EVALI: Symptoms, Causes, Diagnosis, Treatment and When to Seek Emergency Care — What You Need to Know
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
Quick Answer: EVALI (e-cigarette- or vaping-use-associated lung injury) is a serious inflammatory condition that damages your lungs and often requires hospitalization; about 90% of reported cases need inpatient care. It's linked to vaping, and the strongest suspected contributor is vitamin E acetate, an additive sometimes used in THC-containing vape liquids that's safe to eat or put on skin but can damage lung tissue when heated and inhaled. Symptoms cluster around breathing (chest pain, cough, shortness of breath and fast heartbeat), but fever, chills, abdominal pain, nausea and diarrhea can accompany them. The critical warning: if you vape (even rarely) and feel like you can't get enough air into your lungs, call 911 or go to the emergency room immediately. [1]
EMERGENCY: CALL 911 OR GO TO THE ER IMMEDIATELY if you feel like you can't get enough air into your lungs.
TL;DR
EVALI is a serious inflammatory lung injury caused by vaping, which means using an electronic device that inhales tiny particles of liquid nicotine and flavoring. The condition can strike anyone who used vaping products up to 90 days before symptoms began, which makes the link between vaping and symptoms far from obvious at first.
EVALI arrives in two patterns: acute (sudden onset, shorter duration) or subacute (gradual, steadier progression). Roughly 9 in 10 reported cases require hospitalization, and severe cases can be fatal. The leading suspected chemical culprit is vitamin E acetate, a synthetic form of vitamin E added to some THC vape liquids. It is harmless on skin or in the stomach, but damaging when heated into vapor and inhaled.
The good news is that treatment helps most people feel better within several days, and the damage appears reversible if you stop vaping and get treated. The honest caveat is that EVALI is still new (the first U.S. case was reported in 2019), so providers are still learning about its long-term effects, and some people develop symptoms again after treatment ends.
Limitation statement: The referenced clinical source reports that about 90% of reported EVALI cases require hospitalization, with nearly 3,000 hospitalizations and almost 70 deaths recorded as of early 2020. It does not publish current prevalence or incidence figures for EVALI. No additional statistics are invented here; everything in this article comes directly from the cited source.
What Is EVALI?
E-cigarette- or vaping-use-associated lung injury (EVALI) is a serious inflammatory condition that damages your lungs. It develops as a result of vaping, which means using a small electronic device to breathe in tiny particles of liquid nicotine and flavoring. [1]
One of the most important things to understand about EVALI is the timing. It can affect people who used vaping products up to 90 days before symptoms started. So even if you haven't vaped in weeks, recent vaping history is still medically relevant. [1]
EVALI can develop suddenly and last only a little while (acute) or progress gradually and steadily over a longer period (subacute). Severe cases can be fatal. [1]
How serious is EVALI?
EVALI is serious. About 90% of reported EVALI cases require hospitalization. As of early 2020, EVALI was responsible for nearly 3,000 hospitalizations and almost 70 deaths. [1]
Is EVALI long-term?
EVALI is a relatively new condition; the first reported case in the United States was in 2019. As a result, healthcare providers and medical researchers aren't sure of EVALI's long-term effects or outlook. [1]
What Symptoms Does EVALI Cause?
EVALI symptoms generally affect your breathing, but they may also cause abdominal issues, fever and chills. That mix is partly why EVALI can mimic infections and other lung conditions. [1]
Symptom | Category |
Chest pain | Breathing |
Cough | Breathing |
Shortness of breath (dyspnea) | Breathing |
Accelerated heartbeat (tachycardia) | Breathing/circulation |
Abdominal pain | Digestive |
Nausea and vomiting | Digestive |
Diarrhea | Digestive |
Fever | Systemic |
Chills | Systemic |
Unexplained weight loss | Systemic |
In some cases, EVALI may cause death. [1]
What Causes EVALI?
Using e-cigarettes and vaping cause EVALI. Healthcare experts aren't sure which components of e-liquids (e-juice or vape juice) directly lead to inflammation, but there may be a link between EVALI and vitamin E acetate. [1]
What is the vitamin E acetate connection?
