From the Guidelines
The recommended initial evaluation for suspected vaping-associated lung injury (EVALI) includes a thorough history, physical exam, and chest imaging, such as a CT scan, to evaluate for lung injury and rule out other potential causes. When evaluating patients with suspected EVALI, it is essential to consider the patient's history of e-cigarette or vaping product use, as well as other potential causes of lung injury, such as infection 1. The initial clinical assessment should include vital signs, pulse oximetry, focused history, and physical exam, as well as ruling out other possible etiologies, such as influenza or community-acquired pneumonia 1. Chest imaging, typically showing bilateral opacities, is also a crucial component of the evaluation, and a CT scan may be necessary to evaluate the extent of lung injury 1. Treatment begins with immediate cessation of all vaping products, and corticosteroids are the mainstay of therapy, typically starting with methylprednisolone 1-2 mg/kg/day or equivalent, with gradual tapering over 1-2 weeks based on clinical response 1. Supportive care is essential, including supplemental oxygen for hypoxemia and, in severe cases, mechanical ventilation, as well as empiric antibiotics until infection is ruled out 1. Close follow-up is necessary with pulmonary function testing and repeat imaging to monitor recovery, and patients should be counseled on complete cessation of vaping and smoking, and offered resources for nicotine or cannabis dependence if needed 1. The pathophysiology involves an inflammatory response to inhaled substances, particularly vitamin E acetate in THC-containing products, causing direct lung injury 1. Key considerations in the evaluation and treatment of EVALI include:
- Thorough history and physical exam to identify potential causes of lung injury
- Chest imaging, such as a CT scan, to evaluate the extent of lung injury
- Immediate cessation of all vaping products
- Corticosteroids as the mainstay of therapy
- Supportive care, including supplemental oxygen and mechanical ventilation as needed
- Empiric antibiotics until infection is ruled out
- Close follow-up with pulmonary function testing and repeat imaging to monitor recovery
- Counseling on complete cessation of vaping and smoking, and offering resources for nicotine or cannabis dependence if needed.
From the Research
Evaluation and Treatment for Suspected Vaping Lung Injury
- The recommended evaluation for suspected vaping lung injury includes a CT scan to assess the lungs for damage 2, 3.
- High-resolution CT (HRCT) is a precise method for diagnosing and monitoring lung tissue and airway diseases, and can be used to evaluate vaping lung injury 4.
- HRCT can help identify patterns of lung injury, such as parenchymal organizing pneumonia (OP), airway-centered OP, and diffuse alveolar damage (DAD) 2.
- CT findings and patterns can be correlated with vaping behavior, including substance vaped and vaping frequency 2.
- Common CT findings in vaping lung injury include diffuse or lower lobe ground-glass opacity (GGO), septal thickening, lymphadenopathy, and centrilobular nodules (CNs) 2.
CT Scan Techniques
- HRCT scans can be obtained with the patient prone or supine, and the choice of position may depend on the patient's condition and the suspected diagnosis 5.
- The use of contrast-enhanced CT scans may also be helpful in evaluating vaping lung injury 4.
- Technical and patient-related pitfalls, such as motion artifacts and breathing difficulties, can affect the accuracy of HRCT scans 6.
Treatment and Management
- The treatment and management of vaping lung injury depend on the severity of the condition and the patient's overall health 2, 3.
- Patients with severe lung injury may require hospitalization and supportive care, including oxygen therapy and mechanical ventilation 2.
- The use of corticosteroids and other medications may also be helpful in managing vaping lung injury 2.