What Healthcare Providers Should Know

Health Canada and CDC Recommendations For Health Care
Professionals:

Ask all patients who report e-cigarette, or vaping, product use within the last 90 days about signs and symptoms of respiratory illness.
If e-cigarette, or vaping, product use is suspected as a possible etiology of a patient’s lung injury, obtain detailed
history regarding:
  • Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil), flavors, or other substances
  • Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids
  • Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil)
  • Where the product(s) were purchased (to inform public health)
  • Method of substance use: aerosolization, dabbing, or dripping
  • Other potential cases: sharing e-cigarette or vaping products (devices, liquids, refill pods, or cartridges) with others

Clinical improvement of patients with lung injury associated with e-cigarette use has been reported with the use of corticosteroids. The decision to use corticosteroids should be made on a case-by-case basis based on risks and benefits and the likelihood of other etiologies.

Outbreak Surveillance Case Definitions of Severe Pulmonary Disease
Associated with E-Cigarette Use – August 30, 2019*
Confirmed Case

Use of an e-cigarette (vaping) or dabbing in 90 days before symptom onset; and

Pulmonary infiltrate, such as opacities on plain-film radiograph of the chest or ground-glass opacities on chest CT; and

Absence of pulmonary infection on initial workup: the maximum criteria include negative respiratory viral panel and influenza PCR or rapid test if local epidemiology supports testing. All other clinically indicated testing for respiratory infectious disease (e.g., urine antigen testing for streptococcus pneumoniae and legionella, sputum culture if productive cough, bronchoalveolarlavage culture if done, blood culture, and presence of HIV-related opportunistic respiratory infections if appropriate) must be negative; and

No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process)


Probable Cause

Using an e-cigarette (vaping) or dabbing in 90 days before symptom onset; and

Pulmonary infiltrate, such as opacities on plain film chest radiograph or ground-glass opacities on chest CT; and

Infection identified by means of culture or PCR, but the clinical team caring for the patient believes that this is not the sole cause of the underlying respiratory disease process; or as the minimum criteria, to rule out pulmonary infection not met (testing not performed) and clinical team caring for the patient believes that this is not the sole cause of the underlying respiratory disease process; and

No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process)


Current CDC case definition. Note that this diagnosis does not necessarily require bronchoscopy. This case definition may fail to capture mild or early cases (e.g. prior to development of pulmonary infiltrates).

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