PUBLIC HEALTH
SEVERE LUNG INJURY LINKED TO E-CIGARETTE USE
AUTHORS Sarah Moyer, MD, MPH & Lori Caloia, MD
A
new lung mal-
ady linked
to electronic
cigarette use
is sweeping
the nation. It’s
being called
EVALI – E-cigarette or
Vaping product use Associated with Lung Injury.
It began on June 11 when a teenager arrived at the Children’s
Hospital of Wisconsin, suffering from shortness of breath and weight
loss, too fatigued to perform routine activities. Physicians and other
medical professionals started connecting the dots to other young
and otherwise healthy patients with similar symptoms.
The only common denominator was that all had used electronic
cigarettes.
In his excellent article in the October issue of Louisville Medi-
cine, “Curbing the Electronic Cigarette Epidemic: Rationale for a
Nicotine-Level Based Tax,” Gordan Tobin, MD, alluded to EVALI,
pointing out that, as of September, there had been five deaths and
more than 450 cases through September.
Since September, however, the outbreak has rapidly grown.
As of November 13, 2019, 2,172 cases had been reported to CDC
from 49 states (all but Alaska), the District of Columbia and two
US territories. There had been 42 deaths in 24 states, including one
death of an Indiana resident who presented at a Louisville hospital.
As of November 8, 31 cases were under investigation in Kentucky
with 11 probable cases and three confirmed cases. Two of the cases
under investigation involve Louisville residents.
Based upon medical chart abstraction data submitted to CDC,
95% (323/339) of patients diagnosed with EVALI initially experi-
enced respiratory symptoms (e.g., cough, chest pain and shortness
of breath), and 77% (262/339) had gastrointestinal symptoms (e.g.,
abdominal pain, nausea, vomiting and diarrhea). Gastrointesti-
nal symptoms preceded respiratory symptoms in some patients.
Respiratory or gastrointestinal symptoms were accompanied by
constitutional symptoms such as fever, chills and weight loss among
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DECEMBER 2019
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