Once again, I am writing about public health news from the CDC, in case some of us missed it in living our busy lives.
On November 19, 2019, the Center for Disease Control (CDC ) released updated guidance for nurses and other health professionals to help diagnose and treat patients with e-cigarette or vaping lung injury (EVALI). This updated guidance, published in Morbidity and Mortality Weekly Reports (MMWR), comes as the 2019-2020 influenza season approaches, when many patients come in to outpatient clinics or hospitals with symptoms of respiratory illness. This new guidance is an update to the clinical guidance CDC previously reported in October. At that time, we were advised to report any respiratory infections associated with vaping and to take a detailed substance use history on those patients.
Recommendations released in November are as follows:
- Nurses & other health health care providers should ask patients with symptoms of respiratory or gastrointestinal illness, or other symptoms such as fever, chills or weight loss, about their use of e-cigarette, or vaping, products. They should evaluate patients with suspected EVALI as noted above.
- Not all patients with a history of e-cigarette or vaping, product use who present for evaluation of respiratory, gastrointestinal, or other symptoms require hospitalization. EVALI patients can be managed on an outpatient basis if they have normal levels of oxygen in their blood, no respiratory distress, no other health conditions that might compromise lung capacity, reliable access to health care should their symptoms worsen, and strong social support systems.
- Influenza testing should be strongly considered, especially during flu season. Prescribers should consider antiviral medications if clinically indicated.
- Corticosteroids can be considered for outpatients on a case-by-case basis, however, they should be used with caution in outpatients, because this steroid treatment has not been well studied among outpatients, and corticosteroids could worsen respiratory infections.
- Treatment strategies such as behavioral counseling are recommended to help EVALI patients discontinue using e-cigarette, or vaping, products.
- Nurses should emphasize the importance of annual flu vaccines for all patients 6 months of age or older, including patients at risk of EVALI.
As of November 5, 2019, among the 1,977 EVALI patients available for follow-up, 94% were hospitalized. Demographic characteristics were similar between hospitalized and non-hospitalized patients with most being male and under 35 years of age. Many vapers picked up the habit as a ‘safer’ alternative to cigarettes or as a medical cannabis delivery system. Now that we know about the associated problems, we need to spread the word: Inhale fresh air!
Mahalo for all you do! Leslie