Contact Hours: 3
This educational activity is credited for 3 contact hours at completion of the activity.
Course Purpose
The purpose of this course is to provide an overview of vaping, exploring its context, physiological effects, prevalence, clinical implications, treatment options, and nursing considerations.
Overview
In 2006, vaping entered commercialization, marketed as a smoking cessation aid and a healthier option due to its purported absence of nicotine, which was in salt form rather than free. As vaping devices became increasingly prevalent, concerns arose regarding their safety, efficacy, and potential health risks. This course examines vaping, exploring its context, physiological effects, prevalence, clinical implications, treatment options, and nursing considerations.
Course Objectives
Upon completion of this course, the learner will be able to:
- Define vaping, the various devices used for vaping, and the electric liquids (e-liquids) that are available for use.
- Describe the electric cigarette (e-cigarette), and the key components that work together to make a vapor.
- Identify the differences between the electric cigarette and the traditional tobacco cigarette.
- Review the short term and long-term effects associated with vaping, and lung conditions associated with electric cigarette use.
- Understand the correlation between the influence of advertising and the risk of electric cigarette use and dependency in youth.
Policy Statement
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Disclosures
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
To access Vaping, Electric Cigarettes, and Clinical Implications, purchase this course or a Full Access Pass.
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To access Vaping, Electric Cigarettes, and Clinical Implications, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
| 2,3 Pentanedione | An alpha-diketone that is pentane substituted at the 2– and 3-positions by oxo groups. It has a role as a flavoring agent. |
| Acetaldehyde | The first product generated during the metabolism of alcohol (chemically known as ethanol). |
| Acetoin | Produced by yeast during the alcoholic fermentation process. |
| Acrolein | A colorless or yellow liquid with a foul odor, dissolves in water, and changes to a vapor when heated. |
| Alveoli | Where the lungs and the blood exchange oxygen and carbon dioxide during the process of breathing in and breathing out. |
| Arrhythmia | An abnormal heartbeat. |
| Beneficence | An act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. |
| Bronchiolitis Obliterans (Popcorn Lung) | A disease that results in obstruction of the smallest airways of the lungs due to inflammation. |
| Bronchoalveolar Lavage (BAL) | A diagnostic procedure that is used to collect a sample from the lungs for testing. |
| Bronchodilator | A type of medication that make breathing easier by relaxing the muscles in the lungs and widening the airways (bronchi). |
| Bronchoscopy | A technique used to look at your air passages with a small camera that is located at the end of a flexible tube. |
| Cannabidiol (CBD) | The second most prevalent active ingredient in cannabis (marijuana). |
| Carbon Dioxide | A natural greenhouse gas, commonly produced by exhaled air. |
| Carbon Monoxide | An odorless, colorless, and tasteless but dangerous gas. |
| Carcinogen | Substances that may increase the risk of developing cancer. |
| Chronic Bronchitis | Long-term inflammation of the bronchi. |
| Chronic Obstructive Pulmonary Disease (COPD) | A type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. |
| Conduction Heating | The transfer of heat through physical contact. |
| Convection Heating | Process by which heat is transferred by movement of a heated fluid such as air or water. |
| Corticosteroids | A fast-acting class of drugs that can reduce inflammation and overactive immune system responses. |
| Diacetyl | A chemical that has been used to give butter-like and other flavors to food products, including popcorn. |
| Diffusion Capacity (DLCO) | A measurement of the rate of transfer of gas from the alveolus to hemoglobin within a capillary, measured in relation to the driving pressure of the gas across the alveolar-capillary membrane. |
| E-Cigarette Or Vaping Product Use-Associated Lung Injury (EVALI) | A severe pulmonary illness associated with the use of e-cigarettes or vaping. |
| Electronic Cigarette (E-Cigarette) | Devices that allow users to inhale an aerosol containing nicotine or other substances. |
| Emphysema | A type of lung disease that causes breathlessness. |
| Endothelial Dysfunction | A type of non-obstructive coronary artery disease (CAD) in which there are no heart artery blockages, but the large blood vessels on the heart’s surface constrict (narrow) instead of dilating (opening). |
