News: CDC issues vaping-related illness treatment guidelines

As of last week, just short of 1,300 cases of e-cigarette or vaping product use associated lung injury (EVALI) have been reported. Cases have been reported to the Centers for Disease Control and Prevention (CDC) from 49 states, the District of Columbia, and one U.S. territory, with 26 deaths confirmed in 21 states. In response, the CDC released new guidelines for the evaluation and treatment of patients suspected to suffer from EVALI.

All patients admitted for EVALI reported a history of e-cigarette, or vaping product, use with most reporting history using products containing tetrahydrocannabinol (THC). Latest national and state findings suggest that THC containing products, particularly those obtained from illegal sources, are linked to most cases of EVALI and play a major role in the outbreak.

The CDC also notes that while THC containing products appear to be the predominant correlation between cases, exclusive use of nicotine containing products was reported by some patients, so the possibility of these products playing a role cannot be excluded.

No definitive cause has yet to be identified, only the commonality among all cases as the reported use of e-cigarettes or vaping products. The outbreak may have more than one cause and many substances and product sources are still under investigation as specific chemical exposure associated with product use remains unknown.

The CDC recommends clinicians ask patients with EVALI related symptoms in a nonjudgmental and thorough manner if they use e-cigarettes or vaping products. Suspected patients should have a chest radiograph, and providers should also consider empiric use of a combination of antibiotics, antivirals, or steroids based upon clinical context.

The CDC also advises that patients be admitted if they have decreased oxygen saturation on room air, are in respiratory distress, or have comorbidities that compromise pulmonary reserve and EVALI is suspected. The CDC requests that organizations report cases of EVALI with supporting information in order to assist with investigation of the cause of this injury.

The National Center for Healthcare Statistics is currently working to develop an ICD-10 code for the illness so that cases can be systematically linked. Initial symptoms include cough, chest pain, and shortness of breath along with possible symptoms of abdominal pain, nausea, and diarrhea accompanied with fever and weight loss.

Editor’s note: For previous articles related to vaping-related lung injury, click here. For the CDC guidance related to EVALI, click here.