LAUSR

The ongoing U.S. outbreak of vaping-related acute lung injury, recently named EVALI (E-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature reveals 216 patient cases spanning 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, pathologic patterns of lung injury attributable to vaping, as well as provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most common vaped substance and Vitamin E acetate was found in bronchoalveolar lavage specimens from many affected individuals, however no specific component or contaminant has conclusively been identified as the cause for the injury to date. Patients present with cough, dyspnea, constitutional symptoms, and gastrointestinal symptoms. Radiology and histopathology demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the key to an accurate diagnosis. Treatment is supportive, mortality is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease but more rigorous studies are needed to clarify their role in treating vaping related lung injury.