E-Cigarettes and Vaping



By David Thompson, MD, and Gary Marks, DO

Use of electronic cigarettes (vaping) has risen greatly over the last several years. Adult smokers have increasingly turned to e-cigs to quit or decrease tobacco smoking. An especially concerning fact is that e-cigs have become the most widely used tobacco products by youth. One in five high school students use e-cigs, and one in twenty middle schoolers. The U.S. Surgeon General declared the use of e-cigs among young people an epidemic.

The Centers for Disease Control and Prevention (CDC) has reported an outbreak of lung injury from smoking e-cigs. As of October 1, 2019, there have been over 1,000 cases with eighteen deaths.
Telephone triage nurses should be ready to answer questions from concerned callers. Here is an overview of this important topic.

What are Electronic Cigarettes (e-cigs)?

E-cigarettes go by many names such as e-cigs, e-hookahs, vape pens, vapes, tank systems, or ENDS (Electronic Nicotine Delivery system). E-cigarettes have three main parts: a battery, a fluid chamber, and a heating element. The battery powers the heating element and the heating element turns the liquid into vapor. Users inhale the vapor. This is why smoking e-cigs is also called “vaping.”

E-cigarettes may look like pipes, cigars, pens, regular cigarettes, or even USB flash drives. “Pod mods” are re-chargeable and have increasing popularity among teens. A popular brand is JUUL.

E-cigs may be less harmful than smoking normal cigarettes. Still, vaping does have health risks and complications. Click To Tweet

What Is in the E-cigarette Fluid?

E-cigarette fluid has three main types of chemicals:

Nicotine: Nicotine content ranges from none to 36 mg/dL.

Flavor: There are thousands of different flavors. Some flavors are chocolate, cotton candy, gummy bear, and bubble gum. Such flavors may add to the use of e-cigs and nicotine addiction in children.

Other Chemicals: Other likely harmful substances in e-cigarette vapor are propylene glycol, heavy metals (nickel, lead, tin), and possible cancer-causing chemicals. It is not easy for users to know exactly what they are vaping. There have been e-cigarette cartridges labeled “nicotine-free” that contain nicotine.

Some people use marijuana products or other drugs by vaping.

What Are the Risks and Complications?

E-cigs may be less harmful than smoking normal cigarettes. Still, vaping does have health risks and complications:

Nicotine: Nicotine is a stimulant. Nicotine is addictive and can lead to cravings. It is the same chemical that makes normal cigarettes habit-forming. Nicotine can harm the growing brain of adolescents and young adults. For those that are pregnant, nicotine can be harmful to an unborn baby.

Vaping-linked Lung Injury: The Centers for Disease Control and Prevention (CDC) has recently reported an outbreak of lung injury from smoking e-cigs. The cause of this is not yet known. Most of those with lung injury used a marijuana product (THC) with their e-cig. Symptoms are cough, shortness of breath, chest pain, fever, upset stomach, throwing up, diarrhea, and stomach pain. Symptoms appear over days to weeks.

In addition, battery failure can lead to an explosion or fire. And swallowing the e-cigarette liquid can be very harmful and even deadly, especially to children. Last, the long-term effects of vaping are not known.

Do E-cigs Help People Quit Smoking?

Many people start using e-cigs to quit or stop smoking normal cigarettes. It is not yet known if e-cigs work well for those trying to quit smoking. One study found that many smokers trying to quit regular cigarettes by using e-cigs ended up using both products. The FDA has not approved e-cigarettes to help people quit smoking.

Some Closing Recommendations

Here are some recommendations supported by the CDC:

  • Pregnant women, teens, and children should not use e-cigs.
  • If you don’t currently use e-cigs, do not start.
  • If you are currently using e-cigs to quit smoking, do not return to smoking cigarettes. Talk with your doctor about the patch or other treatments.
  • Do not buy e-cigarette products off the streets.
  • Do not change or add anything to the e-cig product beyond what the manufacturer has approved.
  • Call your healthcare provider if you use e-cigs and develop a cough or have trouble breathing.

David Thompson, MD, is the adult content author at Schmitt-Thompson Clinical Content, and Gary Marks, DO, is the adult medical editor at Schmitt-Thompson Clinical Content.