CDC updates guidance for reporting vaping-associated lung injuries as flu activity increases
The Centers for Disease Control and Prevention (CDC) updated its clinical guidance for diagnosing and treating electronic cigarette- or vaping-associated lung injuries (EVALI) in light of the approaching 2019-2020 flu season.
As of November 20, 2,290 cases of EVALI have been reported to the CDC from 49 states as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.
Healthcare providers may find it difficult to distinguish between EVALI and influenza, since patients with EVALI often experience flu-like symptoms including fever, cough, headache, myalgia, and fatigue, according to the CDC. The CDC’s new guidance includes recommendations for providers who treat patients with suspected or known EVALI during flu season, which peaks between December and February but can last as late as May.
Per the updated guidance, treating providers who evaluate patients with suspected or known EVALI who present with flu-like symptoms should:
- Ask patients about their use of e-cigarette, or vaping, products. They should evaluate patients with suspected EVALI according to previously published CDC recommendations.
- Consider using corticosteroids to treat EVALI but be aware that the treatment hasn’t been well studied among outpatients and could worsen other respiratory illnesses.
- Consider using treatment strategies such as behavioral counseling to help patients discontinue use of e-cigarette or vaping products.
- Emphasize the importance of the influenza vaccination for all patients six months or older, including patients at risk for EVALI.
- Keep in mind that not all patients with a history of e-cigarette or vaping product use who present for evaluation of respiratory, gastrointestinal, or other symptoms require hospitalization. EVALI patients can be managed on an outpatient basis if they have:
- Normal levels of oxygen in their blood
- No respiratory distress, no other health conditions that might compromise lung capacity
- Reliable access to health care should their symptoms worsen
- Strong social support systems
- Strongly consider influenza testing and consider prescribing antiviral medications if clinically indicated.
More information on these recommendations, and EVALI and influenza surveillance, can be found on the CDC website.