Rising Cases of EVALI Prompt Development of Diagnostic and Treatment Guide

Introduction to EVALI

In response to the increasing incidents of e-cigarette or vaping lung illness (EVALI) in the United States, health experts have formulated a guide aimed at diagnosing and managing this condition. E-cigarettes enable users to aerosolize liquids containing nicotine or other substances. Since their debut in 2000, the global adoption of these devices has significantly escalated. Many e-cigarette products are flavored, targeting young adults, who may purchase inexpensive items online or modify the devices themselves. Some users have been adapting cartridges to vape tetrahydrocannabinol oil (THC), the psychoactive element in marijuana. Such alterations to the vaping liquid or devices can drastically affect the chemicals produced in the aerosol and inhaled into the lungs.

Rising Incidents of Vaping-Related Lung Injury

Recently, the United States has witnessed a surge in serious lung injuries associated with vaping. Since June 2019, over 2,000 cases of EVALI have been recorded across 49 states, raising alarms among public health officials and respiratory specialists. An expert team from the University of Rochester, New York, has developed a diagnostic and treatment algorithm to assist physicians in identifying, treating, and reporting cases of vaping-related lung illness. Their findings were recently published in *Lancet Respiratory Medicine*.

Overview of Reported Cases

Since the spring of 2019, healthcare providers have noted more than 2,000 cases of acute lung injury related to vaping, resulting in 39 fatalities. Patients have presented with a range of symptoms from mild cough and breathlessness to severe respiratory failure that necessitated intensive care and mechanical ventilation. Gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and abdominal pain, often precede respiratory issues. Investigative efforts reveal significantly low blood oxygen levels in patients, with chest X-rays indicating lung damage. Many individuals have suffered severe lung injuries, leading to prolonged hospital stays and lengthy recovery times. The precise causes of these vaping-related lung injuries remain ambiguous.

Case Studies from the University of Rochester

At the University of Rochester Medical Center, 12 EVALI cases were identified between June and September 2019. Alongside respiratory issues, many patients reported gastrointestinal symptoms. Most had used THC-infused liquids, while others had exclusively consumed nicotine products. All patients achieved recovery following the cessation of vaping, alongside supportive care and steroid treatment, remaining symptom-free during follow-ups.

New Diagnostic and Treatment Algorithm

Leveraging their clinical experience, the University of Rochester team created a comprehensive diagnosis and treatment algorithm to guide the evaluation and management of patients suspected of having vaping lung illness. This new guide expands upon the Centers for Disease Control and Prevention (CDC) recommendations, aiming to enhance the identification of EVALI cases and reduce the likelihood of misdiagnosis, particularly during the flu season when symptoms may overlap with respiratory infections.

Ongoing Investigation into EVALI Causes

Dr. Daniel Croft from the University of Rochester, a lead author of the study, remarked, “This illness has been vexing for physicians across the country, and we continue to see people suffering from the dangerous effects of vaping.” Although the specific causes of vaping-related lung injuries remain unclear, many patients have reported using THC products. Toxicologists are currently analyzing vaping cartridge samples to identify potential causes of EVALI.

Public Health Recommendations

In light of the ongoing investigation into EVALI, the authors advise that the use of vaping products and e-cigarettes should be discontinued. For those utilizing vaping as a means to quit smoking, transitioning to FDA-approved cessation methods, such as nicotine patches, is recommended. Dr. Howard Zucker, New York’s Health Commissioner, stated that the Department of Health is collaborating with healthcare providers statewide to investigate this outbreak. Dr. Zucker urged New Yorkers to refrain from using vaping products until the inquiry is concluded.

References

Kalininskiy A, Bach CT, Nacca NE, et al. E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. *Lancet Respir Med* 2019. Published online, Nov 8, 2019.
University of Rochester Medical Center, Press Release 8 Nov 2019. “Physicians create guide for identifying, treating vaping lung illness.” [EurekAlert](https://www.eurekalert.org/pub_releases/2019-11/uorm-pcg110819.php)
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