“E.V.A.L.I – Weeping lungs due to vaping” 

EVALI: E-cigarette or Vaping use Associated Lung Injury 

What is E-Vaping?

When it comes to addictive substance like caffeine or nicotine, it isn’t the addictive substance that is harmful it’s how it is delivered and thus causing ill health. As we know smoking is becoming a new trend in todays world. E-vaping is one of them. E-vaping is done using electronic cigarettes. An electronic cigarette is a device that simulates the tobacco smoking. It consist of an atomizer, a power source, and a cartridge. Instead of smoking, the user inhales vapors of the “e-juice” which is filled in the cartridge and it contains nicotine. Using an E-Cigarette is often called as “vaping”.

 E-Cigarette is also known as Electronic Nicotine Delivering  System (ENDS). The nicotine is delivered in the form of aerosols through vaping . 

What is EVALI?

 EVALI stands for E-cigarette or Vaping use Associated Lung Injury. Earlier it was also known as VAPI (vaping associated pulmonary illness). The new name is given because there is sudden increase in number of severe lung illness cases due to the use of e-cigarette and vaping products. Pathogenesis The pathogenesis of EVALI is not known. EVALI simulates the clinical features with some lung disease like Community Acquired Pneumonia (CAP), COVID – 19 and hypersensitivity pneumonia.

 According to some reports, it also shows some symptoms of acute eosinophilic pneumonia, diffused alveolar hemorrhage, lipoid pneumonia and respiratory – bronchiolitis interstitial lung disease, suggesting that more than one mechanism of injury may be involved. 

No evidence has been identified for the contamination of disease through infected patient’s fluid and no reports for the bacterial involvement in the fluid. Risk Factors Important risk factor for EVALI is use of e- cigarette or other similar vaping products. Other additives are also reported like cannabinoid oil, nicotine and other substances like coconut oil and limonene.

 After examination of bronchoalveolar lavage fluid (BAL) samples of EVALI patients following products are reported: 

• THC - Tetrahydrocannabinol - the majority of young patients using e-cigarettes are reported with the presence of THC in their bronchoalveolar lavage fluid.

 • Vitamin E acetate - vitamin e acetate is the synthetic form of vitamin E. It increases the fluidity of lung surfactants causing surfactant layer to collapse, and may result in shortnes of breath and lung inflammation

 .• Nicotine - nicotine is also reported in BAL fluid of patients using e-cigarettes as well as it is also reported in asymptomatic individuals who smoked tobacco or used e-cigarettes. 

• Other factors - cannabinoid oil or other plant oils, triglycerides and petroleum distillates:- although these products are not consistently found in BAL fluid of all EVALI patients. 

• Aerosolization devices - E-cigarettes produce aerosol by heating liquid that usually contains nicotine. The devices used for aerosolization includes vape pens, vaporizers, e -pens, e-pipes, e- hookahs and e - cigars. • Dripping - the aerosol substances which are dripped on to the heating element. 

• Dabbing - products smoked in pipes that are highly concentrated with nicotine or THC prepared in wax like substance. 

What are the symptoms of EVALI?

 • Shortness of breath 

• Cough

 • Chest pain

 • Fever and chills 

• Diarrhoea

 • Nausea

 • Vomiting 

• Abdominal pain 

• Rapid heart beat 

• Rapid and shallow breathing 

How is EVALI diagnosed?

 The ailment is still new and hence diagnosis is yet not made by any test. It may be diagnosed by past history of using e-cigarettes or any other vaping device in last 3 months .

 Few X-rays and CT Scans also show the evidence of radio opacities in lungs.

 Prognosis 

EVALI has been found fatal among the patients over the age of 35years and among the patients with history of asthma, cardiac disease or any mental health condition. The mortality rate among obese patients is twice more than non-obese people. Among the recovered patients few were reported with readmissions in hospitals within less than one year of time while others suffered from few abnormalities including lung dysfunction. EVALI is a serious respiratory illness and patients suffering from it may require some oxygen supplements, noninvasive ventilation intubation and mechanical ventilation. 

Conclusion

 E-cigarette, or vaping, product use associated lung injury (EVALI) is an acute or subacute respiratory illness that can be severe and life-threatening caused by inhaling aerosol produced by heating few substances like nicotine or THC in battery operated electronic devices known as E-cigarettes. 

The risk factors include compounds like nicotine, vitamin E acetate and THC. The symptoms of EVALI appears within 2months starting with fever, gastrointestinal symptoms commonly nausea , vomiting , diarrhoea and abdominal pain. 

On taking X-ray of the chest few opacities are seen in the lungs.

 Until more is known about the specific cause of EVALI, the CDC (Centres for Disease Control and Prevention) advises known about the specific cause of EVALI, the CDC (Centres for Disease Control and Prevention) advises complete avoidance of THC-containing e-cigarettes or vaping products and avoidance of all e-cigarette or vaping products by youths, young adults, pregnant women, and adults who do not currently use tobacco products.