Federal health officials have updated their recommendations on managing patients who may have vaping-related lung injuries during flu season.
Vaping has been linked to 2,172 cases of lung injury and 42 deaths, counts that continue to rise. But in the coming months it may be harder to distinguish these from growing numbers of respiratory illnesses, and some may have both, the Centers for Disease Control and Prevention (CDC) noted in Tuesday’s Morbidity and Mortality Weekly Report.
When patients present with respiratory, gastrointestinal or constitutional symptoms, clinicians should ask about their history of vaping, the types of substances they used and where they obtained them. Most of the patients have used products containing tetrahydrocannabinol (THC) and obtained them from informal sources, according to the CDC.
The CDC recently announced it found a link between the lung injuries and vitamin E acetate that is sometimes used as a diluent in THC vaping products, although officials are not ruling out other possible causes.
Patients should be evaluated with a physical exam that includes pulse oximetry. They may also need a chest radiograph or chest computed tomography (CT) scan.
Hospitalization isn’t always necessary. Patients may be treated in an outpatient setting if they meet several criteria including normal oxygen saturation and no respiratory distress or concurrent illness such as flu, according to the CDC.
During flu season, clinicians should consider testing for the virus and treating with antimicrobials including antivirals.
Some patients with vaping-related lung injuries have improved after receiving corticosteroids, but the CDC cautioned such treatment may worsen respiratory infections.
Clinicians also should emphasize the importance of patients quitting their use of e-cigarettes and other vaping products and receiving an annual flu vaccine.
In a second Morbidity and Mortality Weekly Report released Tuesday, the CDC found characteristics of hospitalized and non-hospitalized patients with vaping-related lung injuries to be similar. Most in each group were male, under 35 years of age and used THC-containing products.
Further analysis of non-hospitalized patients with available data showed about 30% had an initial oxygen saturation of less than 95%. About 82% had abnormal findings on chest radiographs and all 28 had abnormal chest CT scans.