Managing Patients With Suspected Vape-Related Lung Problems

Managing Patients With Suspected Vape-Related Lung Problems Posted By:
...

We have been hearing about more and more cases of lipoid pneumonia linked to marijuana oils in e-cigarettes. According to the CDC, as of November 2019, there have been over 2172 cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) and 42 associated deaths. With so many patients coming in complaining of influenza-like symptoms, as healthcare providers we need to always consider EVALI as a possibility. EVALI remains a diagnosis of exclusion because there are no specific tests or markers. Patients may present with complaints of fever, cough, headache, myalgia, fatigue, or respiratory infection.

Recommendations include:
  • Obtaining a focused history and physical exam
    • Inquire if using e-cigarettes or vaping products
      • What type of substance?
        • Nicotine, tetrahydrocannabinol (THC) or cannabis (specify if oil or dabs), modified products or the addition of substances (vitamin E acetate)
        • Product brand and name
      • Duration and frequency?
      • Last time used?
        • Where they were obtained (friends, family, in-person, or online dealer)
  • Obtaining a pulse oximetry (should be >95% on room air) and vital signs
  • Chest imaging (if indicated): CXR or CT (if CXR is normal)
  • Testing patients for influenza (particularly during season) and recommending annual influenza vaccination
  • Administering antimicrobials, antivirals
  • Prescribing corticosteroids (use with caution)
  • Recommending evidence-based treatment strategies, such as behavioral counseling, to help patients with e-cigarette or vaping cessation
  • Recommending cognitive behavioral therapy, motivational enhancement therapy, or family therapy for patients with cannabis use disorder

According to the established definition of EVALI, a patient must report use of e-cigarette or vaping products within 3 months of symptom onset, have a positive image finding, and an evaluation to rule out an infectious cause (negative viral panel and a negative influenza PCR or rapid test).

If EVALI is suspected, follow-up is encouraged. Patients with outpatient management should follow up within 24 to 48 hours. Patients discharged from the hospital should initially follow up within 1 to 2 weeks, at which time a pulse oximetry and repeat CXR should be done. Patients treated with high-dose corticosteroids may need a referral to endocrinologist. Spirometry diffusion capacity for carbon monoxide and CXR should be done at an additional follow-up 1 to 2 months later. All patients should be advised to return as soon as possible if they develop new or worsening respiratory symptoms, with or without fever.

References

Share

Filed under: Infectious Diseases , Public Health , Pulmonary Medicine

Related
HIV Prevention and Testing Is Not Bound By Age

HIV Prevention and Testing Is Not Bound By Age

In 2006, the CDC updated the HIV testing guidelines to recommend routine opt-out testing for people ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, NPs & PAs


Continue Reading
Addressing ASCVD Risk in HIV: An Update to the DHHS HIV Guidelines

Addressing ASCVD Risk in HIV: An Update to the DHH ...

The incidence of atherosclerotic cardiovascular disease (ASCVD) is estimated to be twice as high in ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, Cardiometabolic, NPs & PAs


Continue Reading
Doxy-PEP: A New Opportunity to Reduce STIs

Doxy-PEP: A New Opportunity to Reduce STIs

According to CDC data from 2022, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis w ...

Filed under: Nurses Week, Infectious Diseases, Urology, Preventive Medicine, Public Health, Substance Abuse, NPs & PAs


Continue Reading
Treatment of COVID-19: Practical Questions and Insights for NPs and PAs

Treatment of COVID-19: Practical Questions and Ins ...

Is it reasonable to prescribe a 5-day supply of an oral antiviral to people traveling abroad with ri ...

Filed under: Infectious Diseases, Public Health, NPs & PAs


Continue Reading
Assessment of COVID-19: Practical Questions and Insights for NPs and PAs

Assessment of COVID-19: Practical Questions and In ...

How long should people isolate when they test positive for COVID-19?The CDC recommends that one shou ...

Filed under: Infectious Diseases, Public Health, NPs & PAs


Continue Reading
Tackling Disparities in HIV Prevention

Tackling Disparities in HIV Prevention

Racial and ethnic disparities have been a problem in the HIV epidemic since the very beginning. Rece ...

Filed under: Infectious Diseases, Women's Health, Preventive Medicine, Public Health, NPs & PAs


Continue Reading