Vaping-Associated Lung Injury Riskier for Older Patients

Jennifer Garcia

January 02, 2020

Patients who were rehospitalized or who died after being treated for EVALI (e-cigarette or vaping product use–associated lung injury) were more likely to have been older and to have had at least one chronic illness, the Centers for Disease Control and Prevention (CDC) reports.

In response to these findings, the CDC has issued interim guidance recommending confirmation of patients' medical stability for 24 to 48 hours prior to discharge, outpatient follow-up of patients within 48 hours after discharge, and follow-up with a pulmonologist within 2 to 4 weeks after discharge.

According to the CDC, 2561 cases of EVALI and 55 deaths have been reported as of January 2, 2020, and numbers continue to rise.

These findings underscore the need for incorporating measures that "might minimize EVALI patients' risk for rehospitalization and death, especially among patients with chronic conditions," the authors write.

Christina A. Mikosz, MD, and colleagues from the CDC's Lung Injury Response Epidemiology/Surveillance Task Force partnered with state health departments to develop a voluntary reporting service to collect data "on confirmed and probable hospitalized or deceased EVALI patients."

Using data reported to the CDC as of December 10, 2019, they compared the clinical characteristics of patients with EVALI who were rehospitalized or died after hospital discharge with those of patients with EVALI who were neither rehospitalized nor died after hospital discharge (comparator group). The findings were published online January 2 in Morbidity and Mortality Weekly Report.

Data from 2409 cases that required hospitalization were evaluated, including 52 deaths. The researchers found that among the 1139 patients discharged before October 31, 2019, 31 (2.7%) were rehospitalized, and seven (13.5%) died following discharge. The median interval from discharge to readmission and from discharge to death was 4 days and 3 days, respectively. The comparator group included 768 patients with EVALI who were also discharged before October 31, 2019, but who were not rehospitalized and who did not die.

Mikosz and colleagues found that 70.6% of those who were rehospitalized and 83.3% of those who died had one or more chronic conditions, compared with 25.6% of patients in the comparator group. Chronic conditions included cardiac disease, chronic pulmonary disease (eg, chronic obstructive pulmonary disease and obstructive sleep apnea), and diabetes.

Further, patients who died following their initial visit were more likely to be older (median age, 54 years). All required intubation and mechanical ventilation during their initial hospital visit. Duration of initial hospitalization and use of corticosteroids or antibiotics were similar for all three groups.

Given that most rehospitalizations occurred within 2 to 4 days following initial discharge, the authors suggest "that ensuring clinical stability before discharge as well as postdischarge follow-up optimally within 48 hours might minimize risk for rehospitalization and death, especially among patients with chronic conditions."

Findings Prompt New Guidance

In response to the finding by Mikosz and colleagues, the CDC, in consultation with the Lung Injury Response Clinical Working Group, has provided updated interim guidance for the management of patients with EVALI. These new recommendations include the following:

  • Confirmation of stable vital signs for at least 24 to 48 hours prior to discharge;

  • Follow-up within 48 hours of discharge (previous recommendation was within 2 weeks of discharge);

  • Focused management of comorbidities and coordination of posthospitalization specialty care; and

  • Ensuring access to mental and behavioral health services post discharge.

The authors have disclosed no relevant financial relationships.

MMWR. Published online January 2, 2019. Full text

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