Update on Vaping

What clinicians should do with suspected vaping lung injury cases

ACCORDING to the Centers for Disease Control and Prevention, as of September 24 there have been 805 lung injury cases reported from 46 states and the U.S. Virgin Islands due to vaping. Illinois has one of the highest rates with between 50-99 cases reported. There have been 12 deaths confirmed in 10 states, including one in Illinois.

The injuries have been snowballing since the CDC first started tracking them at the end of March. The CDC reported 530 total cases as of the week ending September 18. Just one week later an additional 275 cases had been reported.

The latest findings from the CDC’s investigation into lung injuries associated with vaping suggest that products containing THC play a role. About 77% of patients reported using THC-containing products; 36% reported exclusive use of THC-containing products. About 57% reported using nicotine-containing products; 16% reported exclusive use of nicotinecontaining products.

Yet, the specific chemical exposure causing lung injuries remains unknown. No single product or substance has been linked to all lung injury cases. The CDC says that more information is needed to know whether one or more vaping products, substances, or brand is responsible.

Data on 771 patients shows that all of them have a history of e-cigarette use. Most of the patients (69%) are male. Nearly two-thirds of patients (62%) are 18 to 34 years old; with 22% of patients between 18-21. Sixteen percent of patients are under 18 years of age.

Recommendations
The CDC recommends that people refrain from using e-cigarettes, particularly those containing THC. E-cigarettes should not be purchased off the street nor modified with any substances not intended by the manufacturer. The agency also suggests that anyone who has recently used a vaping product and has symptoms such as shortness of breath, fever, cough, vomiting and diarrhea see a healthcare provider.

For clinicians in Illinois, the Illinois Department of Public Health (IDPH) recommends asking all patients with a serious respiratory illness of unknown etiology about recent vaping. If a reliable vaping is history is unavailable, clinicians should obtain a urinary toxicology screen, including for THC. IDPH also recommends obtaining a chest radiograph for patients with unexplained respiratory symptoms and vaping exposures presenting to both inpatient and outpatient settings. Of course, clinicians should also rule out common infections (for example, with a respiratory viral panel, influenza testing, or blood/sputum cultures), and any other clinically warranted infectious, and non-infectious, etiology, in patients with unexplained respiratory illness and vaping exposures.

To help with data collection, the IDPH asks clinicians to report patients with unexplained serious respiratory illness and recent vaping to their local health department within normal business hours, retain vaping products from casepatients for testing, and hold clinical samples from bronchoalveolar lavage (BAL) and/or lung tissue biopsies after processing and diagnostic evaluation for potential submission to the IDPH laboratory. BAL samples examined for lipid-laden macrophages may be indicative of vaping exposure if a vaping history is unavailable. No specific testing or processing of BAL or biopsy specimens is required for the public health investigation at this time.

For more information, please visit www.chicagohan.org/vaping. To report cases of vaping-related lung injury, use the case report forms on this website and fax them to 312-746-4683 attn: Tristan McPherson. Email vaping@cityofchicago. org (without patient identifiers) for questions or support.