The Centers for Disease Control and Prevention (CDC) has released updated guidance on evaluating and treating patients with vaping-related lung injuries.
The guidance comes as 1,299 people have experienced such injuries and 26 have died. About 70% of patients have been male; 80% are under 35 years.
“CDC appreciates the valuable input from national pulmonary and critical care experts in developing science-based recommendations to address this concerning outbreak,” CDC Director Robert R. Redfield, M.D., said in a news release. “CDC will continue its investigation of the cause or causes so that we can bring an end to lung injury cases associated with e-cigarette use.”
About 95% of patients with these lung injuries had respiratory symptoms, and 77% had gastrointestinal symptoms. The CDC recommends asking patients about both as well as about the vaping products and substances they used. About 76% reported using tetrahydrocannabinol (THC)-containing products with or without nicotine, but the CDC has not identified a single substance or device causing the injuries.
Patients should undergo a physical exam including vital signs and oxygen saturation via pulse oximetry, chest radiograph and possibly a chest CT to look for pulmonary infiltrates and opacities, according to the guidance released Friday in theMorbidity and Mortality Weekly Report.
The CDC also recommends consideration of an infectious disease evaluation, urine toxicology testing and a complete blood count with differential, liver transaminases and inflammatory markers. Health officials noted it is possible a patient will have both vaping-related lung injury and a respiratory illness, especially as flu season begins.
Most patients have been hospitalized, which is recommended for those with decreased oxygen saturation or respiratory distress. About 47% have been admitted to an intensive care unit, and 22% have required intubation and mechanical ventilation.
To treat patients with vaping-related lung injury, clinicians may consider corticosteroids. Among 140 patients, 82% improved with corticosteroids, although the CDC could not say for sure whether this treatment was responsible for the improvement. It suggested consulting a pulmonologist when considering this therapy.
Patients should return for follow-up one to two weeks after hospital discharge. Clinicians should stress the importance of not vaping and help patients overcome addictions to nicotine and/or marijuana. They also should encourage vaccination against influenza and pneumonia.
Cases of vaping-related lung illness should be reported to state or local health departments. Federal health authorities are collecting specimen and product samples for testing as they continue to investigate the cause of the injuries.
For the full CDC guidance, visit https://www.cdc.gov/mmwr/volumes/68/wr/mm6841e3.htm?s_cid=mm6841e3_w.
