Volume 29, Issue 165, November 2025

Electronic cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI): A Comprehensive Review of Biology, Management, and Outcomes

Wiktoria Kotlarz^1♦, Matylda Kuczma¹, Jakub Molenda2, Marta Kamińska¹, Adrianna Klimczak², Barbara Pietrzak², Mikołaj Patelski², Maciej Czapla³, Wiktoria Mikusek¹, Mateusz Surma³

¹Medical Center HCP, 28 Czerwca 1956 r. 194, 61-485 Poznan, Greater Poland, Poland
²Heliodor Swiecicki Clinical Hospital, Przybyszewskiego 49, 60-355 Poznan, Greater Poland, Poland
³Prof. S. T. Dąbrowski Hospital in Puszczykowo S.A., 11 Józefa Ignacego Kraszewskiego Street, 62-040 Puszczykowo, Greater Poland, Poland

^♦Corresponding author
Wiktoria Kotlarz, Medical Center HCP, 28 Czerwca 1956 r. 194, 61-485 Poznan, Greater Poland, Poland

ABSTRACT

Electronic cigarette, or vaping, product use-associated lung injury (EVALI) is an acute, noninfectious pulmonary syndrome linked to recent use of electronic nicotine-delivery systems and THC-containing vaping products, predominantly affecting adolescents and young adults. Clinically, patients usually present with a range of respiratory, gastrointestinal, and constitutional symptoms, while laboratory tests often reveal elevated inflammatory markers. In this review, the authors conducted a systematic review of original research, including clinical cohorts, epidemiological investigations, computed tomography (CT) pattern studies, bronchoalveolar lavage (BAL) toxicant analyses, experimental cell models, and prospective follow-up. The researchers identified relevant literature through database searches (PubMed; Google Scholar) to synthesize the most current evidence. Imaging studies such as chest CT most frequently disclose organizingpneumonia- spectrum patterns with bilateral ground-glass opacities and subpleural or lobular sparing. Analysis of BAL fluid samples discloses the presence of vitamin E acetate (VEA), which appears to be one of the possible damaging factors. Additionally, experimental cell models demonstrated that similar substances may cause an inflammatory response, injury to alveolar epithelium, and surfactant dysfunction. Management should focus on the immediate cessation of vaping, symptomatic treatment, and administering selective systemic corticosteroids once infection is reasonably excluded. In severe cases, patients may require intensive care therapy. Although short-term survival is generally favorable with contemporary care, a substantial subset of survivors report persistent respiratory, cognitive, and mental health sequelae at one year. Despite these insights, evidence remains largely observational and heterogeneous; prospective, standardized studies are essential for validation biomarkers and evaluating structured survivorship interventions.

Keywords: E-cigarette, or vaping, product use-associated lung injury (EVALI)/ Vaping/ Electronic cigarettes

Medical Science, 2025, 29, e212ms3731

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Published: 07 November 2025