CS 311294-P 12/20/2019

ALGORITHM FOR MANAGEMENT OF PATIENTS 

WITH RESPIRATORY, GASTROINTESTINAL, OR 

CONSTITUTIONAL SYMPTOMS AND E-CIGARETTE, 

OR VAPING, PRODUCT USE (12/20/2019)

Outpatient clinical evaluation 

• Consider CXR if patient has chest pain, shortness

of breath or if indicated by other clinical ndings

• Consider inuenza testing

Management of possible EVALI 

• Advise discontinuation of all e-cigarette, or

vaping, products

• Consider corticosteroids use with caution in 

outpatients due to risk of worsening of

respiratory infections

Management of possible EVALI with a pulmonary

infection, per established guidelines

• Early initiation of antivirals for possible inuenza

• Appropriate antibiotics for CAP

Additional management

• Oer cessation services to all patients; 

facilitate connection 

• Administer routine annual (inactivated or 

recombinant) inuenza vaccination, if not 

previously received 

• Ensure follow-up within 24–48 hours 

Inpatient clinical evaluation

• Urine toxicology, inuenza, and other infectious disease testing as 

indicated by clinical ndings

• CXR, and consider CT scan even if CXR is normal

• Consider pulmonary, critical care, medical toxicology, infectious 

diseases, psychiatry consultations; others

• Bronchoalveolar lavage or lung biopsy, if clinically indicated (in 

consultation with pulmonary specialists)

Inpatient clinical management

• Discontinue e-cigarette, or vaping, products use 

• Oer cessation services to all patients; facilitate connection

• Consider empiric antimicrobial use according to guidelines

• Consider corticosteroids; use with caution

• Administer routine annual (inactivated or recombinant) inuenza 

vaccination, if not previously received 

Discharge planning

• Screen for mental health, substance use disorders, and social care

needs before discharge

• Ensure clinical stability for 24–48 hours before discharge

• Ensure access to social/mental health/substance use disorder services

• Conduct medication reconciliation and patient counseling by inpatient 

pharmacist before discharge

• Ensure initial outpatient follow-up appointment, optimally within 48

hours of discharge

• Follow-up with pulmonologist within 2–4 weeks

Initial clinical assessment

• Vital signs, pulse oximetry

• Focused history and physical exam

• Rule out other possible etiologies (e.g., inuenza, CAP)

Determine if patient is candidate for outpatient EVALI

management 

• O2 saturation ≥95% while breathing room air

• No respiratory distress 

• No comorbidities that could: 1) compromise cardiopulmonary

 reserve, 2) increase risk for severe disease, or 3) aect ability

 to discontinue e-cigarette, or vaping, product use or adhere

to outpatient treatment plan

• Reliable access to care/strong social support systems 

Evaluate and manage patient

as clinically indicated

Patient with fever, cough, sore throat, shortness of breath,

muscle aches, fatigue, nausea, or vomiting

Ask whether patient has used

e-cigarette, or vaping, products

No Yes

Yes

Abbreviations: CXR = chest x-ray, CT = computed tomography, CAP = community-acquired pneumonia

.

No

ALGORITHM FOR MANAGEMENT OF PATIENTS WITH SUSPECTED 

E-CIGARETTE, OR VAPING, PRODUCT USE–ASSOCIATED LUNG 

INJURY (EVALI)

continued >>

PRINT ONLY
Reporting cases with suspected EVALI to state, local, territorial, or tribal health departments is critical for accurate 

surveillance of EVALI. 

Determine whether any remaining product, including devices and liquids, is available for testing. Consider 

submission of any collected specimens, including bronchoalveolar lavage, blood, urine, biopsy, or autopsy 

specimens, to CDC for evaluation. Testing can be coordinated with health departments.

CDC recently developed International Classification of Diseases, Tenth Edition, Clinical Modification coding 

guidance for health care encounters related to EVALI. 

For current guidance on influenza vaccination see: Prevention and Control of Seasonal Influenza with Vaccines: 

Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza 

Season

Recommendations for clinicians regarding the Outbreak of EVALI will be updated at www.cdc.gov/lunginjury.

WWW.CDC.GOV/LUNGINJURY

Print Only