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MHRA urges healthcare professionals to be vigilant in new advice on identifying vaping-related lung injury

The Medicines and Healthcare products Regulatory Agency (MHRA) has released a drug safety update warning healthcare professionals to be alert to possible adverse reactions from vaping among patients with respiratory problems.

The organisation is also calling on doctors and nurses to ask all patients 'routinely' about e-cigarette use and report any suspected side effects from vaping via the Yellow Card Scheme.

There is currently no standard diagnostic criteria for identifying vaping-associated lung injury, but the MHRA has drawn up a list of criteria for healthcare professionals to use, based on expert advice.

In the UK, the MHRA is aware of two potential cases of lung injury associated with vaping, with both resulting in the patient dying.

It follows investigations in the US into 2,600 cases of lung injuries - including 60 where people have died - to determine the association with the use of e-cigarettes or vaping products. 

Healthcare professionals in the UK were sent a letter this week warning that cases of lung injury should be reported via the Yellow Card Scheme as ‘probably’ related to e-cigarette use if they met all the following criteria:

  • Patient has vaped in the last 30 days
  • There is pulmonary infiltrate, such as opacities on plain film chest x-ray
  • Absence of respiratory infection
  • No evidence of alternative diagnosis (such as malignancy)

Cases can be reported as ‘possible’ if all the criteria have been met but the patient either has a respiratory infection or testing for infection has not yet been carried out.

Doctors are also advised to routinely ask patients about their vaping habits and to document the brand and type of products they use and the substances that are vaped.

Public health officials stated in November that regulated e-cigarettes carry only ‘a fraction’ of the risk that normal cigarettes do after concerns were raised following a case report of a boy who nearly died after having a severe lung reaction to vaping.

Public Health England also published an evidence review in 2018 recommending that e-cigarettes should be made available on the NHS as a smoking cessation aid.