptom onset; pulmonary infiltrates or opacities on chest radiograph or chest CT.[4] Presentation is not explained by infectious or other alternate etiology.[4]


Guidelines for treatment of VAPI are not available.[4] Most individuals require supplemental oxygen via nasal cannula, high-flow oxygen, bilevel positive airway pressure (BiPAP), or mechanical ventilation.[4] Anecdotally, treating physicians have trialed the use of steroids with some possible benefit.[4] Information on dosing and duration of steroids is not available.[4] Corticosteroids might be helpful in treating this injury.[2] Several case reports describe improvement with corticosteroids, likely because of a blunting of the inflammatory response.[2] An important part of treatment for VAPI involves quitting vaping.[17]


As of October 8, 2019, the CDC has received complete gender and age data on 1,043 lung injury cases: 70% of cases are male.[3] The median age of cases is 24 years and ranges from 13 to 75 years.[3] 81% of cases are under 35 years old.[3]

On 28 September the first case of vaping-associated pulmonary injury was identified in Canada.[18]

See alsoEdit


  1. ^ Vaping-associated pulmonary injury (VAPI)[4] is also variously known as e-cigarette, or vaping, product use associated lung injury (EVALI),[2] vaping-associated lung Injury,[1] vaping-associated lung disease,[5] vaping-induced lung injury,[6] vaping-induced pulmonary disease,[7] vaping associated respiratory syndrome,[8] vape-related lung disease,[9] vape-related lung illness,[10] vape-related pulmonary illness,[11] or Vape Lung.[12]


