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Posted on: October 14, 2019

Vaping-Associated Lung Injury: Clinician Guidelines, State Board of Health Emergency Rule


The Centers for Disease Control and Prevention, U.S. Food and Drug Administration, state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of vaping-related lung injury. As of October 8, the CDC reported 1,299 cases nationwide, including 26 deaths. Cases have been associated with the use of both regulated and illicit vapor products. Multiple cases have been reported in Washington, including one non-fatal case in Snohomish County. 

 This investigation is ongoing and has not identified a single cause, but all reported cases have a history of using vapor products. Most patients with severe lung disease have reported a history of using vapor products containing THC. Some have reported the use of vapor products containing only nicotine. 

 Per an emergency rule approved by the Washington State Board of Health on October 9, sale of flavored vapor products – both nicotine and THC – is banned, among other measures. A message from the state Liquor and Cannabis Board regarding the new regulation is attached.

 Action Requested

  • For patients presenting with cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever, and/or abdominal pain, ask whether they vaped or dabbed in the past 90 days. 
  • Report cases of vaping-associated lung injury to the Snohomish Health District within 3 days. Report any hospitalized patient who:  
    • Reports vaping or dabbing in the 90 days prior to symptom onset AND 
    • Has a chest X-ray with pulmonary infiltrates or a chest CT scan with ground-glass opacities AND 
    • Has no pulmonary infection (i.e., negative respiratory viral panel, negative flu test, and other clinically-indicated respiratory infectious disease testing negative) or an infection has been identified, but you feel this is not the sole cause of the lung injury or complete infectious disease testing was not performed, but you feel an infection is not the sole cause of the lung injury AND
    • There is no other alternative plausible diagnosis such as a cardiac, rheumatologic or neoplastic process.
  • Healthcare providers and healthcare facilities are required to report vaping-associated lung injury per an emergency rule passed by the State Board of Health on October 9 and, as a rare disease of public health significance, per WAC 246-101-101 and WAC 246-101-301
  • If e-cigarette or vaping product use is suspected as a possible etiology of a patient’s lung injury, healthcare providers should obtain a detailed history regarding: 
    • Substance(s) used 
    • Substance source(s) 
    • Device(s) used 
    • Where the products were purchased 
    • Method of substance use


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