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Electronic Cigarettes

CHKD Doctors and Clinicians to Children: Stop Vaping

Author: Children's Specialty Group, Dr. Christopher Foley
Published Date: Monday, October 14, 2019

By Dr. Christopher Foley, Senior Vice President/Chief of Medicine

Vaping-Related Lung Illnesses Raise Serious Concern for Youth Who Use E-cigarettes

Electronic cigarettes are exploding in popularity, and the negative impact on health is clearly emerging in hospitals.

Doctors and clinicians at Children’s Hospital of The King’s Daughters (CHKD) want to emphasize our concern about a vaping-related lung illness that’s sweeping the country and that has surfaced in our own health system.

As of Oct. 8, the Centers for Disease Control and Prevention (CDC) has reported more than 1,299 cases of vaping-related lung illness in 49 states, the District of Columbia, and one U.S. territory. Twenty-six deaths have been confirmed in 21 states, including one in Virginia. The Virginia Department of Health (VDH) has confirmed 24 cases in the state and classified another 26 as probable, for a total of 50 cases. One person from the southwest region of the state died of the illness on Sept. 26 at a hospital in North Carolina.

Nine confirmed cases and nine probable ones have been in the VDH region that includes Hampton Roads, as of Oct. 8.

Out of the cases that the CDC has complete demographic information on, children younger than 18 made up 15 percent. Another 21 percent of the cases were people 18 to 20 years old.

Since late August, two patients have been treated in CHKD’s pediatric intensive care unit for vaping-related lung illness. Both were treated and released.

Earlier this month, the Virginia Department of Health notified doctors and health care providers in Virginia to immediately report all cases suspected of being a vaping-related lung illness to their local health department.

Also, the CDC has issued a health advisory urging people of all ages to stop using e-cigarettes and other vaping devices, due to the lung illness. Symptoms include gradual onset of cough, shortness of breath, or fatigue, that gets worse over a period of days or weeks, until the patient has to be admitted to the hospital for treatment. Some patients have also reported vomiting, diarrhea, and fatigue. If anyone has these symptoms and has a history of e-cigarette use, seek medical attention immediately.

Electronic cigarettes are also called vapes, e-hookahs, vape pens, and electronic nicotine delivery systems. They work by heating a liquid to produce an aerosol that users inhale into their lungs. The liquid, which can be purchased in devices, refill pods, and cartridges can contain nicotine, tetrahydrocannabinol (THC, the psychoactive mind-altering compound of marijuana that produces the “high”) and cannabinoid (CBD) oils and other substances, such as cyanide.

Many of the “street” cartridges or pods contain vitamin E as a vehicle to dissolve THC. When vitamin E is superheated it becomes a toxic aerosol that may be responsible for hurting the lungs.

The CDC does not know the specific cause of the lung injuries, nor have they identified a specific e-cigarette or vaping product that is linked to all the cases. However, the majority have been linked to products containing THC. Scientists are still learning the long-term health effects of these products to users and bystanders. Due to the lack of regulation, the chemical compounds in an e-cigarette device can vary between brands.

In particular, products that people buy off the street, in “pop-up shops,” or cartridges that they refill themselves are of high risk because they may have been modified with substances not intended by the manufacturer.

The use of e-cigarettes is clearly unsafe for kids. Yet, about one in five high school students now vape, the CDC estimates, and one in 20 middle school students do.

Most e-cigarettes contain nicotine, which is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s. Also, young people who use e-cigarettes may be more likely to smoke regular cigarettes in the future. The American Lung Association does not endorse e-cigarettes as a tool to stop smoking.

Some of the ingredients in e-cigarette aerosol could be harmful to the lungs in the long term, and this outbreak of lung illnesses we are seeing now may just be the beginning. Many also reported using products from informal sources, such as friends and family members, or “off the street,” or by modifying or adding substances to the products.

Some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs. Also, ingredients that are safe for the skin, such as vitamin E, may not be safe to inhale. Products we think of as benign, such as olive oil, may actually do harm.

Even the devices themselves can overheat and explode, presenting another danger.

Young people need to understand the dangers of these products, and parents and community leaders who work with children need to educate them of the risk to their lungs.

If help is needed to quit tobacco products, including e-cigarettes, contact your healthcare provider. Free cessation counseling may be obtained by contacting the VDH quitline at 1-800-QUIT NOW (1-800-784-8669) or www.QuitNow.net/Virginia.



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About Children's Specialty Group

Children's Specialty Group is the only pediatric multi-specialty practice serving southeastern Virginia and northeastern North Carolina. The physicians of Children's Specialty Group base their practices at Children's Hospital of The King's Daughters and serve as faculty in the Department of Pediatrics at Eastern Virginia Medical School. Learn more about our specialists here.