CHEST Guidelines-Diagnosing-EVALI-in-the-Time-of-COVID-19_2020

Diagnosing-EVALI-in-the-Time-of-COVID-19_2020_ches

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The article discusses the challenges in diagnosing e-cigarette, or vaping, product use-associated lung injury (EVALI) during the COVID-19 pandemic. The initial outbreak of EVALI in 2019 in the U.S. was linked to 2800 hospitalizations and 68 deaths, primarily due to the use of illicit THC products containing vitamin E acetate. Although cases have declined, EVALI remains a concern as vaping habits persist, and the pandemic has intensified its diagnosis complexity due to symptom overlap with COVID-19. Both EVALI and COVID-19 present as acute respiratory failures, with similar imaging results, causing difficulties in differential diagnosis.<br /><br />Since the onset of COVID-19 testing, the University of Utah and Intermountain Healthcare have tracked EVALI cases. From March to May 2020, twelve patients were diagnosed with EVALI following the exclusion of influenza and at least one negative COVID-19 test. The typical EVALI patient is young, predominantly male and white, with a history of THC use, and often harbors psychiatric conditions such as anxiety, which can exacerbate vaping frequencies due to pandemic-related stressors.<br /><br />The study highlights the diagnostic challenges due to variable SARS-CoV-2 testing accuracy and inherent apprehension due to the pandemic. EVALI remains a diagnosis of exclusion, further complicated by inconsistent testing for COVID-19. Key distinguishing factors noted include EVALI patients exhibiting leukocytosis, as opposed to common lymphopenia seen with COVID-19, and the positive response to corticosteroid treatment.<br /><br />The data emphasizes the need for thorough patient history, particularly regarding vaping, to ensure accurate diagnosis amid the pandemic. The ongoing prevalence of EVALI, regardless of declining national numbers, suggests that it will remain a health issue until vaping products become entirely safe and regulated.

Keywords

EVALI

COVID-19

vaping

lung injury

THC

vitamin E acetate

diagnosis

respiratory failure

corticosteroids

pandemic