Clinical guidance evaluating patients with lung injury linked to e -cigarette and vaping use

Oct. 14, 2019

The Centers for Disease Control and Prevention (CDC) released updated interim clinical guidance for U.S. health care providers evaluating and caring for patients with lung injury associated with use of e-cigarette, or vaping, products.

This interim guidance offers clinicians a framework for their initial assessment, evaluation, management, and follow-up of people with symptoms of lung injury associated with use of e-cigarette, or vaping, products. It advises close follow-up of these patients, as some patients who initially had mild symptoms experienced a rapid worsening of symptoms within 48 hours.

This report also summarizes national surveillance data describing clinical features of more recently reported cases and refines CDC’s public health recommendations.

When evaluating patients with respiratory or gastrointestinal symptoms, health care providers should consider multiple causes, including the possibility of lung injury associated with use of e-cigarette, or vaping, products. The guidelines highlight the importance of asking patients about their use of using e-cigarette, or vaping, products in a non-judgmental way.

“CDC appreciates the valuable input from national pulmonary and critical care experts in developing science-based recommendations to address this concerning outbreak,” said Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention. “CDC will continue its investigation of the cause or causes so that we can bring an end to lung injury cases associated with e-cigarette use.

As of October 8, 2019, 49 states, the District of Columbia, and the U.S. Virgin Islands have reported 1,299 cases of patients with lung injury associated with use of e-cigarette or vaping products. There have been 26 deaths in 21 states. Among 1,043 patients with data on age and sex, 70 percent are male and 80 percent are under 35 years old.

According to CDC’s national-level report, data about substances used in e-cigarettes or vaping products were self-reported by 573 patients. Of the patients who reported which products they used:

  • 76% reported using tetrahydrocannabinol (THC)-containing products, with or without nicotine-containing products.
  • 58% reported using nicotine-containing products.
  • 32% reported exclusive use of THC-containing products.
  • 13% reported exclusive use of nicotine-containing products.

CDC continues to refine recommendations based on emerging data. At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases and the only commonality between all cases is that patients report the use of vaping products, including e-cigarettes. No one compound or ingredient has emerged as the cause of these illnesses to date and it may be that there is more than one cause of this outbreak. Available data suggest THC-containing products play a role in this outbreak. As such, CDC recommends that you do not use e-cigarette or vaping products that contain THC.  In addition, no youth, young adult, or pregnant women should be using any e-cigarette, or vaping, product, regardless of the substance.

Given that exclusive use of nicotine-containing products has been reported by a small proportion of cases, and that many people with these lung injuries report combined use of THC- and nicotine-containing products, we cannot exclude the possibility that nicotine-containing products play a role in this outbreak. Furthermore, there is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.

More information about the investigation is available on the CDC website,

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