lung disease

CDC Releases New Vaping-Related Lung Injury Guidance

The Centers for Disease Control and Prevention (CDC) has release two reports concerning vaping and e-cigarette, or vaping, product use–associated lung injury (EVALI).

“Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment,” the authors wrote.

For this reason, they issued 7 recommendations for health care providers treating patients with EVALI during times when respiratory infections are more present in the community.1

The recommendations are as follows:

  • Patients with respiratory, gastrointestinal, or constitutional symptoms should be asked about the use of e-cigarette, or vaping, products.
  • Patients suspected to have EVALI should be evaluated with pulse oximetry and chest imaging, as clinically indicated.
  • Outpatient management should be considered for clinically stable EVALI patients who meet certain criteria.
  • Patients should be tested for influenza, particularly during influenza season, and antimicrobials, including antivirals, should be administered in accordance with established guidelines.
  • Caution should be used when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections.
  • Evidence-based treatment strategies, including behavioral counseling, should be recommended to help patients discontinue using e-cigarette, or vaping, products.
  • The importance of annual influenza vaccination should be emphasized for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products.

In the second report, the CDC updated the total number of EVALI cases to 2172 as of November 13, 2019 and announced that they will no longer be collecting national data on cases of EVALI that do not require hospitalization.2

“Available data suggest that nonhospitalized EVALI patients have similar demographic and product use characteristics as do hospitalized EVALI patients. In anticipation of increasing incidence of influenza and other respiratory infections during the winter, CDC engaged with state health departments and clinical partners to assess the value of continuing to report EVALI patients who are not hospitalized,” they wrote.

Due to the likely “significant burden on health systems and health departments during the emerging 2019–20 influenza season” the CDC decided that they will no longer request national data on outpatient EVALI patients.

“Further collection of data on nonhospitalized patients will be at the discretion of individual state, local, and territorial health departments.”

—Michael Potts

References:

  1. Jatlaoui TC, Wiltz JL, Kabbani S, et al; Lung Injury Response Clinical Working Group. Update: interim guidance for health care providers for managing patients with suspected e-cigarette, or vaping, product use–associated lung injury — United States, November 2019 [published online November 19, 2019]. MMWR Morb Mortal Wkly Rep. doi: http://dx.doi.org/10.15585/mmwr.mm6846e2.
  2. Chatham-Stephens K, Roguski K, Jang Y, et al; Lung injury response epidemiology/surveillance task force; lung injury response clinical task force. characteristics of hospitalized and nonhospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use–associated lung injury — United States, November 2019 [published online November 19, 2019]. MMWR Morb Mortal Wkly Rep. doi: http://dx.doi.org/10.15585/mmwr.mm6846e1.