Managing EVALI Patients during Flu Season: 6 CDC Recommendations

November 22, 2019

These 6 recommendations from the CDC can aid physicians in differential diagnosis and treatment of EVALI and the flu. 

Influenza season is quickly approaching, which means many patients will be presenting with the classic symptoms such as fever, cough, headache, and fatigue. But could those symptoms be an indicator for another illness? Perhaps e-cigarette or vaping lung injury (EVALI)?

Patients with EVALI can experience symptoms similar to those associated with influenza, making it more difficult for physicians to differentiate between the 2 conditions at first assessment. EVALI remains a diagnosis of exclusion.

To help aid physicians in differential diagnosis and treatment, the US Centers for Disease Control and Prevention (CDC) released updated recommendations this week for managing patients with suspected or known EVALI when influenza is more prevalent in their area.

Here are 6 key recommendations for primary care physicians:

1. Ask patients with symptoms of respiratory or gastrointestinal illness, or other symptoms such as fever, chills, or weight loss, about their use of e-cigarette products. Evaluate patients with suspected EVALI according to previous CDC recommendations.

2. Not all patients with a history of vaping who present for evaluation of respiratory, gastrointestinal, or other symptoms require hospitalization. EVALI patients can be managed on an outpatient basis if they have:

a. Normal levels of oxygen in their blood
b. No respiratory distress
c. No other health conditions that might compromise lung capacity
d. Reliable access to health care should their symptoms worsen
e. Strong social support systems

3. Influenza testing should be strongly considered, especially during flu season, for any patient presenting with symptoms suggestive of infection. Consider prescribing antiviral medications if clinically indicated.

4. Corticosteroids might be helpful in treating EVALI; they have been shown effective in hospitalized patients. Consider corticosteroids for outpatients diagnosed with EVALI on a case-by-case basis. Corticosteroids should be prescribed with caution in these patients because their use has not been well studied in outpatients with EVALI and corticosteroids may worsen respiratory infections.

5. Advising patients on cessation of vaping or e-cigarette use is integral to the care plan. Treatment strategies such as behavioral counseling are recommended to help EVALI patients discontinue using e-cigarette or vaping products.

6. Emphasize the importance of annual flu vaccines for all patients aged ≥6 months, including patients at risk of EVALI. It is not known if EVALI patients are at higher risk for severe complications of flu or other respiratory infections.

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