eCigarettes & Vaping
October 2019 Update
Authors: Gary Marks DO, David Thompson MD | Copyright 2019. Schmitt‐Thompson Clinical Content
Use of electronic cigarettes (vaping) has risen greatly over the last several years. Adult smokers have increasingly turned to e‐cigs to quit or decrease tobacco smoking. An especially concerning fact is that e‐cigs have become the most widely used tobacco product by youth. They are used by 1 in 5 high school students and almost 1 in 20 middle schoolers. The U.S. Surgeon General declared the use of e‐cigs among young people an epidemic.
The Centers for Disease Control and Prevention (CDC) has reported an outbreak of lung injury from smoking e‐cigs. As of October 1, 2019, there have been over 1000 cases with 18 deaths. Telephone triage nurses should be ready to answer questions from concerned callers. This issue of Clinical Update gives you an overview on this important topic.
What are electronic cigarettes (e‐cigs)?
E‐cigarettes go by many names such as e‐cigs, e‐hookahs, vape pens, vapes, tank systems, or ENDS (Electronic Nicotine Delivery system). E‐cigarettes have three main parts: a battery, a fluid chamber, and a heating element. The battery powers the heating element and the heating element turns the liquid into vapor. The vapor is inhaled by a user. This is why smoking e‐cigs is also called “vaping”. E‐cigarettes may look like pipes, cigars, pens, regular cigarettes, or even USB flash drives. “Pod mods” are re‐chargeable and have increasing popularity among teens. A popular brand is JUUL.
What is in the e‐cigarette fluid?
· E‐cigarette fluid has three main types of chemicals:
· Nicotine: Nicotine content ranges from none to 36 mg/dL.
· Flavor: There are thousands of different flavors. Some flavors are chocolate, cotton
candy, gummy bear and bubble gum. Such flavors may add to the use of e‐cigs and
nicotine addiction in children.
· Other chemicals: Other likely harmful substances in e‐cigarette vapor are propylene
glycol, heavy metals (nickel, lead, tin), and possible cancer‐causing chemicals.
It is not easy for users to know exactly what they are vaping. There have been e‐cigarette cartridges labelled “nicotine free” that have been found to have nicotine. Some people use marijuana products or other drugs by vaping.
What are the risks and complications?
E‐cigs may be less harmful than smoking normal cigarettes. Still, vaping does have health risks and complications:
· Nicotine: Nicotine is a stimulant. Nicotine is addictive and can lead to cravings. It is the same chemical that makes normal cigarettes habit‐forming. Nicotine can harm the growing brain of adolescents and young adults. For those that are pregnant, nicotine can be harmful to the unborn baby.
· Vaping‐linked Lung Injury: The Centers for Disease Control and Prevention (CDC) has recently reported an outbreak of lung injury from smoking e‐cigs. The cause of this is not yet known. Most of those with lung injury used a marijuana product (THC) with their e‐cig. Symptoms are cough, shortness of breath, chest pain, fever, upset stomach, throwing up, diarrhea and stomach pain. Symptoms appear over days to weeks.
· Battery failure can lead to explosion or fire.
· Swallowing the e‐cigarette liquid can be very harmful and even deadly, especially to
children.
· The long‐term effects of vaping are not known.
Do e‐cigs help people quit smoking?
· Many people start using e‐cigs to quit or stop smoking normal cigarettes. It is not yet known if e‐cigs work well for those trying to quit smoking.
· One study found that many smokers trying to quit regular cigarettes by using e‐cigs ended up using both products.
· E‐cigarettes have not been approved by the FDA to help people quit smoking.
Some Closing Recommendations
· Here are some recommendations supported by the CDC:
· Pregnant women, teens, and children should NOT use e‐cigs.
· If you don’t currently use e‐cigs, do NOT start.
· If you are currently using e‐cigs to quit smoking, do NOT return to smoking cigarettes.
· Talk with your doctor about the patch or other treatments.
· Do NOT buy e‐cigarette products off the streets.
· Do NOT change or add anything to the e‐cig product beyond what is approved by the manufacturer.
Call your healthcare provider if you use e‐cigs and develop a cough or trouble breathing.
References:
Centers for Disease Control and Prevention. Smoking & Tobacco Use/Electronic Cigarettes.
Available at: https://www.cdc.gov/tobacco/basic_information/e‐cigs/ Last accessed: 9/17/19
Cullen K, Ambrose B. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. MMWR. Weekly / November 16, 2018 / 67(45);1276–1277
U.S. Department of Health and Human Services. E‐Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. 2016. Available at: https://e‐cigs.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
U.S. Food and Drug Administration. 2018 NYTS Data: A Startling Rise in Youth E‐cigarette Use. Available at: https://www.fda.gov/tobacco‐products/youth‐and‐tobacco/2018‐nyts‐data‐startling‐rise‐youth‐e‐cigarette‐use. Last accessed 9‐17‐19.
Goniewicz M, Gupta R. Nicotine levels in electronic cigarette refill solutions: A comparative analysis of products from the U.S., Korea, and Poland. Int J Drug Policy. 2015 Jun;26(6):583‐8.
Centers for Disease Control and Prevention. About Electronic Cigarettes (E‐cigs). https://www.cdc.gov/tobacco/basic_information/e‐cigs/about‐e‐cigs.html#two. Last accessed on 9/17/19.
Caraballo R. Quit Methods Used by US Adult Cigarette Smokers, 2014‐2016. Preventing Chronic Disease Vol 14, E32. April 2017.
Rigotti N, Kalkhoran S. Vaping and e‐cigs. UpToDate. Topic last updated Sep 10, 2019. Centers for Disease Control and Prevention.
Outbreak of Lung Disease Associated with E‐Cigarette Use, or Vaping. Available at: https://www.cdc.gov/tobacco/basic_information/e‐cigs/severe‐lung‐disease.html. Last accessed 10/7/19
Giardina E. Cardiovascular effects of nicotine. UpToDate. Last updated Dec 16, 2017