The recent outbreak of e-cigarette or vaping-product use–associated lung injury (EVALI) is alarming. As of October 18, 2019, 33 deaths and nearly 1500 hospitalizations associated with e-cigarette use have been reported in 49 states and the US Virgin Islands. Initial epidemiologic investigations of EVALI cases in Illinois and Wisconsin identified that more than 80% of the reported cases occurred in young white male subjects who presented with respiratory, gastrointestinal, and constitutional symptoms that rapidly progressed to severe acute lung injury. Interestingly, underlying asthma was reported in 30% of these cases, which is much higher than the 8% to 10% of asthmatic patients seen in the general population. Although many questions regarding the safety of e-cigarettes have come to the forefront with the emergence of EVALI, health care providers and concerned parents are also asking what might be causing this outbreak and who might be susceptible to EVALI
