In the last several weeks, hundreds of possible vaping-related illnesses and 18 deaths have been reported. The number of cases has been increasing at an alarming rate. Symptoms of the mysterious illness include shortness of breath, fever, fatigue and vomiting. Some patients have experienced respiratory failure, ending up in the intensive care unit or on a ventilator.
Prior to these cases hitting the national media, Pamela McGee, assistant clinical professor, and Karen Goldschmidt, PhD, department chair of RN-BSN Undergraduate Nursing, both in the College of Nursing and Health Professions, co-authored an article in the Journal of Pediatric Nursing, on the dangers of vaping and how nurses and other medical professionals interacting with pediatric patients can intervene.
Additionally, Susan Solecki, an associate clinical professor also in the College of Nursing and Health Professions, co-authored an article on teens vaping in the October 2019 Current Opinion on Pediatrics issue with Enitan Adegite, MD an assistant professor in the College of Medicine, and Renee Turchi, MD, a professor in of the College of Medicine and Dornsife School of Public Health.
When McGee and Goldschmidt’s article was published seven months ago, only four cases of respiratory illness related to vaping and e-cigarette use were reported in literature. These cases seemed to be caused by bronchiolitis obliterans, also known as “popcorn lung.” This condition commonly developed in workers who inhaled diacetyl, a flavoring used in producing microwave popcorn. Diacetyl has also been used as a flavoring in e-cigarettes.
“These products present a new set of challenges, as they are known to be harmful, but their health impact is not yet fully understood,” said Solecki.
Vaping is using a device to inhale vapor or mist into the lungs. Vaping devices, which sometimes resemble pens or USB drives, use an “e-liquid” that is heated to create an aerosol that is inhaled by the user. The liquid may contain nicotine, just flavoring, THC or a combination of flavoring with nicotine or THC.
Although the health impact continues to be explored, studies thus far have linked multiple health problems with vaping. A 2018 study showed that exposure to e-cigarette vapor condensate is toxic to lung cells and shows similar cellular changes to chronic smokers and people with chronic obstructive pulmonary disease. The exposure increases the risk of infection and chronic lung disease.
An April 2019 study found that 27 percent of 75 popular e-cigarette products had traces of bacteria and 81 percent have small amounts of fungi. Exposure to these organisms can lead to asthma, inflammation and a decline in lung function.
The Center for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have become exceedingly concerned about the recent surge in vaping related lung disease and fatalities and are searching for answers.
The epidemic of the mysterious vaping-related illness has exposed the use of e-cigarettes among teens and has the potential to create another generation addicted to nicotine. Many of the patients with the mysterious illness were in their late teens to early 20s and were otherwise healthy.
According to the FDA, 3.6 million kids used e-cigarettes in 2018. As the number continues to rise, so do concerns that adolescents lack the maturity to understand the risks associated with vaping and e-cigarettes.
Despite people mistakenly thinking vaping is a safer alternative to cigarettes, “teens who vape are more likely to use tobacco and/or marijuana,” said McGee.
According to McGee and Goldschmidt’s article, studies have shown that receiving counseling regarding tobacco use has been linked with 47 percent better odds of an attempt at quitting smoking within the year. Unfortunately, only a third of adolescents report being asked about tobacco use by their provider.
“We recommend that nurses, nurse practitioners, and physicians who care for pediatric patients screen for vaping/e-cigarette-use and educate patients about the risks of using these products,” said Goldschmidt.
Goldschmidt suggests the Truth Initiative and SmokefreeTXT for Teens as resources to help teens quit e-cigarettes.
Solecki agrees that health professionals should intervene, as well as advocate for public policies and health initiatives.
“In addition to providing patient and family support, pediatric healthcare providers must advocate for public policies that limit the access of these products to minors,” said Solecki. “Indeed, providers must promote local and national health initiatives aimed at prevention and education about this public health epidemic affecting our adolescent population.”
San Diego, Los Angeles, and San Francisco have enacted bans on flavored vaping liquids which are popular among younger users, as well as several states, like New York and Michigan. The federal government has announced plans for a national ban as well. While companies, such as Walmart, have voluntarily discontinued the sales of electronic nicotine delivery products.
As a result of this publication, Goldschmidt was invited to present on the topic of E-cigarettes, Vaping & “Juuling” at a national webinar for the Society of Pediatric Nurses.
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