Five Years Later, No Definitive Cause for EVALI Vaping Injuries and Deaths Found: Study

E-cigarette users continue to be diagnosed with the mystery illness to this day, leading researchers to warn that it is necessary to continue investigating the potential causes in case of another widespread outbreak emerges.

A nationwide health crisis emerged in 2019, when a number of teens and young adults began suffering from severe breathing problems linked to e-cigarette use, prompting a multi-state investigation that uncovered over 200 cases of they mystery vaping injury across 25 states.

The U.S. Centers for Disease Control and Prevention (CDC) launched an investigation into the illnesses, which health officials termed e-cigarette or vaping-associated lung injury (EVALI), a serious respiratory condition linked to vaping products.

Preliminary findings pointed to a connection between the illnesses and e-cigarette products containing THC (tetrahydrocannabinol), the psychoactive component in marijuana, as well as vitamin E acetate, an additive often used to dilute THC oil. This oil, when inhaled, was found to interfere with lung function and cause severe respiratory distress.

After identifying these common factors, federal officials confirmed the outbreak of EVALI resulted in more than 50 fatalities nationwide and left thousands of others hospitalized with life-threatening lung injuries.

However, a new study published in the journal Pediatric Pulmonary on December 23, notes that, five years later, no concrete root cause for the vaping illnesses has been determined.

The onset of the vaping lung illness outbreak in mid-to-late 2019 was complicated by the COVID-19 pandemic in 2020. Patients suffering from vaping lung illness experienced cough, shortness of breath, chest pain, fever, chills, nausea, rapid heartbeat and shallow breathing. However, symptoms are also often experienced by individuals with COVID-19.

Researchers from the University of North Carolina at Chapel Hill conducted a comprehensive review of published studies, case reports, and CDC data to examine the treatment and challenges of managing EVALI during the pandemic. Their analysis included eight studies highlighting cases where patients were initially misdiagnosed with COVID-19 or pneumonia, despite testing negative for COVID-19.

These individuals were later accurately diagnosed with EVALI, highlighting the complexities of distinguishing between similar respiratory illnesses during a public health crisis.

The researchers, led by Ilona Jaspers, said the exact cause of vaping lung illness is not completely understood but echoed the findings of the CDC, that cases are linked to the use of THC and vitamin E acetate in vapes. Definitively diagnosing vaping lung illness cases was difficult when many patients suffered from other lung conditions, they determined. Especially since there are no biomarkers to diagnose the vaping illness. EVALI is typically diagnosed through a process of eliminating other possible conditions, including COVID-19 and pneumonia.

Jaspers and colleagues also said it is necessary to continue looking for diagnostic markers of EVALI. They indicated investigations into the toxicity of vapes and their side effects are needed to help prevent another vaping lung illness epidemic among teens and adults, noting that there are still rare EVALI cases being diagnosed to this day.

“After alerting the public about the removal of vitamin E acetate from vape liquids in 2020, there has been a decline in cases of EVALI, although they are still detected,” Jaspers said. “Therefore, it is necessary to continue looking for diagnostic markers of EVALI and further investigate the toxicity of vapes and e-cigarettes to prevent the recurrence of another EVALI epidemic, especially among teenagers and young adults.”

Vaping Health Concerns

EVALI is not the only concern researchers and public health officials have with regard to vaping. Other studies have linked a number of different concerns to e-cigarettes, including diverse illnesses and youth addiction.

A 2023 CDC survey indicated 2.13 million middle and high school students in the United States reported currently using e-cigarettes. This means that while vaping use rates have dropped over the past decade largely due to public awareness efforts, many teens are still at risk of suffering side effects from vaping.

Research has linked the use of e-cigarettes to seizures, increased risk of pneumonia and other respiratory conditions, as well as changes to human DNA that are similar to those caused by traditional cigarettes.