The U.S. is currently experiencing an epidemic of a severe lung disease termed Vaping-Associated Pulmonary Illness (VAPI), with over 500 cases and 7 deaths across 38 states and 1 U.S. territory since July 2019.

The clinical presentation of VAPI varies -- 

• Respiratory (SOB, cough, chest pain), constitutional (fever, tachycardia, headache, dizziness), and potentially GI symptoms (vomiting, diarrhea) after the use of vaping devices. GI symptoms may precede respiratory issues.
• Can take days or worsen over weeks and can present or end up with severe respiratory failure

Diagnostics --

• Labs nonspecific: Leukocytosis, elevated ESR, no specific infectious etiology
• Chest CT generally with bilateral infiltrates
• Bronchoscopy with BAL demonstrates PMNs and may have lipid-laden macrophages on Oil red O or Sudan staining

Treatment is supportive +/- steroids -- 

• Current recommendations to treat similarly to ARDS in intubated patients
• Potential benefit to steroids if not contraindicated

 

Bottom Line: Include vaping-associated pulmonary illness in your differential for patients presenting with acute lung disease.

• Ask patients about use of e-cigarette/vaping devices.
• Notify the CDC or your state health department of any suspected cases.
• Counsel your patients to avoid the use of these devices, at the very least until the specific causative agent is found.

 

 

Additional Information

Background: The use of electronic nicotine delivery systems, also known as e-cigarettes or vape pens, has risen precipitously since their introduction in 2006. They heat a liquid that can contain nicotine, THC/CBD, flavors and/or other additives, producing an aersol that is inhaled by users. 

They have been marketed as a way to quit smoking, and as being safer than cigarettes. The U.S. is, however, currently experiencing an epidemic of a severe lung disesae termed Vaping-Associated Pulmonary Illness, with over 500 cases and 7 deaths across 38 states and 1 U.S. territory.

Per data obtained by the CDC:

• Almost 75% are male 
• 83% of cases are under the age of 35
• No one product or substance has been identified in all cases, but e-cigarette exposure is uniform

References

CDC Emergency Preparedness & Response: "Severe Pulmonary Disease Associated with Using E-Cigarette Products" https://emergency.cdc.gov/han/han00421.asp