  1. ^ a b "Vaping-Associated Lung Injuries". Minnesota Department of Health. 24 September 2019.
  2. ^ a b c d Siegel, David A.; Jatlaoui, Tara C.; Koumans, Emily H.; Kiernan, Emily A.; Layer, Mark; Cates, Jordan E.; Kimball, Anne; Weissman, David N.; Petersen, Emily E.; Reagan-Steiner, Sarah; Godfred-Cato, Shana; Moulia, Danielle; Moritz, Erin; Lehnert, Jonathan D.; Mitchko, Jane; London, Joel; Zaki, Sherif R.; King, Brian A.; Jones, Christopher M.; Patel, Anita; Delman, Dana Meaney; Koppaka, Ram; Griffiths, Anne; Esper, Annette; Calfee, Carolyn S.; Hayes, Don; Rao, Devika R.; Harris, Dixie; Smith, Lincoln S.; Aberegg, Scott; Callahan, Sean J.; Njai, Rashid; Adjemian, Jennifer; Garcia, Macarena; Hartnett, Kathleen; Marshall, Kristen; Powell, Aaron Kite; Adebayo, Adebola; Amin, Minal; Banks, Michelle; Cates,, Jordan; Al-Shawaf, Maeh; Boyle-Estheimer, Lauren; Briss, Peter; Chandra, Gyan; Chang, Karen; Chevinsky, Jennifer; Chiang, Katelyn; Cho, Pyone; DeSisto, Carla Lucia; Duca, Lindsey; Jiva, Sumera; Kaboré, Charlotte; Kenemer, John; Lekiachvili, Akaki; Miller,, Maureen; Mohamoud, Yousra; Perrine, Cria; Shamout, Mays; Zapata, Lauren; Annor, Francis; Barry, Vaughn; Board, Amy; Evans, Mary E.; Gately, Allison; Hoots, Brooke; Pickens, Cassandra; Rogers, Tia; Vivolo-Kantor, Alana; Cyrus, Alissa; Boehmer, Tegan; Glidden, Emily; Hanchey, Arianna; Werner, Angela; Zadeh, Shideh Ebrahim; Pickett, Donna; Fields, Victoria; Hughes, Michelle; Neelam, Varsha; Chatham-Stephens, Kevin; O’Laughlin, Kevin; Pomeroy, Mary; Atti, Sukhshant K.; Freed, Jennifer; Johnson, Jona; McLanahan, Eva; Varela, Kate; Layden, Jennifer; Meiman, Jonathan; Roth, Nicole M.; Browning, Diane; Delaney, Augustina; Olson, Samantha; Hodges, Dessica F.; Smalley, Raschelle (2019). "Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019". MMWR. Morbidity and Mortality Weekly Report. 68 (41). doi:10.15585/mmwr.mm6841e3. ISSN 0149-2195.CS1 maint: extra punctuation (link)  This article incorporates text from this source, which is in the public domain.
  3. ^ a b c d "Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping". Centers for Disease Control and Prevention (CDC). 3 October 2019.  This article incorporates text from this source, which is in the public domain.
  4. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab "CDPH Health Alert: Vaping-Associated Pulmonary Injury" (PDF). California Tobacco Control Program. California Department of Public Health. 28 August 2019. pp. 1–5.  This article incorporates text from this source, which is in the public domain.
  5. ^ Henry, Travis S.; Kanne, Jeffrey P.; Kligerman, Seth J. (September 2019). "Imaging of Vaping-Associated Lung Disease". The New England Journal of Medicine. doi:10.1056/NEJMc1911995. ISSN 0028-4793. PMID 31491070.
  6. ^ Christiani, David C. (September 2019). "Vaping-Induced Lung Injury". The New England Journal of Medicine. doi:10.1056/NEJMe1912032. ISSN 0028-4793. PMID 31491071.
  7. ^ Hswen, Yulin; Brownstein, John S. (2019). "Real-Time Digital Surveillance of Vaping-Induced Pulmonary Disease". New England Journal of Medicine. doi:10.1056/NEJMc1912818. ISSN 0028-4793. PMID 31539466.
  8. ^ Gotts, Jeffrey E; Jordt, Sven-Eric; McConnell, Rob; Tarran, Robert (2019). "What are the respiratory effects of e-cigarettes?". BMJ: l5275. doi:10.1136/bmj.l5275. ISSN 0959-8138.
  9. ^ Fentem, Sarah (4 October 2019). "As More People Die After Using Vaping Products, St. Louis Doctor Warns Of The Risks". KWMU.
  10. ^ Naftulin, Julia (6 September 2019). "A number of vape-related lung illnesses are linked to 'Dank Vapes,' a mysterious black market brand selling THC products". Insider.
  11. ^ Bentley, Jimmy (7 October 2019). "First Massachusetts Vape-Related Death Confirmed". Patch Media.
  12. ^ Carlos, W. Graham; Crotty Alexander, Laura E; Gross, Jane E; Dela Cruz, Charles S; Keller, Jonathan M; Pasnick, Susan; Jamil, Shazia (September 2019). "ATS Health Alert—Vaping Associated Pulmonary Illness (VAPI)". American Journal of Respiratory and Critical Care Medicine. 200 (7): P15–P16. doi:10.1164/rccm.2007P15. ISSN 1073-449X. PMID 31532698.
  13. ^ a b c Carlos, W. Graham; Crotty Alexander, Laura E; Gross, Jane E; Dela Cruz, Charles S; Keller, Jonathan M; Pasnick, Susan; Jamil, Shazia (September 2019). "Vaping Associated Pulmonary Illness (VAPI)". American Journal of Respiratory and Critical Care Medicine. 200 (7): P13–P14. doi:10.1164/rccm.2007P13. ISSN 1073-449X. PMID 31532695.
  14. ^ Layden, Jennifer E.; Ghinai, Isaac; Pray, Ian; Kimball, Anne; Layer, Mark; Tenforde, Mark; Navon, Livia; Hoots, Brooke; Salvatore, Phillip P.; Elderbrook, Megan; Haupt, Thomas; Kanne, Jeffrey; Patel, Megan T.; Saathoff-Huber, Lori; King, Brian A.; Schier, Josh G.; Mikosz, Christina A.; Meiman, Jonathan (2019). "Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report". New England Journal of Medicine. doi:10.1056/NEJMoa1911614. ISSN 0028-4793. PMID 31491072.
  15. ^ "Initial State Findings Point to Clinical Similarities in Illnesses Among People Who Use E-cigarettes or "Vape"". Centers for Disease Control and Prevention (CDC). 6 September 2019.  This article incorporates text from this source, which is in the public domain.
  16. ^ Ghinai, Isaac; Pray, Ian W.; Navon, Livia; O’Laughlin, Kevin; Saathoff-Huber, Lori; Hoots, Brooke; Kimball, Anne; Tenforde, Mark W.; Chevinsky, Jennifer R.; Layer, Mark; Ezike, Ngozi; Meiman, Jonathan; Layden, Jennifer E. (2019). "E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019". MMWR. Morbidity and Mortality Weekly Report. 68 (39): 865–869. doi:10.15585/mmwr.mm6839e2. ISSN 0149-2195. PMID 31581166.  This article incorporates text from this source, which is in the public domain.
  17. ^ Henry, Travis S.; Kligerman, Seth J.; Raptis, Constantine A.; Mann, Howard; Sechrist, Jacob W.; Kanne, Jeffrey P. (2019). "Imaging Findings of Vaping-Associated Lung Injury". American Journal of Roentgenology: 1–8. doi:10.2214/AJR.19.22251. ISSN 0361-803X. PMID 31593518.
  18. ^ "Quebec resident confirmed as first Canadian case of vaping-related illness". cbc. Retrieved 29 September 2019.

Further readingEdit

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