| Forced Expiratory Volume in One Second (FEV1) | The volume of air (in liters) exhaled in the first second during forced exhalation after maximal inspiration. |
| Forced Vital Capacity (FVC) | The maximum amount of air that can forcibly be exhaled from the lungs after fully inhaling. |
| Formaldehyde | A colorless, highly toxic, and flammable gas at room temperature. |
| Lung Transplantation | A surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor. |
| Marijuana | Refers to the dried leaves, flowers, stems, and seeds from the hemp plant, Cannabis sativa. |
| Nicotine | The addictive drug in tobacco products. |
| Nonmaleficence | The principle of refraining from causing intentional harm toward another human being. |
| Oxidative Stress | A bodily condition that happens when your antioxidant levels are low. |
| Propylene Glycol (PG) | A synthetic liquid substance that absorbs water. |
| Stimulant | A substance that raises levels of physiological or nervous activity in the body. |
| Tetrahydrocannabinol (THC) | A medicinal compound utilized to manage and treat chemotherapy-induced nausea and vomiting and stimulate appetite. |
| Tobacco | Derived from the leaves of the genus Nicotiana, a plant from the night-shade family, indigenous to North and South America. |
| Vape Pen | Battery-operated devices that people use to inhale an aerosol, which typically contains nicotine, though not always. |
| Vaping | To use a handheld device to breathe in a mist. |
| Vaporizers | The backbone of gas phase processes, serving as the catalyst for converting liquids into gases. |
| Vegetable Glycerin (VG) | A clear, odorless liquid usually made from soy, palm, and coconut oils. |
| Vitamin E Acetate | A fat-soluble vitamin. |
In 2006, vaping entered commercialization, marketed as a smoking cessation aid and a healthier option due to its purported absence of nicotine, which was in salt form rather than free.1 Given trendy names like e-cigarettes, vape pens, and vaporizers, this innovation sparked a global surge in consumption and, with it, an industry boom. In a span of a few years, more advanced devices, kits, and flavors flooded the market. However, despite its rapid adoption, the short- and long-term health implications remained largely unknown during this phase of public distribution. As vaping devices became increasingly prevalent, concerns arose regarding their safety, efficacy, and potential health risks. Research began to emerge, shedding light on the physiological effects of vaping, including its actual impact on respiratory health, cardiovascular function, and nicotine addiction. This course examines vaping, exploring its context, physiological effects, prevalence, clinical implications, treatment options, and nursing considerations. Through an evidence-based approach, this course offers insights into the challenges presented by vaping and how to deliver informed, compassionate care to individuals affected by vaping-related conditions.
Vaping is a recreational activity that involves inhaling and exhaling the gas form of a specially formulated concoction produced by an electronic cigarette, vape pen, or similar device.2 The concoction may be an e-liquid, dry herbs, oils, or waxes. E-liquids are a mixture of nicotine, propylene glycol (PG), vegetable glycerin (VG), and flavorings.3 Nicotine is a stimulant, and the primary psychoactive ingredient found in tobacco. It is a highly addictive vasoconstrictor that increases blood pressure, heart rate, and blood flow. Nicotine also interacts with neurotransmitter systems in the brain, particularly the dopamine reward pathway, leading to feelings of pleasure and reinforcement. Nicotine content varies greatly in e-liquids, ranging from none to 36 milligrams per milliliter.4 Propylene glycol is an odorless synthetic medium that makes artificial smoke and carries flavor. It also provides the “throat hit” sensation similar to traditional cigarettes. Vegetable glycerin is a thick, sweeter liquid that contributes to the production of vapor clouds, enhances the mouthfeel, and adds sweetness. Flavorings are the additives that give e-liquids their distinct tastes. There are over seven thousand flavors available, including tobacco-flavored, menthol, fruity flavors, and desserts such as sweet tart. Other than e-liquids, dry herbs such as cannabidiol (CBD) flowers, oils like CBD oils, and waxes like tetrahydrocannabinol (THC) wax are also vaped.5 These products are extracted from marijuana or hemp plants. Cannabidiol is a non-psychoactive compound shown to have a calming effect, reducing pain and inflammation. Tetrahydrocannabinol is the psychoactive substance responsible for the “high” associated with marijuana use.
