Breaking News
Get 40% Off 0
Is NVDA a 🟢 buy or 🔴 sell? Unlock Now

Amid vaping crisis, U.S. to issue new advice for doctors focused on lung infections

Published Oct 10, 2019 05:24PM ET
Saved. See Saved Items.
This article has already been saved in your Saved Items
© Reuters. Jeffrey Manzanares lies in the intensive care unit of the University of Utah Hospital

By Julie Steenhuysen

CHICAGO (Reuters) - U.S. health officials are preparing to release new guidance for doctors stressing the need to ask every patient with an apparent respiratory infection about their vaping history.

The updated guidance will also advise physicians on how to diagnose and manage patients who may have both a lung infection and a vaping injury.

Dr. Ram Koppaka, a medical officer with the Centers for Disease Control and Prevention (CDC), said doctors need to be aware that there is an overlap between the early symptoms of vaping injury and common respiratory infections.

The CDC has already recommended doctors start asking patients about their vaping history during routine visits, but gathering that information is especially important as doctors evaluate patients with respiratory symptoms from infectious causes.

"Both diagnoses must be evaluated,” Koppaka said in a phone interview.

The CDC reported on Thursday that as of Oct. 8, 1,299 people in the United States have had confirmed or probable cases of lung injuries linked to vaping. Some 80% of those patients were under age 35, and 26 deaths have been linked to the illness.

Of 573 patients whose vaping habits have been evaluated so far, 76% reported using THC - the psychoactive ingredient in marijuana - some of whom also used nicotine vape products. Nearly a third said they only vaped THC products, while 13% percent said they only vaped nicotine.

Some U.S. doctors have raised concerns that vaping injury cases will be missed in the crush of patients seeking treatment for seasonal flu and other respiratory ailments.

The early symptoms of vaping injury include shortness of breath, cough, chest pain, fever, and in some cases, gastrointestinal symptoms such as nausea, vomiting and diarrhea. "All of those can also be seen with influenza," Koppaka said.

In the United States, flu activity starts to pick up in October and November and typically peaks between December and February.

"The fact that a given individual that presents for clinical evaluation could have flu, could have lung injury due to e-cigarettes, or both, makes it complicated for providers," Koppaka said.

As many as 72% of the earliest vaping patients in Illinois and Wisconsin sought medical treatment in outpatient clinics and emergency rooms before doctors admitted them to a hospital with severe lung injuries from vaping, state officials reported last month in the New England Journal of Medicine.

Most of those patients initially were given antibiotics. When those failed, many responded to treatment with supplemental oxygen and steroids.


In addition to flu, many respiratory infections, including fungal infections, can cause symptoms that could confound doctors and delay a vaping injury diagnosis.

The University of Utah Hospital in Salt Lake City has treated 22 patients with vaping injuries, including Jeffrey Manzanares, 33, who was also infected with a cold and human metapneumovirus that led to pneumonia.

Manzanares, who said he routinely vaped nicotine and occasionally vaped THC, first sought treatment at a local hospital on Sept. 3, where he was given an antibiotic and oxygen for his pneumonia and sent home, his vaping injury undetected.

"I ended up in agony from the lack of oxygen. It felt like someone was stabbing a knife into my whole body," he said in a phone interview.

He went to the University of Utah Hospital the next day, where he spent 21 days, including 17 in intensive care. During his illness, Manzanares said he lost 50 pounds (22.7 kg), a third of his normal body weight.

"He was wildly sick," said Dr. Scott Aberegg, a pulmonologist who treated Manzanares. "If that is any harbinger of what is to come in viral pneumonia season, this could be very problematic."

Aberegg said many doctors who get back a positive flu test may just assume the patient has the flu and not realize they are also a vaper.

State health officials are on alert.

"We want to make sure to investigate all cases that are reported and make sure we don't miss anything that may be thought of as flu or may be associated with vaping or vice versa," Dr. Pam Pontones, Indiana's deputy health commissioner and state epidemiologist, said in a phone interview.

Influenza can be deadly in people who have other underlying illnesses.

"It's really important that anyone, but especially people who have underlying pulmonary infections of any kind, be vaccinated for influenza," Pontones said.

The CDC recommends everyone over the age of six months get a flu shot.

Amid vaping crisis, U.S. to issue new advice for doctors focused on lung infections

Related Articles

Add a Comment

Comment Guidelines

We encourage you to use comments to engage with other users, share your perspective and ask questions of authors and each other. However, in order to maintain the high level of discourse we’ve all come to value and expect, please keep the following criteria in mind:  

  •            Enrich the conversation, don’t trash it.

  •           Stay focused and on track. Only post material that’s relevant to the topic being discussed. 

  •           Be respectful. Even negative opinions can be framed positively and diplomatically. Avoid profanity, slander or personal attacks directed at an author or another user. Racism, sexism and other forms of discrimination will not be tolerated.

  • Use standard writing style. Include punctuation and upper and lower cases. Comments that are written in all caps and contain excessive use of symbols will be removed.
  • NOTE: Spam and/or promotional messages and comments containing links will be removed. Phone numbers, email addresses, links to personal or business websites, Skype/Telegram/WhatsApp etc. addresses (including links to groups) will also be removed; self-promotional material or business-related solicitations or PR (ie, contact me for signals/advice etc.), and/or any other comment that contains personal contact specifcs or advertising will be removed as well. In addition, any of the above-mentioned violations may result in suspension of your account.
  • Doxxing. We do not allow any sharing of private or personal contact or other information about any individual or organization. This will result in immediate suspension of the commentor and his or her account.
  • Don’t monopolize the conversation. We appreciate passion and conviction, but we also strongly believe in giving everyone a chance to air their point of view. Therefore, in addition to civil interaction, we expect commenters to offer their opinions succinctly and thoughtfully, but not so repeatedly that others are annoyed or offended. If we receive complaints about individuals who take over a thread or forum, we reserve the right to ban them from the site, without recourse.
  • Only English comments will be allowed.
  • Any comment you publish, together with your profile, will be public on and may be indexed and available through third party search engines, such as Google.

Perpetrators of spam or abuse will be deleted from the site and prohibited from future registration at’s discretion.

Write your thoughts here
Are you sure you want to delete this chart?
Post also to:
Replace the attached chart with a new chart ?
Your ability to comment is currently suspended due to negative user reports. Your status will be reviewed by our moderators.
Please wait a minute before you try to comment again.
Thanks for your comment. Please note that all comments are pending until approved by our moderators. It may therefore take some time before it appears on our website.
Are you sure you want to delete this chart?
Replace the attached chart with a new chart ?
Your ability to comment is currently suspended due to negative user reports. Your status will be reviewed by our moderators.
Please wait a minute before you try to comment again.
Add Chart to Comment
Confirm Block

Are you sure you want to block %USER_NAME%?

By doing so, you and %USER_NAME% will not be able to see any of each other's's posts.

%USER_NAME% was successfully added to your Block List

Since you’ve just unblocked this person, you must wait 48 hours before renewing the block.

Report this comment

I feel that this comment is:

Comment flagged

Thank You!

Your report has been sent to our moderators for review
Continue with Google
Sign up with Email