Peaks and EVALIs

vaping2.jpg

The uncharted territory of vaping associated lung injury

Vaping: The act of inhaling a vapor from a vaporizer

  • In contrast to smoking, which is burning a substance and inhaling it

  • You aren’t burning anything when you vape, just heating it

Routes to Vape

ecig.jpg

E-cigs: Simple, disposable devices pre-filled with some liquid - gives the feel of smoking a real cigarette

vape pen.jpeg

Vape pens: reusable don’t look like pens; you purchase refills for

desktopvap.jpeg

Desktop Vaporizers/Vape mods: for enthusiasts; for people who want to control flavor, consistency and more

What Substances are in vaping fluid?

“Don’t tell me what I can vape”

  • E-liquids “vape juice” - may or may not contain nicotine

  • Dry herbs (usually marijuana)

  • Waxes/Oily concentrates (usually marijuana)

    • Vaporizing oily concentrates: “Dabbing”

    • Vitamin E acetate: fatty substance used to carry THC - may be associated with EVALI

epidemiology

  • Average age 28

  • Many are male

  • Of the reported cases, 82% vaped product with THC

Symptoms

  • Most common presenting symptoms: dyspnea, cough, chest pain, fever and chills, GI symptoms. URI symptoms have not been a feature, but fever, hypoxia are

Phenotypes/Radiology

Lipoid Pneumonia phenotype: low attenuation within the consolidated area reflecting a fat content, may have a predilection for dependent portions of lung; crazy paving pattern may be seen

Lipoid Pneumonia phenotype: low attenuation within the consolidated area reflecting a fat content, may have a predilection for dependent portions of lung; crazy paving pattern may be seen

Organizing pneumonia phenotype: ground glass haziness and consolidation in sub-pleural and peri-bronchial distributions

Organizing pneumonia phenotype: ground glass haziness and consolidation in sub-pleural and peri-bronchial distributions

Eosinophilic Pneumonia phenotype: bilateral ground glass areas, interlobular septal thickening, thickening of bronchovascular bundles and airspace consolidation

Eosinophilic Pneumonia phenotype: bilateral ground glass areas, interlobular septal thickening, thickening of bronchovascular bundles and airspace consolidation

Diagnosis

  • Confirmed

    • Vaping or dabbing 90 days before symptoms onset

    • Pulmonary infiltrate (laterality not specified)

    • Absence of pulmonary infection on initial work up

    • No alternative plausible diagnoses (like cardiac, rheumatologic, or neoplastic process)

  • Probable

    • Still have vaping or dabbing 90 days before symptom onset and pulmonary infiltrates

    • Still have no alternative plausible diagnosis

    • But here – pulmonary infection is identified on the initial workup

      • With the caveat being that the clinical team does NOT think that the pulmonary infection is the sole cause of the patient’s symptoms

Summary

  • Diagnostic criteria include

    • Hx vaping in past 90 days

    • Infiltrates

    • No alternative plausible diagnosis

    • We have confirmed cases (which have NO infection in the initial workup) and probable cases (which have an infection in the initial workup but the clinicians do NOT believe this is the sole cause of the patient’s presentation)

  • Don’t forget to incorporate questions on vaping in your routine history for all of your patients

    • Make sure you ask questions about what the patient vaporizes, where they get it, how much of it they vape, and if they add anything else in the mix

  • When working up these patients – perform your classic pneumonia workup. Add in ESR, CRP, HIV, and maybe a viral panel

  • Treatment is pretty uninspiring thus far – steroids, O2, and antibiotics

  • Report your case to your local health department

  • From a counseling standpoint, don’t start vaping, don’t switch back to smoking cigarettes

ATTRIBUTIONS

“talking and laughter.wav” by PlusMinusZero is licensed under CC BY-NC 3.0 / Song has been cropped in length from original form

“SNAP 028.aiff” by loofa is licensed under CC BY-NC 3.0 / Song has been cropped in length from original form

“Yawning” by ckvoiceover is licensed under CC BY 3.0 / Song has been cropped in length from original form

“Air Conditioner ambience_01.wav” by ceberation is licensed under CC BY 3.0 / Song has been cropped in length from original form

“jingle news” by Jay_You is licensed under CC BY 3.0 / Song has been cropped in length from original form

“DoingtheDishes.flac” by qubodup is licensed under CC BY 3.0 / Song has been cropped in length from original form

"Tension” by Lee Rosevere is licensed under CC BY-NC 4.0 / Song has been cropped in length from original form

"Vector Melody”, “La Di Day”, “Spring Comes Early”, “Trellis”, “Celadon” and “Sunset Part 2” by Podington Bear is licensed under CC BY-NC 3.0 / Songs have been cropped in length from original form

"HAXYI ФРИ ИМПРОВИЗЭЙШН!” by Kosta T is licensed under CC BY 4.0 / Song has been cropped in length from original form

90s channel surfing - https://www.youtube.com/watch?v=YYdEnawFlHk

News clips:

  • https://www.youtube.com/watch?v=J6AGX564eqk

  • https://www.youtube.com/watch?v=0e-fOM1dx3s

  • https://www.youtube.com/watch?v=17s4OXJX0_Y

Rachel Mulder2020Comment