Many experts say there’s a simple piece of advice physicians should give to patients about vaping: Stop.
As a sixth death was reported this week from a mysterious lung illness linked to vaping and an investigation continues into what specifically caused the illnesses, using electronic or e-cigarettes is not safe and doctors should warn their patients, experts said.
Amid a worrying surge in vaping among young people and the nationwide outbreak of severe lung illness linked to vaping, the Trump administration yesterday announced plans to ban flavored electronic cigarettes. The announcement came following a meeting at the White House between President Donald Trump, Health and Human Services Secretary Alex Azar and Food and Drug Administration (FDA) Acting Commissioner Ned Sharpless, M.D.
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The U.S. Centers for Disease Control and Prevention (CDC) is currently investigating 450 possible cases of serious lung illness believed to be caused by e-cigarette use in 33 states and one U.S. territory.
With a Kansas resident the sixth person to die in the U.S. in the outbreak, health officials have issued warnings about vaping. “It is time to stop vaping. If you or a loved one is vaping, please stop,” Kansas State Health Officer Lee Norman, M.D., said in a statement (PDF). Kansas has six reports associated with the outbreak.
In interim guidance published in its Morbidity and Mortality Weekly Report, the CDC said until a definitive cause for the lung illnesses is determined, people should consider not using e-cigarettes.
Commenting on the vaping epidemic in a New England Journal of Medicine editorial, David C. Christiani, M.D., a pulmonary specialist at Massachusetts General Hospital in Boston, concluded with this bottom line, “physicians should discourage their patients from vaping.”
Given the cases of lung illness, doctors need to tailor their advice to patients, Christiani said in an email to FierceHealthcare. Doctors should question patients about whether they are vaping and ask specifics such as when they started vaping, which products they are using and how much vaping they are doing per day, said Christiani, a professor of environmental genetics at the Harvard T.H. Chan School of Public Health.
Until the investigation into the cause is complete, doctors cannot say which compound or compounds in vaping are causing the injuries and deaths, he said. The CDC says the suspected cause is chemical exposure, but no single product or substance is conclusively linked to the disease.
Doctors need to be aware to look for cases of lung problems associated with vaping, Christiani said. Physicians are advised to promptly report any cases to their state or local health department.
Doctors still need to ask patients about cigarette smoking as well as vaping, and they should note that data shows that vaping increases the chances of being addicted to nicotine, he said.
Both the American Medical Association (AMA) and the American Osteopathic Association (AOA) this week warned about the use of e-cigarettes and said doctors should educate their patients about the potential for serious harm.
“In light of increasing reports of e-cigarette-associated lung illnesses across the country, the AMA urges the public to avoid the use of e-cigarette products until health officials further investigate and understand the cause of these illnesses,” AMA President Patrice A. Harris, M.D., said in a statement.
Both groups advised anyone who has used e-cigarette products to seek medical care promptly if they experience any adverse health effects, such as coughing, shortness of breath, chest pain, nausea, diarrhea, vomiting, fatigue, abdominal pain, fever or weight loss.
Both also called for action from the FDA. “The American Osteopathic Association calls upon the U.S. Food and Drug Administration to take immediate action to make people aware of the risks associated with these products,” said AOA President Ronald Burns, D.O., calling the threat a “public health crisis,” particularly for adolescents and young adults.
Harris said the FDA should speed up the regulation of e-cigarettes and remove all unregulated products from the market. She also called on the FDA to ban flavored products that appeal to young people, which the White House announced yesterday it planned to do.
Azar said the administration will be finalizing policies to remove flavored e-cigarettes from the market but may not stop there. In a statement on Twitter, he said while the current plan is not to include tobacco-flavored e-cigarettes, that could change if young people migrate to those products.
Burns said doctors and other healthcare professionals need to make e-cigarette users aware of the possible dangers. “The AOA is especially concerned that flavored vaping materials were targeted to vulnerable youth, some of whom would never have smoked a cigarette but lost their lives to vaping because they didn’t know it could quickly kill them or permanently damage their lungs,” he said.
But while many were recommending doctors simply recommend patients stop vaping, there are situations where physicians should take a more nuanced approach, said Michael J. Blaha, M.D., director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.
For adult patients who are carefully using vaping devices as they are marketed off the shelves to quit smoking cigarettes, Blaha says he still thinks that is appropriate. It’s a different story for patients using e-cigarettes as their first tobacco product.
“It’s very problematic. Doctors have got to ask their patients about it. If you don’t ask, they may not tell you,” he said. Physicians should also ask patients how they are using an e-cigarette device and if they are altering that device to use e-liquids.
Blaha said he would caution anyone from using liquids bought from vaping shops or on the black market that may contain potentially harmful ingredients.
It may take time to unravel the cause of these serious lung injuries from vaping. “The epidemiology here is like the wild west. There are so many moving parts in terms of different devices, different flavors, different e-liquids,” he said. “The general message should be relatively simple that e-cigarettes are bad, but the story is likely much more complicated that we need to work out.”
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