By Rachel Clevenger, RRT, ECG, CTP
For the last few weeks of September, it would appear that every other post on social media or breaking news story is about another case of severe lung infection or fatality tied vaping or e-cigarettes use. This tragedy of over 300 teens and adults that have been hospitalized from either using contaminated THC cartridges or flavored vaping fluids gives a proverbial throat punch to the respiratory profession.
Respiratory therapists are on a heightened alert about these acute lung injury cases, as our patient assignment tomorrow might very well be announced on the news this evening.
While many governmental state institutions like New York have taken bold moves with legislation to get in front of this crisis, accurate education of the true vaping effects on the pulmonary system are sadly being lumped together with older and partially outdated programs for smoking cessation. Why is this happening, and what should be done to excise correct information from the vaping hype? How do we make a difference before another family is damaged?
To begin, we must first understand that vaping or e-cigarette process cannot be placed parallel to the data on traditional smoking habits; regardless of the few similarities. Here are three reasons for this assessment.
1st: Delicious flavorings. Although some users of vaping and e-cigarettes may utilize nicotine, many teens and young people ONLY use the flavoring fluids in their vapes. Often these flavored fluids do not contain nicotine. The taste and aroma are the main appeal to their usage and one that makes the smell more enticing to others around them. Deliciously smooth vapors that smell of butterscotch, vanilla, mango, and countless varieties make them difficult to ignore.
Because of this factor, if the main issues of tobacco and nicotine are the only focus for education, the high incidence of severe lung injuries from the irritants (flavoring vape fluids, THC) will not be addressed.
Nicotine addiction is a separate issue that complicates the problem, but not the primary reason for vaping’s appeal. While the overuse of nicotine can lead to a cardiovascular crisis, it is not the only angle by which to direct the care process.
2nd: Contamination and lung infections. Vaping products, e-pens, and e-cigarettes are nearly impossible to sanitize due to the inability to disassemble the components. Unlike a traditional cigarette that is discarded after one use, vape devices are reusable; and easily grow/culture bacteria from the user’s mucus membranes, mouth, hands, pocket, purse, or other storage areas.
The maximum temperature inside some of the e-cigarette devices from the lithium battery and coil do not reach a high enough level or duration to kill most pathogens, and this can become a direct route of infection into the airways and lung parenchyma.
In addition to the above statement, users are quickly becoming thrifty by observing on YouTube the ability to refill fluid cartridges with syringes. This single act can lead to more issues with cross-contamination, and exacerbate the problem. All of these contaminated vapors have the ability to grow pathogens inside the respiratory system with devastating results for the user.
3rd. Acute vs Chronic. The tobacco smoking cessation campaign highlights the chronic use of traditional smoking, and the long term side effects like lung and laryngeal cancer, shortness of breath, COPD, and nicotine addiction issues. While it is important to have this knowledge, education for traditional smoking is NOT directly linked to vaping. Vaping must have its own education specialty, and our Medical Boards should be striving hand in hand with respiratory therapists to make this possible!
A vaping education campaign needs to show immediate dangers of using;
- acute lung injury (burns, pneumothorax, blebs)
- acute respiratory distress syndrome
- acute viral and bacterial lung infections from cross-contamination
- nicotine toxicity
- cardiac arrest
- septic shock
- emergency conditions that lead to respiratory failure.
These conditions often lead to being placed on mechanical ventilation, or eventual death.
While traditional smoking might kill you in 40 years, vaping incorrectly could kill you in a day!
There are not enough respiratory care practitioners, pulmonologists, or available ventilators in the Texas Medical Center to help all of these patients should the vaping trend keep growing at this rate. Sadly, these respiratory emergencies will continue to expand until the respiratory profession starts a real push for change. This is OUR profession. We know as clinicians that inhaling any manufactured chemical into our lungs has a potential for lung inflammation and complications.
If we fail to rise to this challenge, vaping education might only happen when our health insurance companies realize the daily cost of placing young people on mechanical ventilators in our hospital ICUs, which is close to $5,000 a day.
Vaping and e-cigarette education cannot just be lumped in with tobacco cessation training and certification programs for respiratory therapists and critical care nurses. It is simply not the same animal! Tailored learning and treatments are vital for putting a dent in this problem, and we have the ability to create this program immediately. Respiratory clinicians must have the ability to treat and educate patients and family members because many do not understand the hazards of what they are choosing to do.
It is crucial to understand that this article is not a stand against the vaping or e-cigarette industry, any more than I would advocate banning the sale or use of alcoholic beverages. I wish to educate my patients that they might have the best possibility of a life long healthy respiratory system.
While every adult has the right to make a personal choice about their entertainment, and what they chose to consume; there appears to be some pertinent information lacking from our school of thought. Informed consent should be exactly that: an informed decision based on the evidence presented. How can we continue to believe that the young users of these products truly appreciate the severe lung injury that they could easily do to themselves?
Do they really know that they might end up in a coma in an ICU, with a breathing tube down their throat; fighting for their life after puffing on butterscotch vapors?
Let the respiratory profession stand up for knowledge on this issue, and create a Vaping Education Certification Program to stand in the gap. Our passion is pulmonary, and the action to intercede as lung advocates is needed today.
Rachel Clevenger, RRT, ECG, CTP is a respiratory therapist at Houston Methodist Hospital. She is a frequent blogger and passionate about lung health. Visit her website lunghelp.net to learn more about her efforts to create a Vaping Lung Injury Specialist (RRT/VLI-S) certification. The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of Houston Methodist Hospital.