Vitamin E acetate is a synthetic form of vitamin E. Manufacturers may add it to e-liquids that contain THC (tetrahydrocannabinol), the primary chemical in marijuana that causes you to feel high. [1]
The paradox is striking: vitamin E acetate is safe to ingest or apply to your skin as a lotion or cream, but it may cause lung damage when you heat it and inhale it as a vapor. [1]
Is EVALI reversible?
Medical professionals aren't entirely sure if EVALI is reversible. However, as they collect more information, it seems like EVALI damage may be reversible if you stop vaping and get treatment from a healthcare provider. [1]
Who does EVALI affect?
EVALI can affect anyone who vapes. However, you may be at a greater risk of hospitalization from EVALI if you are younger than 35, vape THC, or use THC-containing vapes from informal sources, such as online sellers, family or friends. [1]
Risk Factor | Detail |
Age under 35 | Younger vapers carry greater hospitalization risk |
Vaping THC | THC-containing products carry elevated risk |
Informal sources | Online, family or friends: products without regulated quality controls |
How Is EVALI Diagnosed?
EVALI can be challenging to diagnose because it has the same symptoms as many other lung conditions. Your provider starts by reviewing your medical history and performing a physical exam, listening to your lungs with a stethoscope (auscultation). [1]
They'll also ask questions such as: What are your symptoms? Do you vape? Have you vaped in the last three months? Do you vape nicotine, THC or both? Where did you get the e-liquid for your vape? [1]
Test | What It Measures |
Blood oxygen level test | How much oxygen is in your blood; low levels indicate lung damage; measured via blood sample or pulse oximetry |
Imaging tests (chest X-ray or CT scan) | Painless, noninvasive tests that look for lung damage |
Pulmonary function tests (PFTs) | Determine how well your lungs work |
How Is EVALI Treated?
Because EVALI shares many of the same symptoms as lung infections such as pneumonia, a healthcare provider may initially treat you with antibiotics or antivirals to rule out an infection. Your treatment may also include several targeted approaches. [1]
Treatment | How It Works |
Corticosteroids | Reduce inflammation; may be delivered via inhaler or nebulizer so you breathe them directly into your lungs |
Oxygen therapy | Supplemental "extra" oxygen through a nasal cannula: two flexible prongs in your nostrils connected to an oxygen tank |
Mechanical ventilation | A ventilator machine that partially or entirely breathes for you in severe cases |
How soon after treatment will I feel better?
Most people start to feel better a few days after beginning EVALI treatment. However, it may take longer to return to your usual activities after treatment. A healthcare provider will tell you what to expect. [1]
What's the Outlook?
EVALI is a relatively new condition and healthcare experts aren't sure of its long-term effects. Some people develop symptoms again after they finish treatment, so it's important to schedule follow-up appointments with a healthcare provider. Your provider may refer you to a pulmonologist, a doctor who specializes in diagnosing and treating conditions that affect your lungs and other parts of your respiratory system. [1]
When should I seek immediate care?
EMERGENCY BANNER: CALL 911 OR GO TO THE ER IMMEDIATELY IF you feel like you can't get enough air into your lungs.
Seek a healthcare provider if you vape and have symptoms of EVALI. Call your provider immediately if your symptoms come back after treatment.
How Can EVALI Be Prevented?
You can prevent EVALI by avoiding vaping products, especially those containing THC or vitamin E acetate. If you vape, make sure you buy vaping products from a licensed seller. [1]
How do I take care of myself if I have EVALI?
If you have EVALI, your healthcare provider will work with you to develop a treatment plan. Be sure to take all your prescribed medications. Your provider will also help you quit vaping; many tips that help people quit smoking can also help you quit vaping. [1]
When should I see a healthcare provider?
