Once commercialized, vaping has rapidly expanded to new markets. Companies have aggressively promoted vaping to adolescents, using advertisement campaigns on Instagram and products of various flavors, including fruit and candy flavors. Consequently, vaping has become common among adolescents, who have been led to believe that vaping is a safer alternative to smoking. Currently, more than a third of high school seniors report some use of vaping.
Explore This IssueACEP Now: Vol 38 – No 10 – October 2019
The gastrointestinal tract has evolved to take in widely heterogeneous material, absorb nutrients, and excrete the remainder. Overall, the gut is astonishingly successful at coping with foreign materials while remaining healthy. In comparison, the lungs are not well-designed to deal with foreign material. Vaping exposes the lungs to a dizzying array of chemicals (some of which are known to cause lung disease). This is a recipe for potential disaster.
About a dozen case reports over the last several years have described various forms of lung disease that may result from vaping. The most fulminant form is acute eosinophilic pneumonia, a form of respiratory failure, which may also be caused by smoking cigarettes. Other forms of lung disease associated with vaping include lipoid pneumonia and cryptogenic organizing pneumonia. These are more gradual but may nonetheless progress to ventilator-dependent respiratory failure. To simplify matters, these various forms of VAPI share similar features—they cause bilateral pulmonary infiltrates, which generally respond to steroids.
Despite some early signals of harm, most practitioners have remained blissfully unaware of vaping risks, so it is not a part of medical culture to think about it. Vaping wasn’t taught to us as something to ask about during a medical history the way other substance use was. It’s possible that some cases of VAPI weren’t diagnosed simply because we didn’t know enough to ask about it.
Public Health Considerations
The current epidemic has cast a harsh light on the lack of regulation of vaping products. Vaping is now a billion-dollar industry in the United States and may already be influenced by substantial political contributions. The U.S. Food and Drug Administration (FDA) was given authority to oversee vaping in 2016. However, companies have been given until 2022 before they must submit products for review. Overall, the industry has remained largely unregulated.
Vaping itself may turn out to be safer than smoking, as it takes oncogenic tobacco and smoke out of the equation. In fact, the current epidemic of VAPI most likely relates to adulterants (eg, vitamin E acetate), which, once discovered and banned from e-cigarettes, will likely render VAPI a rare entity. However, this outbreak is doubtless facilitated by the use of vaping products that are designed to be modifiable. And so one of e-cigarettes’ appeals—the diversity in product it can deliver—may be a setup for other hazards we have yet to discover.