What is the management of E-cigarette or Vaping Product-Use-Associated Lung Injury (EVALI)?

From the Guidelines

Management of E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) requires a comprehensive approach focusing on respiratory support, corticosteroid therapy, and cessation of vaping products.

Key Components of EVALI Management

• Discontinue e-cigarette, or vaping, product use immediately, as this is crucial for recovery and preventing further lung injury 1
• Offer cessation services to all patients and facilitate connection to these services to support long-term abstinence from vaping products
• Consider empiric antimicrobial use according to guidelines, such as azithromycin and ceftriaxone, until infection is ruled out 1
• Consider corticosteroids, such as methylprednisolone 0.5-1 mg/kg/day, for 2-4 weeks, gradually tapered based on clinical response, to reduce the inflammatory response 1
• Administer routine annual influenza vaccination if not previously received to prevent complications from influenza infection

Supportive Care and Follow-Up

• Provide supplemental oxygen to maintain oxygen saturation above 92% and consider mechanical ventilation if respiratory failure develops
• Offer supportive care including IV fluids and bronchodilators for wheezing
• Follow-up should include pulmonary function testing 1-2 months after discharge and chest imaging at 3 months to ensure resolution of lung injury
• Outpatient follow-up with primary care providers or pulmonology specialists within 48 hours after hospital discharge is recommended to prevent adverse outcomes, including rehospitalization or death 1

Discharge Planning and Post-Discharge Care

• Assess clinical readiness for discharge, ensuring patients meet discharge criteria for at least 24-48 hours before discharge without significant fluctuations in vital signs 1
• Ensure social support and access to mental health and substance use disorder services, as these are critical for supporting patients in their efforts to discontinue e-cigarette or vaping product use
• Follow best practices for medication adherence, including tapering of corticosteroids as prescribed, to prevent recurrence of lung injury symptoms 1

From the Research

EVALI Management

EVALI (e-cigarette or vaping product use-associated lung injury) management involves a combination of diagnostic evaluation, treatment, and prevention strategies.

• The diagnosis of EVALI is typically made through a process of exclusion, as there are no specific biomarkers for the condition 2.
• Evaluation should be guided by clinical judgment, and patients with suspected EVALI should be asked about their use of e-cigarette or vaping products, and undergo pulse oximetry and chest imaging as clinically indicated 2.
• Treatment for EVALI may involve systemic glucocorticoid therapy, which has been shown to improve clinical outcomes in some patients 3.
• Inhaled corticosteroids may also be used in some cases, particularly for patients with persistent respiratory symptoms or abnormalities on pulmonary function testing 3.

Clinical Care and Follow-up

Clinical care for EVALI patients involves close follow-up and monitoring for potential complications, such as respiratory failure or cardiac arrhythmias.

• Patients with EVALI should be evaluated for potential underlying conditions, such as asthma or chronic obstructive pulmonary disease (COPD), which may impact their treatment and management 4.
• Follow-up assessments should include pulmonary function testing and chest imaging to monitor for resolution of lung injury and potential long-term sequelae 3, 5.
• Healthcare providers should also provide guidance on cessation of e-cigarette or vaping product use, and offer evidence-based treatment strategies to support patients in quitting 2.

Prevention and Public Health Strategies

Prevention of EVALI involves a combination of public health strategies and individual-level interventions.

• The US Centers for Disease Control and Prevention (CDC) recommends that persons consider refraining from use of all e-cigarette or vaping products while the outbreak investigation continues 6, 2.
• Healthcare providers should emphasize the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette or vaping products 2.
• Public health strategies, such as regulation of e-cigarette or vaping products and education campaigns, are also critical for preventing EVALI and reducing the risk of future outbreaks 4, 5.