News Alert: CDC and FDA Issue Framework to Aid Clinicians for Treating Vaping

Agencies continue their investigation into the underlying cause of electronic cigarette/vaping-associated lung injury.

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to investigate the underlying cause of electronic cigarette/vaping-associated lung injury (EVALI).   

In order to assist public health response in recognizing and treating EVALI, the CDC and FDA have developed a framework to aid clinicians with an initial assessment, evaluation, management, and follow-up. The quicker the injury is recognized and treated, the better mortality and morbidity are reduced.

EVALI does not have a test that confirms the diagnosis. All potential diagnoses are eliminated to identify this condition. If EVALI is suspected, it is important to obtain the patient’s history regarding substance use, as well as electronic cigarette usage.

Clinical Evaluation

The physician should look for cough, chest pain, and shortness of breath. Some patients have presented with abdominal pain, nausea, vomiting, and diarrhea. And other patients have complained of fever, chills, and weight loss.   

Physical Examination

The physician should begin with vital signs and pulse oximetry. EVALI patients presented with oximetry < 95 percent on room air, as well as tachycardia and tachypnea. The respiratory auscultation has been unremarkable. 

Laboratory/Imaging Testing

The laboratory tests that have been positive in EVALI patients include white blood cell (WBC), C-reactive protein, erythrocyte sedimentation rate (ESR), and liver transaminases. Other laboratory testing should be guided by the patient’s presentation and history. The patient should be tested for influenza and other opportunistic infections. A provider may consider (with the patient’s consent) a urine toxicology test to determine tetrahydrocannabinol (THC) usage. A chest X-ray (CXR) should be completed, especially if the patient has a history of electronic cigarette usage. A chest CT is not required but should be considered on a case-by-case basis. The chest CT may be helpful in the diagnosis of pulmonary embolism or pneumonia.


A pulmonologist may be consulted to perform a bronchoalveolar lavage (BAL) or bronchoscopic lung biopsy. The specimen may be tested for respiratory infections. The benefit of lung biopsy with the staining of the specimen has not been proven to date. Depending on the severity of the patient’s respiratory distress, critical care specialists may be consulted. In some cases, EVALI patients were intubated and placed on a mechanical ventilator. Other specialists, depending on the patient’s history or presentation, include addiction specialists, psychiatrists, infectious disease specialists, etc.

Patient Management

Almost all EVALI patients have been admitted to the hospital. Patients with pulse oximetry < 95 percent on room air, respiratory distress, and other conditions that impact the patient’s respiratory function should be admitted. These patients have developed rapidly worsening respiratory conditions within 48 hours. Outpatient management of suspected EVALI patients should be considered on a case-by-case basis.


Corticosteroids have been a treatment for EVALI patients. Corticosteroids should be held until the infection workup has been completed. Infections must be evaluated, as the influenza season started on Oct. 1. The problem regarding treatment is that the natural progression of the disease has not been identified, so investigators are unsure if the patients would improve without corticosteroids. Patients who were older than 50 were more likely to be intubated or mechanically ventilated.

At-Risk Population

The patients who are at risk include those who are older, have a history of cardiac/lung disease, or who are pregnant.  

Follow-Up Required

EVALI patients should follow up one to two weeks after discharge. The post-discharge visit should include pulse oximetry and chest X-ray. Patients who were treated with high-dose corticosteroids may require follow-up with an endocrinologist. Patients who require home oxygen may require ongoing follow-up with a pulmonologist.  


According to the Mortality and Morbidity Weekly Report of Oct. 22, the source of EVALI is still unknown. The risk of relapse or aftereffects of EVALI is not known at this time. The CDC is recommending that people not use an e-cigarette or vaping products containing THC. Ultimately, the CDC recommends that no e-cigarette or vaping products be used until the origin of lung injuries is known.


Programming Note:

Listen to Laurie Johnson report this story live today during Talk Ten Tuesday, 10-10:30 a.m. EST.

Print Friendly, PDF & Email

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an AHIMA-approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Revolutionize Case Management and Revenue Cycle Team Collaboration to Improve Patient and Financial Outcomes

Revolutionize Case Management and Revenue Cycle Team Collaboration to Improve Patient and Financial Outcomes

Unlock the keys to bridging the clinical-finance disconnect by transforming your approach to revenue cycle collaboration for superior patient care and financial prosperity!

Join Dr. Ronald Hirsch as he delves into the pivotal connection between case management, utilization review, and hospital revenue cycles, unveiling strategies to enhance communication and align goals effectively. Discover how to overcome hidden challenges hindering seamless collaboration and gain insights imperative for success

Print Friendly, PDF & Email
December 7, 2023
Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.

Print Friendly, PDF & Email
September 19, 2023
Unlocking Clinical Documentation Excellence: Empowering CDISs & Coders

Unlocking Clinical Documentation Excellence: How to Engage the Provider

Uncover effective techniques to foster provider understanding of CDI, empower CDISs and coders to customize their queries for enhanced effectiveness, and learn to engage adult learners, leveraging their experiences for superior learning outcomes. Elevate your CDI expertise, leading to fewer coding errors, reduced claim denials, and minimized audit issues.

Print Friendly, PDF & Email
December 14, 2023
Coding for Spinal Procedures: A 2-Part Webcast Series

Coding for Spinal Procedures: A 2-Part Webcast Series

This exclusive ICD10monitor webcast series will help you acquire the critical knowledge you need to completely and accurately assign ICD-10-PCS and CPT® codes for spinal fusion and other common spinal procedures.

Print Friendly, PDF & Email
October 26, 2023
Inpatient Spinal Fusions: Mastering Anatomy, Coding and Documentation

Inpatient Spinal Fusions: Mastering Anatomy, Coding and Documentation

During this exclusive ICD10monitor webcast, inpatient coders will gain a profound understanding of prevalent spinal procedures. They’ll delve into the intricate anatomy, grasp the purpose and method behind these procedures, uncover essential elements within physician documentation, and receive expert guidance, step by step, on constructing accurate ICD-10-PCS codes. It’s the key to enhancing their expertise and ensuring coding precision.

Print Friendly, PDF & Email
October 26, 2023

Trending News