Severe Respiratory Illness Associated with E-cig/Vaping – Resource for Clinicians

The Hawaii Department of Health has confirmed four cases of e-cigarette, or vaping, product use associated lung injury (EVALI) in residents in Hawaii, one from each county. Two of the cases are adults, and two are adolescents.

The Hawaii Department of Health has developed the following algorithm to assist clinicians in recognizing and reporting new cases of EVALI:

HDOH Clinical Algorithm (pdf)

If you suspect a patient under your care may have respiratory illness caused by vaping, please complete the case report form:

Preliminary Vaping Case Report Form (pdf)

If you do have a suspected case of EVALI, to collect a preliminary history of the patient’s vaping history, have them fill out this form:

Patient Vaping History Survey (pdf)

Fax to the Disease Outbreak Control Division at (808)586-8347 or email to
[email protected] using encryption or password protection.

 

Action Items for Hawaii Clinicians:

Inpatient setting:

  • Assess patients for a vaping history for THC, nicotine, and/or any other products in the 90 days before illness onset.
  • Consider this syndrome in patients with severe respiratory disease and vaping history,
    especially those with no explicative etiology.
  • Consider consulting a pulmonologist to guide additional diagnostics and management.

Outpatient setting:

  • Assess patients for recent or prior use of vaping products.
  • Consider potential for worsening disease progression if risk factors present.

All settings:

  • Educate all patients on the risks associated with vaping nicotine and other products.
    Advise patients to seek care if symptoms worsen or return after initial resolution.
  • While the national investigation is ongoing, persons should consider not using e-cigarette
    products, especially those purchased from sources other than authorized retailers (e.g., e-cigarette products with THC) and those modified in a manner not intended by the
    manufacturer.
  • Contact the Disease Outbreak Control Division immediately (refer to contact information
    below) if you suspect you are managing a case of vaping associated severe respiratory
    illness. If e-cigarette product use is suspected as a possible cause for a patient’s
    respiratory disease, please obtain a detailed history of the substances used, the sources,
    and the devices used. Determine also if any remaining product, devices, and liquids are
    available for testing.

We are advising the public to contact their physician should they have any concerns. E-cigarettes
should never be used by youths, young adults, pregnant women, and adults who do not currently
use tobacco products. If you have any questions or need to report a suspect case of vaping
associated severe respiratory illness, please contact the Department of Health immediately.

Oahu (Disease Reporting Line)………………………………. (808) 586-4586
Maui District Health Office…………………………………….. (808) 984-8213
Kauai District Health Office……………………………………. (808) 241-3563
Big Island District Health Office (Hilo)……………………. (808) 933-0912
Big Island District Health Office (Kona)……………………(808) 322-4877
After hours on Oahu……………………………………………….(808) 600-3625
After hours on neighbor islands……………………………..(800) 360-2575 (toll free)

Links and Resources: