Current incidence of lung injury associated with electronic vaporizers (EVALI) was notably reported during an outbreak primarily in the United States in 2019 and early 2020, with a confirmed 2807 hospitalized cases and 68 deaths as of October 2020, representing approximately a 2.4% mortality rate Benam KH 2024 Cao et al. 2020.
This outbreak highlighted clusters of e-cigarette or vaping product use-associated lung injury (EVALI) cases, predominantly linked to inhalation of vitamin E acetate (VEA) used as a diluent in tetrahydrocannabinol (THC) vape cartridges Cao et al. 2020 Benam KH 2024.
Following the peak in September 2019, the incidence of EVALI declined sharply by February 2020, leading to the cessation of case reporting by the CDC Shin et al. 2022 Cao et al. 2020.
Despite this, EVALI remains a relevant clinical diagnosis, particularly in differential consideration of respiratory symptoms overlapping with other conditions, including COVID-19 Shin et al. 2022.
In terms of broader population-level prevalence, the use of electronic cigarettes and vaporizers has increased substantially, especially among adolescents and young adults, with studies indicating vaping incidence rates around 18.3% in U.S. young adults aged 18–24 years Benam KH 2024.
Although most users do not develop acute lung injury, respiratory symptoms such as wheezing, bronchitic symptoms, and shortness of breath have been associated with e-cigarette use, indicating a subclinical or milder spectrum of lung injury in a significant subset of users Benam KH 2024.
Thus, while the clinically severe presentations characterized by EVALI remain relatively uncommon and temporally clustered, the widespread and increasing use of vaping devices suggests that the overall respiratory health impact may be broader and variable in severity Benam KH 2024 Cao et al. 2020.
Key References
- SmPC: Nicorette 15 mg Inhalator
- SmPC: Nicorette Cools 4mg Lozenge
- SmPC: Nicorette Cools 2mg Lozenge
- SmPC: Nicorette Fruit 2 mg Lozenge
- NICE NG209: Tobacco: preventing uptake, promoting quitting and treating dependence
- (Cao et al., 2020): Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury.
- (Shinbashi and Rubin, 2020): Electronic cigarettes and e-cigarette/vaping product use associated lung injury (EVALI).
- (Llanes et al., 2023): Young Adults' Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study.
- (Mears et al., 2026): Multisystem Toxicity of E-Cigarettes in Preclinical and Clinical Studies: Pathophysiologic Effects of E-Cigarette Aerosol Exposures from Head to Toe.
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- (Benam KH., 2024): Multidisciplinary approaches in electronic nicotine delivery systems pulmonary toxicology: emergence of living and non-living bioinspired engineered systems.