See a healthcare provider if you vape and have symptoms of EVALI. Call your provider immediately if your symptoms come back after treatment. Schedule follow-up appointments to test how well your lungs work and determine your blood oxygen levels. [1]
A note from your care team: "E-cigarette- or vaping-use-associated lung injury (EVALI) causes inflammation in your lung tissues. If you vape, even rarely, and develop symptoms of EVALI, see a healthcare provider or go to the ER. Treatment helps most people feel better within several days. If you don't vape, it's a good idea not to start. If you do, healthcare providers are available to help you quit."
What questions should I ask a healthcare provider?
Question | Why It Matters |
How do you know I have EVALI? | Confirms the diagnosis reasoning |
Is there permanent damage to my lungs? | Long-term outlook is still unknown |
When should I start to feel better? | Sets recovery expectations |
What do I do if my symptoms come back? | Relapse is possible, so you need a plan |
How often should I schedule follow-up appointments? | Lung function and blood oxygen need monitoring |
Can you recommend a vaping cessation program or a vaping support group? | Quitting support improves outcomes |
Conclusion: If You Vape and Develop Lung Symptoms, Don't Wait
EVALI is the cautionary tale of vaping: a serious inflammatory lung injury that sent about 90% of its early cases to the hospital and was linked to a common additive, vitamin E acetate, that's perfectly safe on skin but dangerous when inhaled as vapor. The 90-day window means even vaping that happened weeks earlier matters.
The encouraging part: most people feel better within a few days of starting treatment, and the damage appears reversible if you stop vaping and get treated. The uncertain part: EVALI is so new that its long-term effects are still unknown, and relapses happen. Prevention is simple: avoid vaping, especially THC products or those from informal sources, and if you do vape, buy from licensed sellers only. If you feel like you can't get enough air into your lungs, call 911 or go to the ER immediately.
Frequently Asked Questions
What does EVALI stand for?
EVALI stands for e-cigarette- or vaping-use-associated lung injury. It's a serious inflammatory condition that damages your lungs as a result of vaping. [1]
Is EVALI a serious condition?
Yes. About 90% of reported EVALI cases require hospitalization, and as of early 2020 it was responsible for nearly 3,000 hospitalizations and almost 70 deaths. Severe cases can be fatal. [1]
Can EVALI kill you?
Yes, in some cases EVALI may cause death. It's a serious inflammatory condition that can severely damage your lungs. [1]
What causes EVALI?
Using e-cigarettes and vaping cause EVALI. There may be a link between EVALI and vitamin E acetate, a synthetic form of vitamin E sometimes added to THC-containing e-liquids. [1]
What is vitamin E acetate?
Vitamin E acetate is a synthetic form of vitamin E. Manufacturers may add it to e-liquids that contain THC. It's safe to ingest or apply to skin as a lotion or cream, but it may cause lung damage when heated and inhaled as a vapor. [1]
Can you get EVALI from vaping nicotine only?
EVALI can affect anyone who vapes, and healthcare experts aren't sure which components of e-liquids directly lead to inflammation. THC-containing vapes, especially from informal sources, carry the greatest hospitalization risk. [1]
How soon after vaping can EVALI develop?
EVALI can affect people who used vaping products up to 90 days before symptoms started. [1]
Can you get EVALI from vaping a few weeks ago?
Yes. The 90-day window means someone who vaped weeks before symptoms began can still develop EVALI, so recent vaping history matters when providers evaluate you. [1]
Does EVALI come on suddenly or gradually?
Both. EVALI can develop suddenly and last only a little while (acute) or progress gradually and steadily over a longer period (subacute). [1]
What is acute EVALI?
Acute EVALI develops suddenly and lasts only a little while. It's one of two patterns the condition can follow. [1]
What is subacute EVALI?
Subacute EVALI progresses gradually and steadily over a longer period. [1]
What are the breathing symptoms of EVALI?
Breathing symptoms include chest pain, cough, shortness of breath (dyspnea) and accelerated heartbeat (tachycardia). [1]
What are the digestive symptoms of EVALI?
Digestive symptoms include abdominal pain, nausea, vomiting and diarrhea. [1]
Can EVALI cause fever and chills?
