Title: Vaping Associated Pulmonary Illness (VAPI)<br/>Author: Kami Windsor<br/><a href='http://umem.org/profiles/faculty/742/'>[Click to email author]</a><hr/><p> </p> <p> The U.S. is currently experiencing an epidemic of a severe lung disease termed Vaping-Associated Pulmonary Illness (VAPI), with over 500 cases and <u>7 deaths</u> across 38 states and 1 U.S. territory since July 2019.</p> <p> The clinical presentation of VAPI varies -- </p> <ul> <li> Respiratory (SOB, cough, chest pain), constitutional (fever, tachycardia, headache, dizziness), and potentially GI symptoms (vomiting, diarrhea) after the use of vaping devices. <em>GI symptoms may precede respiratory issues.</em></li> <li> Can take days or worsen over weeks and can present or end up with severe respiratory failure</li> </ul> <p> Diagnostics --</p> <ul> <li> Labs nonspecific: Leukocytosis, elevated ESR, no specific infectious etiology</li> <li> Chest CT generally with bilateral infiltrates</li> <li> Bronchoscopy with BAL demonstrates PMNs and may have lipid-laden macrophages on Oil red O or Sudan staining</li> </ul> <p> Treatment is supportive +/- steroids -- </p> <ul> <li> Current recommendations to treat similarly to ARDS in intubated patients</li> <li> Potential benefit to steroids if not contraindicated</li> </ul> <p> </p> <p> <u>Bottom Line:</u> Include vaping-associated pulmonary illness in your differential for patients presenting with acute lung disease.</p> <ul> <li> Ask patients about use of e-cigarette/vaping devices.</li> <li> Notify the CDC or your <a href="https://healthfinder.gov/FindServices/SearchContext.aspx?show=1&topic=820">state health department</a> of any suspected cases.</li> <li> Counsel your patients to avoid the use of these devices, at the very least until the specific causative agent is found.</li> </ul> <p> </p> <p style="text-align: center;"> <img alt="Image result for vapi map vaping associated pulmonary illness" src="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/images/lung-illness-map-0918-650x423.jpg" /></p> <p> </p>
<div align='center'>
<a href='http://www.umem.org/educational_pearls/3664/' target='_blank'><b>CLICK TO VIEW MORE IN-DEPTH INFORMATION</b></a><br/>
(Must disable pop-up blocker to open new window)
</div>
<fieldset><legend>References</legend>
<p> CDC Emergency Preparedness & Response: "Severe Pulmonary Disease Associated with Using E-Cigarette Products" <a href="https://emergency.cdc.gov/han/han00421.asp">https://emergency.cdc.gov/han/han00421.asp</a></p> </fieldset>