Vaping-associated pulmonary injury
|Vaping-associated pulmonary injury|
|Other names||Vaping-associated lung injury, e-cigarette, or vaping, product use associated lung injury (EVALI)|
|CT scan of the chest showing vaping-associated lung injury|
|Symptoms||Shortness of breath, hypoxic, fever, cough, diarrhea|
|Diagnostic method||Opacities on chest radiograph|
|Treatment||High-flow oxygen therapy|
|Deaths||26 (1,299 cases U.S.)|
Signs and symptomsEdit
In September 2019, the Centers for Disease Control and Prevention (CDC) reported an outbreak of severe lung disease linked to vaping. The cases of lung injury date back to at least April 2019. The clinical presentation of VAPI can initially mimic common pulmonary diagnoses like pneumonia, but individuals typically do not respond to antibiotic therapy. High clinical suspicion is necessary to make the diagnosis of VAPI. In some cases, individuals seek care at outpatient clinics in the days prior to hospital presentation and received antibiotics for presumed pneumonia or bronchitis, which did not improve their symptoms. Affected individuals typically present for care within a few days to weeks of symptom onset. At the time of hospital presentation, the affected individual is often hypoxic and meets systemic inflammatory response syndrome (SIRS) criteria, including high fever. In some cases, they have progressive respiratory failure following admission, leading to intubation. Several affected individuals have needed to be placed in the ICU while being hooked up to a ventilator. Time to recovery for hospital discharge has been from days to weeks. Commonly reported symptoms include shortness of breath, cough, fatigue, body aches, fever, vomiting, and diarrhea. Non-specific laboratory abnormalities have been reported, including elevation in white blood cell count, transaminases, procalcitonin, and inflammatory markers. Negative infectious disease testing (influenza, respiratory viral panel, cultures, etc.). Imaging abnormalities are typically bilateral and may be described as: Chest x-ray: pulmonary infiltrates or opacities. Chest CT: ground-glass opacities. Bronchoalveolar lavage specimens may exhibit an increased level of neutrophils and sparse to moderate amounts of lipid-laden alveolar macrophages.
Vaping refers to the increasingly popular practice of inhaling aerosol (vapor) from an electronic cigarette device, which works by heating a liquid that can contain nicotine, cannabis, or other drugs. The long-term health impacts of vaping are unknown. Some individuals also use a different type of device to heat and extract cannabinoids for inhalation in a process called "dabbing." Both vaping and dabbing have been associated with VAPI. Most individuals report vaping the cannabis compounds THC and/or CBD, and some also report vaping nicotine products. A smaller group reported using nicotine alone. On October 4, 2019, the CDC reported that the cause of the lung illnesses is unknown but it might be related to prefilled THC cartridges.
VAPI is a clinical diagnosis of exclusion when infectious, rheumatologic, neoplastic, cardiac, or other processes cannot explain an acute pulmonary illness in a person known to vape cannabinoids and/or nicotine. The diagnosis is commonly suspected when the person does not respond to antibiotic therapy, and testing does not reveal an alternative diagnosis. Common documented hospital diagnoses for these people have included: acute respiratory distress syndrome (ARDS), sepsis, acute hypoxic respiratory failure, pneumonitis, and pneumonia.
A case of VAPI meets the following criteria: Respiratory illness requiring hospital admission; history of vaping or dabbing within 90 days of symptom onset; pulmonary infiltrates or opacities on chest radiograph or chest CT. Presentation is not explained by infectious or other alternate etiology.
Guidelines for treatment of VAPI are not available. Most individuals require supplemental oxygen via nasal cannula, high-flow oxygen, bilevel positive airway pressure (BiPAP), or mechanical ventilation. Anecdotally, treating physicians have trialed the use of steroids with some possible benefit. Information on dosing and duration of steroids is not available. Corticosteroids might be helpful in treating this injury. Several case reports describe improvement with corticosteroids, likely because of a blunting of the inflammatory response. An important part of treatment for VAPI involves quitting vaping.
As of October 8, 2019[update], the CDC has received complete gender and age data on 1,043 lung injury cases: 70% of cases are male. The median age of cases is 24 years and ranges from 13 to 75 years. 81% of cases are under 35 years old.
On 28 September the first case of vaping-associated pulmonary injury was identified in Canada.
- Vaping-associated pulmonary injury (VAPI) is also variously known as e-cigarette, or vaping, product use associated lung injury (EVALI), vaping-associated lung Injury, vaping-associated lung disease, vaping-induced lung injury, vaping-induced pulmonary disease, vaping associated respiratory syndrome, vape-related lung disease, vape-related lung illness, vape-related pulmonary illness, or Vape Lung.
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