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CDC provides guidance on treating serious vaping-related illnesses as cases rise :

August 30, 2019

As the number of cases of severe pulmonary disease linked to vaping continues to rise, federal health officials are providing clinicians with additional guidance on treating patients and investigating the cause.

There have been 215 such illnesses reported in 25 states including one death, though etiologies for all have not been confirmed, according to the Centers for Disease Control and Prevention (CDC). All had vaped within days or weeks of getting sick and many had used e-cigarettes with cannabinoid products containing tetrahydrocannabinol (THC) or cannabidiol (CBD).

The patients, many of whom are adolescents and young adults, complained of difficulty breathing, shortness of breath and/or chest pain. Some also experienced diarrhea, vomiting and fatigue, according to the CDC. In addition, there have been reports of fever, tachycardia and elevated white blood cell count, but the CDC does not believe an infectious disease is causing the illnesses.

In some patients, imaging has found bilateral pulmonary infiltrates and diffuse ground-glass opacities. Most have needed supplemental oxygen and some required intubation.

Corticosteroids have been effective in treating some patients, while antimicrobial therapy alone has not, according to the CDC.

The CDC provided the following guidance for clinicians:

  1. Report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days to your state or local health department.
  2. Ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness.
  3. If e-cigarette product use is suspected as a possible etiology of a patient's severe pulmonary disease, obtain a detailed history regarding:
  • Substance(s) used;
  • Substance source(s);
  • Device(s) used;
  • Where the product(s) were purchased;
  • Method of substance use; and
  • Sharing of e-cigarette products with others.
  1. Determine if any remaining product, including devices and liquids, is available for testing.
  2. 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. Consider consultation with specialists.
  3. Clinical improvement of patients with severe pulmonary disease associated 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 etiologies.
  4. Lipoid pneumonia due to inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the detection of lipid-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL) and lipid staining (e.g., oil red O). The decision about whether to perform a BAL should be based on individual clinical circumstances.
  5. Lung biopsies have been performed on some patients. 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. Consultation with specialists in pulmonary medicine and pathology should inform any evaluation plan.
  6. Patients who have received treatment for severe pulmonary disease related to e-cigarette product use should undergo follow-up evaluation as clinically indicated.

Regardless of the ongoing investigation, the AAP and CDC advise that teens, young adults and pregnant women never use e-cigarettes.

The CDC encourages the public to report any unexpected tobacco or e-cigarette-related health or product issues to the FDA online Safety Reporting Portal, http://www.safetyreporting.hhs.gov. The CDC's health advisory also includes recommendations for public health officials and the public. The full detailed alert is available at https://emergency.cdc.gov/han/han00421.asp.

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