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E-Cigarette and Vaping Associated Lung Injury

The United States of America has recently seen a significant increase in the incidence of e-cigarette or vaping associated lung injury (EVALI). The outbreak is thought to have begun in June 2019, with a peak in incidence in September. Since September the number of reported EVALI cases has declined, however they have not returned to the levels previously seen before June 2019, and healthcare workers are still encouraged to report cases so more can be learned about this relatively new issue.

Data from the Centers for Disease Prevention and Control released on December 27, 2019, states that a total of 2,561 hospitalized EVALI cases or deaths have been reported from all 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands). Fifty-five deaths have been confirmed in 27 states and the District of Columbia (as of December 27, 2019).

Characteristics of EVALI patients who were readmitted or died following hospital discharge indicate that some chronic medical conditions, including cardiac disease, chronic pulmonary disease, and diabetes, as well as increasing age might be risk factors leading to higher morbidity and mortality among some EVALI patients.

Patients experiencing EVALI have been hospitalized for symptoms including:

  • Respiratory symptoms, including cough, shortness of breath, or chest pain
  • Gastrointestinal symptoms, including nausea, vomiting, stomach pain, or diarrhea
  • Nonspecific constitutional symptoms, like fever, chills, or weight loss

Symptoms may develop rapidly or gradually over a couple of weeks. Healthcare professionals should take a detailed history of the substances the patient used, the sources of products, the duration and frequency of use, and the devices used and how they are used should be obtained. Data that has been analyzed so far suggest that there is an increased likelihood of EVALI when using products containing THC (the psycho-active chemical found in marijuana) and Vitamin E.

In order to prevent patient re-hospitalization and even death post-discharge, guidance for healthcare professionals state that patients should:

  • be clinically stable for 24 – 48 hours prior to discharge
  • have a follow up appointment with a primary care provider or pulmonary specialist within 48 hours of discharge

For more information on EVALI and the use of e-cigarettes please visit the Centers for Disease Prevention and Control at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

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