Long-term Outcomes of EVALI: A 1-Year Retrospective Study

January 30, 2022

Experts from the Division of Pulmonary, Allergy and Critical Care Medicine and the Department of Emergency Medicine recently published a report in The Lancet Respiratory Medicine that examines the clinical characteristics and long-term outcomes of patients with e-cigarette or vaping use-associated lung injury (EVALI) one year after their initial hospital admission.

Pulmonary and Critical Care Medicine fellows Richard H. Zou, MD, Perry J. Tiberio, MD, PhD, and Georgios A. Triantafyllou, MD, led by UPMC physician Jason J. Rose, MD, MBA, previously reported clinical characteristics of 36 patients with EVALI in a study published in the American Journal of Respiratory and Critical Care Medicine in 2019.

Their follow-up report examined electronic medical records of 41 patients with EVALI who were admitted to UPMC hospitals between July 2019 and September 2020. They evaluated clinical outcomes, including type and duration of symptoms, emergency department encounters or hospital readmissions, chest radiographic abnormalities, pulmonary function testing, and all-cause mortality within one year after the patients’ first hospitalization.

The median patient age was 21 years, 78% were males, and 68% had at least one comorbid medical condition. 

Approximately half of patients continued to experience respiratory symptoms at the first outpatient follow up visit, but most became asymptomatic within the first year after their initial hospital readmission. 

Additionally, ten patients (24.4%) required hospital readmission within the first year following initial hospitalization for EVALI. These patients had comorbid medical conditions and tended to present with respiratory-related illnesses that led them to seek medical care.

Common radiographic abnormalities, including ground-glass opacities and consolidations, were found on thoracic CT scans during the initial presentation for EVALI. Most radiographic abnormalities resolved within the first year after initial hospital admission. Many of the patients in follow up have abnormal pulmonary function testing. We still do not fully understand the long-term effects of e-cigarette use on the respiratory system. More studies are needed as e-cigarette use becomes more common.  

Several patients continued to vape despite hospital admission with critical illness and counseling regarding the importance of vaping cessation. Individuals who continue to vape are at increased risk for relapse of EVALI-related symptoms.

Ultimately, it is believed that vaping cessation is essential in preventing EVALI recurrence. The authors suggested that future studies should continue to focus on the long-term outcomes of EVALI so that standardized follow-up protocols can be developed to improve the overall pulmonary health of patients. 

It should be noted that the strong faculty mentorship within the Division of Pulmonary, Allergy and Critical Care Medicine allows fellows to reach the early success and visibility present in this follow-up report.

Read more about the study results here.