By Rachel Clevenger, RRT, ECG, CTP
The snowballing effect of digital publicity has placed vaping and e-cigarette related lung injuries at the pinnacle of every modern medical conversation for the last several weeks. There are floating questions about a push for state legislation of the products, discussions about CEOs stepping down, and a shark feeding frenzy of our leaders scrambling to find solutions around quitting for young teens and adults, all without addressing areas of vital concern for clinicians like myself.
As a respiratory therapist, I deeply fear that the jump for “big fix legislation” will fall on its face to educate others about critical areas of this problem. While mandating the restriction of nicotine vaping products to minors might positively impact the anti-vaping narrative, infection control of vaping devices and the inflammatory mediators related to vape liquids will be lost in the shuffle.
There is a better way to cut the head from this snake, and respiratory must lead the charge with anyone else who is not afraid to stand tall against the “lack of data” opposition that continues to keep its eyes closed against the hazards of inhaling aerosolized chemicals.
Several claims have been made that there does not yet exist a plan to help teens and young people quit vaping and e-cigarette use.
Let me denounce those claims below with my new respiratory driven coalition:
#educate_the_vape
Step one: Education, not judgement
No one likes to be told what they are doing is wrong, and doing this might immediately shut down any conversation that could be productive. Rather than taking an approach to shame the user into quitting, start first by educating them about proper cleaning of their devices and components. Respiratory therapists and nurses should have the ability to disassemble vape pens and similar devices and explain infection control to the person. If the device cannot be fully cleaned, let the user know why this is so. This step can begin by simply setting up a table at public events and conferences for free cleaning of devices in exchange for a conversation to measure the user’s knowledge about the products. This opens the initial conversation and can lead to a more significant discussion into the next step: triggers and reasons for use.
Step two: Identify triggers and reasons for use
Finding the reason a person is vaping is the key to eventually helping them quit. The adult who is vaping as a transition from traditional cigarettes will not have the same reason as a young teen that loves the taste of their Sugar Cookie vapors without any nicotine. College students that vape for concentration before exams do not have the same trigger as someone who vapes THC for anti-inflammation properties. The number one complaint of traditional smoking cessation is eventual weight gain, and this should be addressed in regards to vaping.
Oral fixation, concentration issues, compulsive behaviors, eating disorders, anxiety, and depression might all funnel into this bucket of “triggers,” and this is where the mental health professional and counselors become the key to discovery. Addressing some of these underlying issues is already needed, and even more the case if the vaping culture is a side effect of their influence.
Step Three: Be specific in gathering information
Know the differences in types of devices, components, liquids (flavored, unflavored, TCH, nicotine-free, hand-mixed), waxes, and other details about what the person is using. Know the difference between water vapor and aerosolized oil; and what that means. Advocates like myself will provide lists of common names and pictures, but you must educate yourself if you want to be effective on this front.
If you don’t have a clue: you will look incompetent and will not be seen as credible despite your credentials. Kids pick up on this and will figuratively eat your lunch!
Step four: Use medical knowledge at a layman’s level
If you discuss side effects and conditions of vaping with users, do not use highly technical medical language that is difficult to understand. Speak to them as you would explain to a patient’s family member about an illness and the methods of treatment. Failing to use tangible language will again risk shutting down the conversation, which is the opposite of what we want. Use open-ended questions so that they can use you as a sounding board for their concerns. Pediatric dentists can play a crucial role in this process as they have the ability to show their patients the progression of the effects of vaping on their oral cavities. Respiratory and nurses can address patterns and changes. If you are speaking with someone who has concerns, allow them to speak freely to you without bias on your behalf. People are our priority, and however we may personally feel about vaping; we must strive to guide our patients to a healthy place, even if we are unsuccessful in convincing them to consider quitting.
Step five: Use a multidisciplinary approach to spread the word
The A-team needed to fight this battle of #educate_the_vape includes the respiratory therapist, the critical care nurse, the dentist, the addiction specialist, and the mental health counselor. Respiratory should be the driver due to the pulmonary effects of vaping, but we need all hands on deck to spread the message.
The major respiratory associations, including the AARC and the American Lung Association, should champion this practice and encourage it throughout school and clinical settings of all varieties.
While much of the direct research on vaping is still ongoing, patient admittance to hospitals never stops! In other words, at this moment, we are responsible for treating vaping related injuries in our ICUs regardless of the final conclusion of the medical board. We should implement our training to assist and treat.
Standing tall on this issue is a bold step and not viable for those with a fear of rejection. Many people will refuse to discuss the issue on any level, so you must be prepared for ten times as many no’s as you have yes’s. If you want to stand against the incoming tide, you must be sure of your footing and know how to swim. But this issue is well inside the wheelhouse of the respiratory therapist’s education. This next step is not fearmongering, nor is it placid drivel littered with medical terminology. Our job is to save lives, either with prevention or follow-up.
Help me to #educate_the_vape.
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.
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