The CDC released updated statistics and a new framework for identifying, diagnosing and treating e-cigarette or vaping-related lung disease Oct. 11, putting a name to the recent phenomenon in the process.
As of Oct. 8, the federal agency had confirmed 1,299 cases of EVALI (e-cigarette or vaping product use-associated lung injury) across 49 states, the District of Columbia and one U.S. territory. The latest report made note of 26 deaths from vaping-related lung injury in 21 states, but governmental agencies remain unable to identify the root of the crisis.
“At this time, FDA and CDC have not identified the cause or causes of the lung injuries among EVALI cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products,” the CDC’s report read. “This outbreak might have more than one cause, and many different substances and product sources are still under investigation.”
National and state data suggest products containing THC—especially those purchased on the black market—are linked most strongly to EVALI, though the CDC said the possibility that nicotine products play a role in the recent crisis “cannot be excluded.” Of 572 patients who provided the CDC with information about vaping product use in the 90 days leading up to symptom onset, 76% reported using THC-containing products and 58% reported using nicotine-containing products. Thirty-two percent reported using THC products exclusively.
EVALI is considered a diagnosis of exclusion since it lacks a specific test or marker, so going forward, the CDC recommends healthcare providers consider a number of etiologies when examining potential victims. Patient history is an important factor in evaluating EVALI, the agency said, and lab tests, physicals, imaging exams and specialist consultations can all factor into a diagnosis.
The CDC said patients with suspected EVALI should be admitted to the hospital if they show signs of decreased O2 saturation, are in respiratory distress or have comorbidities that could compromise their pulmonary health. Ninety-six percent of cases reported to the CDC by Oct. 8 involved hospitalizations, but the agency said outpatient management could be considered on a case-by-case basis for patients who are clinically stable and exhibit less severe symptoms.
It’s tough to land on treatment recommendations for an elusive disease, but evidence suggests corticosteroids could be an effective therapy in patients with suspected EVALI. People at a particularly high risk for EVALI, including older patients, pregnant women and people with a history of cardiac or lung disease, should be treated with extra caution.
The CDC recommended that, based on evidence to date, people should reconsider using e-cigarettes. If someone is using e-cigarettes as a smoking cessation tool, the agency said they shouldn’t revert to smoking traditional cigarettes but rather take alternative approaches to quitting like counseling or FDA-approved medications.
“There is no safe tobacco product, and the use of any tobacco products, including e-cigarettes, carries a risk,” the report read. “Therefore, persons who do not currently use tobacco products should not start using e-cigarette, or vaping, products.
“This investigation is ongoing. CDC will continue to work in collaboration with FDA and state and local partners to investigate cases and to update guidance, as appropriate, as new data emerges from this complex outbreak.”