Management of Vaping-Induced Lung Injury

Initial Assessment and Triage

Patients with oxygen saturation <95% on room air should be hospitalized 1
Patients with respiratory distress should be hospitalized 2
Patients with comorbidities that could compromise cardiopulmonary reserve should be hospitalized 3
Patients who are unable to discontinue e-cigarette/vaping product use should be hospitalized 4
Patients with inadequate social support or unreliable access to care should be hospitalized 1

Vital signs with pulse oximetry should be assessed to evaluate respiratory status 4
A focused history, including specific vaping products used, should be taken 2
Other possible etiologies, such as influenza and community-acquired pneumonia, should be ruled out 3
A chest radiograph (CXR) should be performed for all patients, and a CT scan should be considered even if the CXR is normal 1
Laboratory testing, including urine toxicology and infectious disease testing, should be performed as clinically indicated 4

All e-cigarette and vaping product use should be discontinued immediately 1, 4
Empiric antimicrobial therapy should be considered according to community-acquired pneumonia guidelines until infection is ruled out 2
Systemic corticosteroids should be considered, as they have shown benefit in many cases 1, 4
Routine annual influenza vaccination should be administered if not previously received 2

Supplemental oxygen should be provided to maintain SpO2 ≥95% for patients with hypoxemia 1

Patients should be discharged when they have been clinically stable for 24-48 hours, have no clinically significant fluctuations in vital signs, and have adequate oxygenation on room air 1, 5
Patients should be screened for mental health, substance use disorders, and social care needs 1
Patients should be ensured access to social/mental health/substance use disorder services 2
Medication reconciliation and patient counseling should be performed by an inpatient pharmacist, particularly for patients on corticosteroid taper 1
An initial outpatient follow-up appointment should be scheduled within 48 hours of discharge 5
Follow-up with a pulmonologist should be arranged within 2-4 weeks 1

Patients managed as outpatients should be advised to discontinue all e-cigarette and vaping products 1
Corticosteroids should be considered with caution due to the risk of worsening respiratory infections 4
A chest radiograph should be considered for patients with chest pain or shortness of breath 2
Influenza testing should be considered during flu season 1

Patients who received prolonged corticosteroid courses should be evaluated for risk of secondary adrenal insufficiency before hospital discharge 1
Patients who received prolonged steroid treatment should be considered for corticosteroid taper and follow-up with an endocrinologist 1
Patients should be counseled about signs and symptoms of adrenal insufficiency 1
Cessation services should be offered to all patients, and connection to these services should be facilitated 1
Behavioral interventions for smoking/vaping cessation should be considered 6

Patients with cardiac disease, chronic pulmonary disease, diabetes, and older age have a higher risk for rehospitalization and death 5

Clinical stability is typically achieved within 24–48 hours after initiating systemic corticosteroid therapy and vaping cessation, permitting discharge on room air. 7

The CDC recommends a pulmonary specialist visit 2–4 weeks post‑discharge, with spirometry, diffusing capacity (DLCO), and chest radiograph performed at 1–2 months to identify any persistent lung function abnormalities. 8

Immediate discontinuation of all e‑cigarette and vaping products is essential for reversal of lung injury. 9
Strict adherence to a corticosteroid taper is critical; failure to taper appropriately has been associated with rehospitalization. 9
Patients who receive prolonged systemic corticosteroid courses should be screened for secondary adrenal insufficiency. 9