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Guidelines to identify, treat vaping-associated lung injuries

By 26th November 2019No Comments

Detection of LME using 7T MRI in relapsing-remitting multiple sclerosis. Example of LME in RRMS subjects as detected by 3D FLAIR sagittal sequences at 7T MRI. Pre-contrast (a, ) and post-contrast (b ) images showing representative foci of LME arrows. Image from Zurawski et al. MSJ.

doi: 10.1177/1352458519885106.

This chest x-ray of a patient being treated for e-cigarette or vaping-associated lung injury shows lung opacities, densities and whitish cloud-like areas which are typically seen with unusual pneumonias, fluid in lungs or lung inflammation. Credi  Intermountain Healthcare.

As the outbreak of lung injuries and deaths associated with e-cigarettes, or vaping, continues to spread across the U.S., researchers at Intermountain Healthcare in Salt Lake City have effectively developed a best practice treatment guide to quickly identify and treat patients who develop the new and potentially fatal respiratory injury, according to a new study (Blagev DP  et al. Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study. Lancet. 2019 Nov 8. pii: S0140-6736(19)32679-0. doi: 10.1016/S0140-6736(19)32679-0).

This is still an ongoing outbreak, and not something we’ve seen with vaping before,” said Dr. D Blagev, a pulmonary and critical care physician at Intermountain Healthcare, lead author of the new study that outlines best practices for treatment for patients with e-cigarette or vaping-associated lung injury (E-VALI).

The lung injury diagnosis and treatment guidelines developed by Intermountain Healthcare clinicians are based on the cumulative clinical experience of treating more than 60 patients throughout the health system’s 24 hospitals and 215 clinics.  The Intermountain guidelines recommend shorter courses of moderate-dose steroids for patients who are either treated as outpatients, or admitted to hospitals, and higher doses of intravenous steroids that are tapered more slowly for patients who are critically ill on admission. Clinicians also recommend close outpatient follow-up, as complications after initial recovery are recognized.

While the majority of E-VALI patients were admitted to an intensive care unit, many weren’t critically ill and recovered more quickly. These patients typically had flu-like symptoms, shortness of breath, cough, chest pain, and abdominal symptoms such as nausea, vomiting, and abdominal pain.

Most patients with lung injuries associated with e-cigarettes or vaping were treated with antibiotics (due to overlapping pneumonia symptoms), oxygen, and steroids. While specific infectious disease testing was negative for all of the patients, most received antibiotics, researchers reported.

Being vigilant about obtaining a patient’s vaping history when they’re admitted and keeping it in mind throughout their hospital stay, is essential,” said Dr. Blagev. “For some patients in our study, their vaping history didn’t emerge until they were well into the course of their disease.”

doi: 10.1016/S0140-6736(19)32679-0.