CDC asks physicians to report cases of vaping-related respiratory illness

Physicians should report cases of severe pulmonary disease in patients with a history of e-cigarette use in the past 90 days to state or local health departments, the CDC said.

Three hundred eighty possible cases of pulmonary disease related to e-cigarette use in 36 states and one U.S. territory had been reported as of Sept. 12, and six patients have died. The cause of these cases has not been definitively determined, but all affected patients have reported using e-cigarettes, many containing cannabinoid products, the CDC said. Patients have experienced respiratory symptoms (e.g., cough, shortness of breath, or chest pain), and some have had gastrointestinal (GI) symptoms, such as nausea, vomiting, or diarrhea, or nonspecific constitutional symptoms (fatigue, fever, or weight loss), according to the CDC. While symptoms have typically developed over a period of days, they can manifest over several weeks, the CDC said, and GI symptoms have sometimes preceded respiratory symptoms. Many affected patients have first sought care in ambulatory settings before hospital admission, according to the CDC.

The CDC has issued the following recommendations for clinicians:

• Report cases of severe pulmonary disease of unclear cause in patients with a history of e-cigarette use within the last 90 days to state and local health departments.
• Ask all patients who report e-cigarette use within the past 90 days about signs and symptoms of pulmonary illness.
• Obtain a detailed history of e-cigarette use if it is suspected as a cause of patients' severe pulmonary disease, including substance used, substance sources, device used, place of purchase, method of use, and potential for other cases related to sharing of e-cigarette products.
• Determine if any remaining product is available for testing.
• Consider all possible causes of illness in patients reporting respiratory and GI symptoms and e-cigarette use, evaluate and treat for other possible causes as clinically indicated, and consider consultation with subspecialists as appropriate.
• Consider use of corticosteroids on a case-by-case basis after weighing risks and benefits and likelihood of other disease causes.

The CDC also issued recommendations regarding consideration of bronchoalveolar lavage and lung biopsy and noted that patients who have been treated for severe pulmonary disease related to e-cigarette use should be followed to monitor pulmonary function. All of the CDC's recommendations for clinicians and for public health officials and the public are available at the CDC's website.