What is Electronic Cigarette Disease (EVALI)?

Electronic cigarette disease (EVALI) is a health problem characterized by severe lung inflammation due to vaping. If not diagnosed and treated early, life-threatening complications can occur. Therefore, it is important to first understand the answer to the question “What is EVALI disease?” and to be informed about how to prevent health problems that may arise due to the use of electronic cigarette puffs.

What Causes EVALI, the Electronic Cigarette Disease?

It is possible to answer the question “What is EVALI?”, which has been frequently mentioned in recent years, briefly as electronic cigarette disease. EVALI disease (EVALIE-cigarette and vaping use associated lung injury) is a health problem that manifests itself with lung damage due to electronic cigarette use. In other words, the cause of EVALI disease is the use of electronic cigarettes, also commonly called puffs. In recent years, some studies on people who use electronic cigarettes have shown that vitamin E acetate has been found in fluid samples taken by bronchoalveolar lavage (BAL) method used in the diagnosis of various lung diseases. These results suggest to experts that there is a close relationship between EVALI and vitamin E acetate.

Vitamin E acetate is a kind of chemical often used to regulate or thicken the consistency of the liquids of electronic cigarettes containing THC (tetrahydrocannabinol). Vitamin E acetate can stay in the lungs for a long time and cause serious health problems. The CDC (Centers for Disease Control and Prevention) therefore recognizes vitamin E acetate as a potential toxin. However, there are many chemicals in electronic cigarette types with and without THC (tetrahydrocannabinol) that can cause EVALI disease. Therefore, although the exact cause of EVALI disease is unknown, it can be said that various chemicals in the electronic cigarette compound cause damage to the lungs.

What are the Symptoms of Electronic Cigarette Disease (EVALI)?

According to research, various chemicals in electronic cigarettes can cause damage to the lungs and trigger inflammation. The symptoms of EVALI can therefore be similar to those of other lung diseases. However, it is important that the symptoms are well evaluated by an expert physician and EVALI is differentiated from other lung diseases so that the treatment process can be planned appropriately for the patient. EVALI is usually manifested by respiratory and digestive disorders. Accordingly, the main symptoms of EVALI can be listed as follows:

• Chest pain
• Cough
• Shortness of breath
• Heart palpitations
• Abdominal pain
• Nausea and vomiting,
• Diarrhea
• High fever
• Tremors
• Loss of appetite
• Involuntary weight loss.

In addition, in some cases of EVALI, symptoms such as shortness of breath can be severe and patients may need a respirator. Therefore, it is possible to say that life-threatening problems may occur in patients if not intervened in the early period.

How is Electronic Cigarette Disease (EVALI) Diagnosed?

Because the symptoms of EVALI are similar to those of lung diseases such as pneumonia, it is not always easy to diagnose. Patients presenting with complaints such as shortness of breath, cough and nausea are evaluated in detail by a specialist doctor. At this stage, experts may ask various questions to obtain the patient’s medical history, such as what symptoms the patient has, whether the patient smokes or has used electronic cigarettes in the last 90 days. Experts may recommend X-rays for patients with a history of vaping in the last 90 days, even if their symptoms are mild. In addition, in patients with low oxygen saturation (< 95%), specialists may decide to perform imaging with CT (computed tomography). In addition to these, other diagnostic methods used in the diagnosis of EVALI are as follows:

• Blood tests to measure oxygen levels in the blood,
• Finger oxygen measurement using an oximeter,
• Pulmonary function tests (PFTs) that can help assess lung function.

In addition, bronchoscopy may be necessary to rule out other infectious diseases that cause damage to the lungs, especially in people whose immune system is suppressed for any reason and who are therefore at risk of infectious diseases. In addition, a urine toxicology test can be performed to investigate the presence of tetrahydrocannabinol (THC) in the urine sample if necessary.

Ways to Prevent Electronic Cigarette Disease (EVALI)

Since vaping is closely associated with the use of electronic cigarettes and heated tobacco products, the most effective method known to prevent EVALI is to avoid vaping. In addition, it is important for those who have difficulty in abandoning the use of electronic cigarettes to stay away from electronic cigarettes sold illegally and to obtain products from reliable places if possible. According to research, the vast majority of EVALI cases are associated with the use of electronic cigarette products containing the chemical THC. For this reason, experts recommend avoiding THC-containing electronic cigarette products when it is not possible to quit vaping completely. Accordingly, the main EVALI prevention methods are as follows:

• Avoiding the use of electronic cigarettes,
• Prefer reliable products,
• Checking whether products contain chemicals such as THC.

In addition to the above-mentioned, since EVALI is a relatively new health problem, in order to protect public health, health authorities should raise public awareness about the harms of puff cigarettes to help protect the public, especially young people, from EVALI.

What are the Risks of E-Cigarette Use?

E-cigarettes are relatively new tobacco products compared to other tobacco products. The fact that electronic cigarettes are touted as a new alternative that can minimize the risk of developing health problems associated with traditional cigarette use and quit smoking causes the use of electronic cigarettes to increase day by day. However, contrary to popular belief, e-cigarettes, like traditional cigarettes, can have significant health risks. Containing health-threatening chemicals such as acetaldehyde, acrolein and formaldehyde, e-cigarettes can cause various health problems, especially lung diseases such as EVALI. The main electronic cigarette harms are as follows:

• Chemicals such as THC, especially vitamin E acetate, can cause inflammation in the lungs and EVALI disease.
• As with other tobacco products, nicotine in e-cigarettes can increase blood pressure and cause heart palpitations. This can increase the risk of developing cardiovascular diseases.
• Like traditional cigarettes, electronic cigarettes can be addictive.
• During pregnancy, it can harm both the expectant mother and the fetus.
• It can cause digestive system problems such as ulcerative colitis.
• It can negatively affect brain development in adults and young people.
• In case of ignition or explosion, serious injury may result.

In addition to the above, although the long-term health effects are not yet clearly known, electronic cigarettes, which contain various chemicals, especially nicotine, acetaldehyde, acrolein and formaldehyde, can cause cancer in the long term.

E-Cigarette Quitting Methods

The use of tobacco and tobacco products, including e-cigarettes, can cause various health problems, including lung diseases and cardiovascular diseases. Those who want to quit e-cigarettes should first seek help from a specialist doctor. In addition, here are some suggestions that can help you quit e-cigarettes:

• Setting a day to quit: For those who decide to quit e-cigarettes, setting a suitable day for themselves and sharing the date they set with their relatives, if possible, can be an important step to quit electronic cigarettes.
• Determining the method of quitting: It is important to determine the method of smoking cessation individually. Smoking can be quit all at once or by reducing the number of cigarettes. At this point, it may be useful for people to choose the method that suits them best.
• Determine why you want to quit e-cigarettes: One of the most important reasons underlying the desire to quit tobacco products is the fear of losing health. In addition, reminding oneself of various reasons, such as saving money, can help to quit e-cigarettes.
• Nicotine replacement therapy: Nowadays there are various products such as nicotine patches, gum, etc. that can help to combat nicotine withdrawal that is likely to occur during the smoking cessation process. Nicotine replacement therapy administered under the supervision of a specialist doctor can help quit e-cigarettes.

In addition, engaging in activities or taking up hobbies that can help reduce stress can also contribute positively to the process of quitting e-cigarettes.