A Teen With Cough: Could This Be Vaping Related?

Susan Adkins, MD; Mark Layer, MD; Emily Koumans, MD


December 13, 2019

Editorial Collaboration

Medscape &

Since late summer of 2019, the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and state and local public health agencies have been investigating a multistate outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI).

As of December 3, 2019, more than 2200 cases of EVALI have been reported by states to CDC, with 42 deaths among these cases. Almost three quarters of patients are male (68%), and the median age is 24 years (range, 13-78 years). The median age of those who have died is 45 years (range, 17-75 years).

Early diagnosis of EVALI and appropriate treatment remain critical to improving patient outcomes. CDC's updated clinical guidance provides a framework for healthcare professionals in their initial assessment, evaluation, management, and follow-up of persons with symptoms of EVALI.

Challenge yourself with the following hypothetical case that illustrates key EVALI evaluation and treatment scenarios. Would you know what to do?

Case Presentation: A Simple Case of Influenza?

John, a 17-year-old with no significant past medical history, presents to his primary care physician's (PCP's) office complaining of 2 days of subjective fever, chills, myalgia, arthralgia, fatigue, and a nonproductive cough. He also describes intermittent abdominal pain with nausea, accompanied by two episodes of nonbloody, nonbilious emesis. John denies recent overseas travel, but a week ago he visited his grandfather, who had been moderately ill with a confirmed diagnosis of influenza. John arrives at the office with his mother, who is the policyholder for his health insurance; neither of them has received an influenza vaccine this year.

On physical examination, he appears tired but in no distress. His lungs are clear to auscultation, his abdomen is nontender to palpation, and the remainder of his physical examination is unremarkable. An antigen-based influenza rapid test is conducted and the result is negative. Vital signs are as follows:

  • Temperature: 99.4° F (37.4° C)

  • Pulse: 80 beats/min, regular

  • Blood pressure: 124/82 mm Hg

  • Respiratory rate: 18 breaths/min

  • Oxygen saturation: 99% on room air