Yes. Fever and chills are among the systemic symptoms EVALI can cause. [1]
Can EVALI cause weight loss?
Yes. Unexplained weight loss is one of the symptoms EVALI can cause. [1]
Does EVALI look like a lung infection?
Yes. EVALI has the same symptoms as many other lung conditions, which is why it can be challenging to diagnose and why providers may initially prescribe antibiotics or antivirals to rule out infection. [1]
Who is most at risk of EVALI hospitalization?
You may be at greater risk of hospitalization from EVALI if you are younger than 35, vape THC, or use THC-containing vapes from informal sources such as online sellers, family or friends. [1]
Is EVALI reversible?
Medical professionals aren't entirely sure, but as they collect more information it seems EVALI damage may be reversible if you stop vaping and get treatment from a healthcare provider. [1]
How is EVALI diagnosed?
A provider reviews your medical history, performs a physical exam and listens to your lungs with a stethoscope (auscultation). They'll ask about vaping, what you vape and where you got your e-liquid. Tests may include blood oxygen measurement, chest X-ray or CT scan, and pulmonary function tests. [1]
What tests confirm EVALI?
Providers may order a blood oxygen level test (via blood sample or pulse oximetry), imaging tests (chest X-ray or CT scan), and pulmonary function tests (PFTs) to determine how well your lungs work. [1]
What does a low blood oxygen level mean in EVALI?
Low blood oxygen levels indicate lung damage: the lungs can't transfer enough oxygen into your bloodstream. [1]
How is EVALI treated?
Providers may initially use antibiotics or antivirals to rule out infection, then treat with corticosteroids (via inhaler or nebulizer), oxygen therapy, or mechanical ventilation in severe cases. [1]
Do corticosteroids help EVALI?
Yes. Corticosteroids are drugs that reduce inflammation. Your provider might prescribe an inhaler or nebulizer to deliver them directly into your lungs. [1]
What is oxygen therapy for EVALI?
Oxygen therapy is supplemental "extra" oxygen delivered through a flexible plastic tube with two prongs (a nasal cannula) that go into your nostrils, connected to an oxygen tank. [1]
When does EVALI need a ventilator?
Severe cases of EVALI may require mechanical ventilation, a machine that partially or entirely breathes for you. [1]
How soon will I feel better after EVALI treatment?
Most people start to feel better a few days after beginning EVALI treatment, though it may take longer to return to your usual activities. [1]
Can EVALI come back after treatment?
Yes. Some people develop symptoms again after they finish treatment. That's why scheduling follow-up appointments is important. [1]
What are the long-term effects of EVALI?
Healthcare experts aren't sure yet. EVALI is a relatively new condition (first U.S. case reported in 2019), and providers and researchers are still learning about its long-term effects and outlook. [1]
Can vaping worsen asthma or other lung conditions?
Yes. Vaping can make the symptoms of any other lung conditions you have, like asthma, worse. [1]
How quickly can vaping damage your lungs?
Some studies suggest that vaping can cause lung damage after only three days of use. [1]
How can EVALI be prevented?
You can prevent EVALI by avoiding vaping products, especially those containing THC or vitamin E acetate. If you vape, make sure you buy vaping products from a licensed seller. [1]
Should I see a provider if I vape and have symptoms?
Yes. See a healthcare provider if you vape and have symptoms of EVALI. Call your provider immediately if symptoms come back after treatment, and schedule follow-ups to test lung function and blood oxygen levels. [1]
When should I go to the ER for EVALI?
Call 911 (or your local emergency number) or go to the emergency room immediately if you feel like you can't get enough air into your lungs.
What questions should I ask my provider about EVALI?
Ask how they know you have EVALI, whether there's permanent lung damage, when you should feel better, what to do if symptoms come back, how often to schedule follow-ups, and whether they can recommend a vaping cessation program or support group. [1]
Additional Resources
Related reading on Rinnit:
References
EVALI: Cleveland Clinic (last updated May 2, 2023)
External authoritative references cited on the source page:
Medical Disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare provider with any questions about a medical condition.
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