E-cigarette and Vaping use-Associated Lung Injury (EVALI): The unidentified killer of modern youth

The use of electronic cigarettes has become an integral part of modern youth culture, initially adopted as a safer alternative to traditional tobacco smoking. This shift was driven by active marketing, increased accessibility, and the perception that electronic nicotine delivery systems are permitted for use in any public place. However, electronic cigarette use has been associated with a growing number of severe lung complications, such as lung damage caused by E-cigarette or Vaping product use-Associated Lung Injury (EVALI). This article presents a review primarily based on American literature sources from the PubMed database on EVALI for the period 2019–2023. It includes the history of the lung injury outbreak related to electronic nicotine delivery systems in The United States of America (USA), the definition of EVALI as a diagnosis, its epidemiology, pathophysiological mechanisms, typical clinical symptoms of main variants, lung damage confirmed by imaging methods, diagnostic criteria, and potential outcomes. Clinical manifestations of EVALI can be divided into three groups: systemic, respiratory, and gastrointestinal symptoms. Several forms of EVALI are identified among patients, including organizing pneumonia, diffuse alveolar damage, hypersensitive pneumonitis, acute eosinophilic pneumonia, acute respiratory distress syndrome, respiratory bronchiolitis, interstitial lung disease-associated, acute fibrinous organizing pneumonia, and granulomatous pneumonitis. Histological patterns most commonly observed in lung biopsies of EVALI patients are organizing pneumonia and diffuse alveolar damage. The current understanding suggests that EVALI develops due to oxidative stress caused by ingredients in e-cigarette liquids. These findings can aid clinicians of various specialties in rapid diagnosis and treatment initiation.