UMEM Educational Pearls

Title: Vaping Associated Pulmonary Illness (VAPI)

Keywords: VAPI, acute respiratory failure, vaping, e-cigarettes, e-hookah, juul, pulmonary disease, acute lung diease, ARDS (PubMed Search)

Posted: 9/23/2019 by Kami Windsor, MD (Emailed: 9/24/2019)
Click here to contact Kami Windsor, MD

Question

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.

Image result for vapi map vaping associated pulmonary illness

Answer

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