Tracking E-Cigarette Use: Guidance for Health Professionals

The American Lung Association warns against the use of all e-cigarettes. The Centers for Disease Control (CDC) and the U.S. Food and Drug Administration, along with state and local health departments, have been investigating multi-state reports of lung injury (referred to by CDC as EVALI) associated with e-cigarette and vaping product use. This guidance is intended to support healthcare providers in their understanding and tracking of this important issue.

Guidelines for Everyday Tracking of E-cigarette Usage

Similar to the tracking of tobacco use, tracking of e-cigarette or vaping product use is important to understanding a patient's health status.

• The Lung Association recommends that questions be added to an institutions' Electronic Health Records (EHR) to ensure that the use of e-cigarettes be incorporated into all patient tracking so that the health impacts can be followed. Automated prompts and language which reflects the words used by patients to refer to vaping should be incorporated into EHRs.
• Additional questions should be asked regarding e-cigarette use when the patient is being examined by a healthcare professional. For example, have you ever used (and if so, do you now use every day, some days, or not at all) electronic cigarettes? If a physician suspects e-cigarette, or vaping, product use associated lung injury (EVALI) the CDC has recommendations for initial clinical evaluation and follow up, which include patient history, physical examination, laboratory testing, imaging and consultation with specialists. As these recommendations may change as more information becomes available, please check here for specifics. Doctors may also be aware of e-cigarette products as vape-pens, JUULs, vapes, e-hookahs, or e-vaporizers. Some look like cigarettes, and others look like thumb drives, pens or small pipes. These are battery-powered, usually contain liquid nicotine, and produce vapor instead of smoke.

Guidelines for More Serious Cases

As this investigation continues, CDC encourages clinicians to report possible cases of lung injury associated with e-cigarette use or vaping to their local or state health department for further investigation.

• If e-cigarette or vaping product use is suspected as a possible cause for a patient's lung injury, a detailed history of the substances used, the sources, and the devices used should be obtained. This is outlined in the CDC's Health Alert Network (HAN) update. Health Departments can be supported by obtaining and sending products and devices in additional to clinical and pathologic specimens for testing. Additional advice can be found here.
• If a lung biopsy or autopsy is performed on a patient suspected of lung injury related to e-cigarette or vaping product use, consider submission of fixed lung biopsy tissues or autopsy tissues to CDC for evaluation. Testing can include evaluation for lipids on formalin-fixed (wet) lung tissues that have not undergone routine processing. Routine microscopic examination will be performed, as well as infectious disease testing, if indicated, on formalin-fixed (wet) tissues, or formalin-fixed, paraffin-embedded tissue specimens. For more information, see the CDC’s specimen submission guidance.
• Guidance is available on general specimen collection and storage for healthcare providers and public health laboratory personnel involved in the care of patients who meet, or are highly suspected of meeting, the case definition for lung injury related to e-cigarette use or vaping. For information on the submission of non-tissue samples, please contact NCEHSampleLogistics@CDC.gov.

The CDC is updating its information on this issue on an ongoing basis. To find updated data and information on the extent of the problem, please access CDC.gov/lunginjury.

More Resources to Assist Your Patients

• The Lung Association maintains a large suite of information on e-cigarettes and lung health. Healthcare providers can share this information with patients who use e-cigarettes, parents and teens, and anyone else to help educate about the potential dangers of e-cigarette use.
• For youth, Not On Tobacco is available through school and community settings.
• The Lung Association has tobacco cessation programs that have been proven effective in helping people quit. These programs incorporate e-cigarette use in their implementation. For adults, Freedom From Smoking is available in four delivery options: in-person group clinic, online, by phone and via self-help guide.
• The American Lung Association's Lung HelpLine is also a great resource for both youth and adults looking to quit. The HelpLine is free and available in over 250 languages by calling 1-800-LUNGUSA. To learn more visit Lung.org/ffs.