The multistate outbreak of vaping-related lung injury is ongoing, but the CDC's updated interim guidance can help physicians navigate the clinical evaluation and management of these patients.
Reported cases of e-cigarette, or vaping, product use associated lung injury (EVALI) has been on the rise across the US with 1479 confirmed and probable cases reported in 49 states and 33 confirmed deaths in 24 states as of October 15. Because this multistate outbreak is ongoing, patient information is still being collected. The cause of the lung injury is still unknown. The US Centers for Disease Control and Prevention (CDC) recently released their updated interim guidance to provide a framework for physicians in their initial clinical evaluation and management of suspected patients with EVALI. Above, we highlight these recommendations.
Physical Exam: Assess vital signs and O2 saturation via pulse-oximetry. Lab testing: Infectious disease evaluation might include respiratory viral panel (including influenza during flu season), Streptococcus pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, endemic mycoses, and opportunistic infections. During initial lab evaluation, consider CBC with differential, ALT/AST, and inflammatory markers. For all patients, a urine toxicology should be conducted (with informed consent) including testing for THC.
Other considerations. Further evaluation of patients meeting inpatient admission criteria may include:
Admission criteria and outpatient management. Admit patients for decreased O2 saturation on room air (consider modifying factors such as altitude to guide interpretation of measured O2 saturation), respiratory distress, and comorbidities that compromise pulmonary reserve. Consider outpatient management for patients with clinically stable, less severe injury, and for whom follow-up within 24-48 hours of initial evaluation can be assured. Outpatient management for patients with suspected lung injury that is less severe may be considered case-by-case.
Patients not admitted to hospital:
Post-hospital discharge follow-up:
Cessation services and preventive care: