Recommendation 1: Report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette use within the past 90 days to your state or local health department. Reporting cases may help CDC and state health departments pinpoint the cause(s) of these lung illnesses. Recommendation 2: Ask all patients who report e-cigarette use within the last 90 days about signs and symptoms of lung illness.
Recommendation 3: If e-cigarette use is suspected as a possible cause of a patient's severe pulmonary disease, obtain detailed history regarding:
- Substance(s) used: Nicotine, cannabinoids (eg, marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids, hash oil, Dank vapes), flavors, or other substances.
- Where the product(s) were bought.
- Device(s) used: Manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized; and any product modifications by the user.
Recommendation 3 (continued): If e-cigarette use is suspected as a possible cause of a patient's severe pulmonary disease, obtain detailed history regarding:
- Substance source(s): Commercially available liquids, homemade liquids, and reuse of old cartridges/pods with homemade or commercially bought liquids.
- Method of substance use: Aerosolization, dabbing, or dripping.
- Other potential cases include sharing e-cigarette products (devices, liquids, refill pods, or cartridges) with others.
Recommendation 4: Determine if any remaining product, including devices and liquids, are available for testing, which can be coordinated with local or state health departments. Recommendation 5: Consider all possible causes of illness in patients reporting respiratory and gastrointestinal symptoms and of e-cigarette product use; evaluate and treat for other possible causes of illness as clinically indicated; consider consultation with specialists as appropriate.
Recommendation 6: Clinical improvement of patients with severe lung disease linked with e-cigarette use has been reported with the use of corticosteroids. The decision to use corticosteroids should be made on a case-by-case basis based on risks and benefits and the likelihood of other causes.
Recommendation 7: Lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the detection of lipid-laden alveolar macrophages obtained by BAL and lipid staining. Base decision regarding whether to perform a BAL on individual clinical circumstances.
Recommendation 8: If a lung biopsy is obtained, lipid staining may be considered during pathologic examination, and is best performed on fresh tissue. Routine pathology tissue processing can remove lipids. Conducting routine tissue processing and histopathologic evaluation is still important. Consider consultation with specialists in pulmonary medicine and pathology to help inform any evaluation plan.
Recommendation 9: If a patient has received treatment for severe pulmonary disease related to e-cigarette use, conduct a follow-up evaluation as clinically indicated to monitor lung function.
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According to a newly released statement from the Centers for Disease Control and Prevention (CDC), there have been 380 confirmed and probable cases of lung disease associated with electronic cigarette (e-cigarette) use in the US. A count released by the CDC just days earlier was higher because it included possible cases that were being investigated by states; the current number reflects confirmed (patient recently used e-cigarette product, developed a breathing illness, and testing did not show infection) and probable (patient recently used e-cigarette product, developed a breathing illness, and has had some tests to rule out infection) cases. Because of this, the current total is expected to rise as more cases are classified. (continued below)
