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Evali (E-Cigarette or Vaping-Associated Lung Injury)

Medically reviewed by Last updated on Feb 6, 2023.

What is e-cigarette or vaping-associated lung injury (EVALI)?

EVALI is life-threatening lung damage from vaping. Effects can start days to weeks after you use a vaping product.

The Lungs

What causes EVALI?

The cause is not known for sure. The following may cause or increase your risk for EVALI:

  • Vitamin E acetate (oil) can harm lung function. Vitamin E acetate is sometimes used to thicken vaping products, especially products containing THC (marijuana). Vitamin E can safely be used as a vitamin supplement or in skin care products. But it can prevent your lungs from working correctly if you inhale it.
  • Direct lung damage may happen from chemicals, fumes, and metals. The liquid form of some substances can change when it becomes a vapor. New, harmful chemicals can be produced that were not in the liquid. They can also react or combine with other chemicals, causing more damage. Metals such as nickel, tin, and aluminum can be put into your lungs.

What are the signs and symptoms of EVALI?

You may feel like you have the flu at first. The following can happen suddenly or get worse quickly:

  • A cough or shortness of breath
  • Pain in your chest or abdomen
  • A fast heartbeat or fast breathing
  • Fever and chills
  • Nausea, vomiting, or diarrhea
  • Weight loss without trying

How is EVALI diagnosed?

Tell your healthcare provider when your symptoms began, and if they are getting worse. No test is available to diagnose EVALI. Your provider will rule out other conditions, such as pneumonia or the flu. He or she may diagnose EVALI based on your vaping activity and results of certain tests. Tell your provider if you have a health condition, especially a lung condition such as asthma or COPD.

  • Describe what you vaped. Tell your provider what you used, when you used it, and how much you used. Include the product brand name and delivery device you used. It will also help if you include where you got the product. Make sure you tell your provider if you added vitamin E acetate or other additive.
  • A pulse oximeter is a device that measures the amount of oxygen in your blood. A low oxygen level can be a sign that your lungs are not working well.
    Pulse Oximeter
  • Bronchoscopy is a procedure to look inside your airway and learn the cause of your condition. A bronchoscope (thin tube with a light) is inserted into your nose or mouth and moved down your throat to your airway. Tissue and fluid may be collected from your airway or lungs to be tested.
  • Samples from your nose or lungs may be tested for viruses. Blood samples may be tested for signs or inflammation or other problems. You may also be asked to give a urine sample to check your THC level.
  • X-rays or CT scans may be used to check your lungs for pneumonia or signs of damage.

How is EVALI treated?

EVALI is almost always treated in the hospital. This is especially important if your condition is severe or you have other health problems. If you are a woman, tell your healthcare provider if you are or think you may be pregnant. EVALI can be more dangerous during pregnancy. Any of the following may be needed to treat your symptoms:

  • Medicine may be given for a fever, pain, or inflammation. Medicine may also be given to help prevent or fight a bacterial or viral infection.
  • Extra oxygen may be given if your oxygen level is too low. A respirator may be used to help you breathe.

What do I need to do if I am not admitted to the hospital?

You must follow up with healthcare providers in 24 to 48 hours. Someone needs to stay with and care for you until your follow-up visit. The person needs to know the signs and symptoms of EVALI to watch for. Signs and symptoms can be mild at first but become severe quickly. The person will need to help you get immediate care if your symptoms get worse.

What can I do to prevent or manage EVALI?

  • Stop using vaping products until the cause is known. Authorities recommend that you at least do not use products that contain THC. But it is not known for sure which vaping products cause EVALI. It is safest to stop using all vaping products until the cause is known. Ask your healthcare provider for information if you want to quit but need help. Do not start or go back to smoking cigarettes in place of vaping.
  • Do not buy any vaping products from outside sources. If you plan to continue vaping, only buy from licensed sources. This is especially important if you want to vape products that contain THC. Do not use vaping products given to you by friends or family members.
  • Never add vitamin E acetate to thicken a product. This is especially important for products that contain THC. You may want to stop adding anything to your vaping products until the cause of EVALI is known.
  • Call your healthcare provider right away if you have symptoms of EVALI. Even if your symptoms are mild, let your provider know. Symptoms can get worse quickly.
  • Ask about vaccines you may need. Influenza (the flu), COVID-19, and pneumonia can become life-threatening for a person who has EVALI. Get a flu vaccine as soon as recommended each year, usually starting in September or October. Get a COVID-19 vaccine and recommended booster doses. The pneumonia vaccine may be given every 5 years, or as directed. Ask about other vaccines you may need and when to get them.

Where can I find support and more information?

  • US Food and Drug Administration
    10903 New Hampshire Avenue
    Silver Spring , MD 20993
    Phone: 1- 888 - 463-6332
    Web Address:
    Phone: 1- 800 - 784-8669
    Web Address:

Call your local emergency number (911 in the US) if:

  • You have severe breathing problems.
  • You have chest pain.

When should I seek immediate care?

  • Your symptoms get worse.
  • You cough up blood.
  • Your heart beats more than 100 beats in 1 minute.
  • You are very tired, confused, and cannot think clearly.
  • Your lips or fingernails turn gray or blue.

When should I call my doctor?

  • You have a fever higher than 101°F (38.3°C).
  • You cannot eat, or you have loss of appetite, nausea, or are vomiting.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

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