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VAPI: Vaping Associated Pulmonary Injury

Mizuho Morrison, DO and Solomon Behar, MD

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Given the recent spike of VAPI (vaping associated pulmonary injury) cases, our HIPPO medical editorial team review the clinical presentation and latest management recommendations for this lung disease. Mizuho Morrison and Sol Behar discuss a recent case, and review the hot-off-the-press published CDC health alert. Take a listen!


  • There has been a recent explosion in vape associated pulmonary injury, with serious morbidity and mortality.

  • VAPI has been more commonly associated with THC-containing products ,although a wide variety of nicotine containing products and devices have been reported.

  • Symptoms: 

    • Constitutional symptoms (100%)

    • Respiratory distress and cough (98%)

    • GI symptoms: nausea, vomiting, diarrhea (80%)

    • Fever (30%)

  • Diagnosis: Vaping in past 90 days, bilateral pulmonary infiltrates on imaging, Ground-glass appearance noted on CT chest. Absence of detectable bacterial/viral infection. 

  • Treatment: 

    • Respiratory support

    • Steroids may be beneficial

    • Antibiotics alone do not appear to help as this is not an infectious process, rather an inflammatory one. However given initial mixed presentation, it is not unreasonable to initiate antibiotics until pneumonia is ruled out and diagnosis is confirmed. 



  1. Layden JE1,Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report. N Engl J Med. 2019 Sep 6. 




Jeanna T. -

I am wondering if starting prednisone in an out patient setting PCP office would have helped in VAPI or is sending for admission and work up at the hospital the best option for a suspected case?

Mizuho M., DO -

Good question. And the truth is we don't have enough evidence to suggest just one tx at this point. Disposition of the pt should depend on their severity. If clinically the pt is in respiratory distress (increased work of breathing, hypoxemia, increased RR etc) steroids alone are not sufficient. VAPI is a clinical diagnosis at this point...and thus if you suspect VAPI and the pt is sick, getting them to higher level of care should be your priority. If on the other hand, you suspect "mild vapi" and based on CXR, vitals, presentation think they are stable to go home...certainly a trial of steroids couldn't hurt with strict return precautions. However I'd caution anyone to rely on steroids alone. Additional warning given these patients for the most part are young...hence can mask severe disease pretty well. If you suspect VAPI, be conservative is my recommendation. Hope that helps. ~miz

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