CDC Issues Warning About Cases of Severe Pulmonary Disease Linked to E-Cigarette Use

The use of e-cigarette products has been associated with several cases of severe pulmonary disease, according to the Centers for Disease Control and Prevention (CDC).

In an official health advisory, the CDC stated that 215 possible cases have been reported across 25 states, with additional suspected cases still under investigation. One death has also been reported in a patient with a history of recent e-cigarette use who was hospitalized with severe pulmonary disease.

An analysis of the cases showed that patients experienced respiratory symptoms such as cough, shortness of breath, or chest pain; gastrointestinal symptoms (which sometimes preceded respiratory symptoms), fatigue, fever, and weight loss were also noted in some patients. As for radiologic findings, bilateral pulmonary infiltrates and diffuse ground-glass opacities have been reported, however, these findings were not present in all patients upon initial presentation.

With regard to treatment, most patients were provided with supplemental oxygen, while some required assisted ventilation and oxygenation or intubation; corticosteroids appeared to be effective in some cases.

Based on currently available information, the CDC advises the following:

  • Cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days should be reported to the state or local health department
  • Patients who have used e-cigarette products within the last 90 days should be asked about signs/symptoms of pulmonary illness
  • Obtain detailed history if e-cigarette use is suspected as a possible etiology of severe pulmonary disease (ie, substance used, substance source, device used, place of purchase, method of use)
  • Provide device/substance to health department for testing if it is still available  
  • Consider all possible etiologies; evaluate and treat as clinically indicated
  • Corticosteroids have led to clinical improvement in some cases; the decision to use these agents should be made on a case-by-case basis 
  • In some cases, patients have presented with lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes; the decision about whether to perform bronchoalveolar lavage should be based on individual clinical circumstances
  • Lung biopsies have been performed in some cases; if obtained, lipid staining may be considered during pathologic examination, and is best performed on fresh tissue
  • Patients who received treatment for severe pulmonary disease related to e-cigarette use should undergo follow-up evaluation

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Commenting on the investigation, Acting FDA Commissioner Ned Sharpless, MD, and CDC Director Robert R. Redfield, MD, stated in a press release that more information is needed to better understand the relationship between the products and the reported illnesses. “At this time, there does not appear to be one product involved in all of the cases, although THC and cannabinoids use has been reported in many cases. Our agencies are working to standardize information collection at the state level to help build a more comprehensive picture of these incidents.”

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