RN

Vaping: Not as Safe as First Thought

Suzan Miller-Hoover DNP, RN, CCNS, CCRN-K
Lung Illness EVALI

Human lungs were not meant to breathe in anything but clean air. Despite this many individuals continue to inhale tar, nicotine and other chemicals by smoking cigarettes. To help smokers reduce or quit smoking, many technologies were introduced, the latest is vaping or e-cigarettes.

The impact of vaping is becoming evident. As of November 13, 2019 there have been 42 deaths, 2172 confirmed lung injuries, and one double lung transplant performed to save the life of a teenaged vaper. The Centers for Disease Control and Prevention (CDC) states that the deaths have occurred across 24 states and lung illness is occurring in every state except Alaska (Faber, 2019).

Vaping Facts:
  •   Commercially manufactured and retailed e-cigarettes must meet certain requirements by June 2019
     o   Registering an establishment and submitting lists of products, including labeling and advertisements
     o   Submitting tobacco health documents
     o   Submitting ingredient listings
     o   Including a required warning statement
     o   E-cigarettes may not be sold to anyone under the age of 18 years, 21 years in some states
  •   Non-commercially manufactured and retailed e-cigarettes MAY NOT meet these requirements.
  •   E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
  •   The liquid can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives.
     o   THC is the psychoactive mind-altering compound of marijuana that produces the “high”.
  •   14% of patients are under 18 years old
  •   40% of patients are 18 to 24 years old
  •   25% of patients are 25 to 34 years old
  •   21% of patients are 35 years or older
(Centers for Disease Control and Prevention (CDC), 2019; Food and Drug Administration (FDA), 2019; Shmerling, 2019; and Sharpless, 2019)

What we know about e-cigarettes, or vaping product use associated lung injury (EVALI)
  •   70% of the patients are male
  •   All patients diagnosed with EVALI have reported a history of e-cigarette and/or vaping use
     o   86% reported using THC-containing products
     o   34% reported exclusive use of THC-containing products
     o   64% reported using nicotine-containing products
     o   11% reported exclusive use of nicotine-containing products
  •   Vitamin E acetate has been identified as a “chemical of concern”
     o   Vitamin E acetate was found in ALL the bronchoalveolar lavage samples in all submitted specimens from EVALI patients
     o   Vitamin E acetate may be used as a thickening agent in THC-containing fluids
  •   Most patients report a history of using THC-containing products
     o   THC is present in most of the samples tested by Food and Drug Administration (82%)
  •   National and local findings suggest that products containing THC, when obtained from friends, family, on-line or in-person dealers are linked to most cases (Centers for Disease Control and Prevention (CDC), 2019; Food and Drug Administration (FDA), 2019; Shmerling, 2019; and Sharpless, 2019)

What we don’t know about EVALI
  •   There is not enough evidence to rule out other chemicals found in the vaping liquids.
  •   Many different substances and sources are under investigation, such as: plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products
(Centers for Disease Control and Prevention (CDC), 2019; Food and Drug Administration (FDA), 2019; Shmerling, 2019; and Sharpless, 2019)

How to prevent or decrease the effects of EVALI
  •   Do not use e-cigarettes
  •   Do not permit your adolescents or young adults to use e-cigarettes
  •   Pregnant women should not use e-cigarettes
  •   Do not use e-liquids that include THC
  •   If you use e-cigarettes, ensure you purchase the liquid from a commercial manufacturer
     o   Do not modify or add substances to e-liquid
  •   Monitor yourself for the following symptoms, especially if a lung infection is not causing the symptoms.
     o   Cough, shortness of breath, or chest pain
     o   Nausea, vomiting, abdominal pain, or diarrhea
     o   Fever, chills, or weight loss
  •   Symptoms may develop over a few days or several weeks
(Centers for Disease Control and Prevention (CDC), 2019; Food and Drug Administration (FDA), 2019; Shmerling, 2019; and Sharpless, 2019)

E-cigarettes were developed to help adult smokers stop smoking cigarettes. Unfortunately, many teens and young adults who have never smoked are now vaping. This group of vapers are more prone to buying from non-commercial manufacturers; which may expose them to a multitude of additives, especially vitamin E acetate. E-cigarettes not only have a lung injury named after them, EVALI, but also increase the incidence of other lung diseases; most importantly, our young people are dying. Vaping is a relatively newcomer to the tobacco industry, we need to ensure that the product is safe if we are to continue supporting the manufacture of such products.



References
Centers for Disease Control and Prevention (CDC). (2019). Outbreak of lung injury associated with use of e-cigarette use, or vaping. Retrieved from: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Food and Drug Administration. (2019). Vaporizers, e-cigarettes, and other electronic nicotine delivery systems (ENDS). Retrieved from: https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends

Sharpless, N. (2019). How FDA is regulating e-cigarettes. Retrieved from: https://www.fda.gov/news-events/fda-voices-perspectives-fda-leadership-and-experts/how-fda-regulating-e-cigarettes

Shmerling, R.H. (2019). Can vaping damage your lungs? What we do (and don’t) know. Retrieved from: https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734

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