Unlike traditional smoking, which uses combustion, vaping uses conduction heating, convection heating, or both. Conduction heating is a method of energy transfer through direct contact between materials or substances.6 In vaping devices, conduction heating happens when the e-liquid or herb directly contacts a heated component, causing it to vaporize. This type of heating is commonly used in simpler and less expensive vaporizers. Convection heating transfers heat through the movement of a fluid.6 In more advanced or high-end vaporizers, particularly those designed for dry herbs, heated air passes over the herbs, causing them to release vapors. The temperature inside a vape pen varies as it depends on the type of device and its settings. Generally, vape pens operate within a range to effectively vaporize e-liquids or other substances without burning them. On the lower end of the spectrum, between 200°F to 350°F and on the higher end, 400°F to 450°F.7 Vaping eliminates the need for combustion. Therefore, it does not produce tar, carbon monoxide, or other toxic byproducts like conventional cigarette smoke. This has led to the perception that vaping is a less harmful alternative to smoking traditional tobacco products. However, this is not the case. Vaping comes with its own risks and potential health complications.
The Electric Cigarette (E-Cigarette)
The first modern e-cigarette was invented by Hon Lik, a Chinese pharmacist, in 2003.8 Lik was motivated to create a safer alternative to smoking after his father, a heavy smoker, died of lung cancer. His design used a piezoelectric ultrasound-emitting component to vaporize a jet of pressurized liquid containing nicotine diluted in a propylene glycol solution. This innovation laid the foundation for the e-cigarettes we see today. Electronic cigarettes, also known as e-cigarettes, vaporizers, and vape pens, are specific devices designed to deliver e-liquid to users in the form of vapor rather than smoke. They consist of three key components that work together to create a vapor: a battery, an atomizer, and an e-liquid.9 The battery powers the vaping device, providing the necessary energy to heat the atomizer, the part responsible for converting the e-liquid, oil, or wax into vapor. The atomizer includes a base that connects to the battery that powers the internal coil. Usually made of metal such as stainless steel, nickel, or titanium, the coil is the source of the conduction heating. It warms up and vaporizes the e-liquid that comes into contact with it. Some atomizers also have adjustable airflow control that allows the user to customize the amount of air that mixes with the vapor. This can affect the density and flavor of the vapor produced. Vape pens that heat dry herbs work slightly differently. They do not have an atomizer. Instead, they circulate hot air (convection heating) to warm herbs to a specific temperature that is hot enough to produce vapors but still below combustion temperatures.
There are several types of e-cigarettes available, each catering to different preferences. These include disposable e-cigarettes, rechargeable e-cigarettes, mods, pods, and dab pens.10 Disposable e-cigarettes are single-use devices that come pre-charged and pre-filled with e-liquid. Once the e-liquid is depleted, the entire device is discarded. Rechargeable e-cigarettes are designed for repeated use. They come with rechargeable batteries and refillable e-liquid tanks or replaceable cartridges. Mods and pods are more advanced variations of e-cigarettes. Mods, short for modifications, offer more customization. Users are able to adjust settings such as wattage and temperature for a more unique vaping experience. These devices often have larger batteries and can produce more vapor. Pods are a more recent innovation, offering a middle ground between disposables and mods. They consist of a compact device that uses pre-filled or refillable e-liquid pods. Pods are popular for their convenience, portability, and ease of use. Dap pens are similar to vape pens but are specifically designed for cannabis products such as waxes and oils.
E-cigarettes and traditional tobacco cigarettes differ significantly in both their physical and chemical composition, as well as their methods of use and user experiences.11 E-cigarettes are devices made of several components. They vaporize a specific solution that does not contain tobacco leaves. In contrast, traditional cigarettes are paper tubes containing shredded or finely cut tobacco leaves. Once lit, they trigger a combustion process that burns the tube and leaves, releasing nicotine-laced smoke. The concentration of nicotine inhaled depends on the type of cigarette and how it is smoked. With e-cigarettes, nicotine is optional, and concentrations vary greatly. As traditional cigarettes are smoked by lighting one end and inhaling the smoke through a filter at the other end, it comes with a strong ‘throat hit,’ a warming, tickling feeling in the oral cavity caused by the rapid onset of nicotine effects. The throat hit sensation is considered a defining characteristic of the smoking experience, and e-cigarettes try to mimic it to provide a satisfying and familiar experience.
E-cigarettes are used in several different ways.12 One common method is the “mouth-to-lung” inhale, where the user draws vapor into their mouth first, then inhales it into their lungs. This method mimics the sensation of smoking traditional cigarettes. Another technique is the “direct lung inhale,” where users deeply inhale the vapor directly into their lungs, similar to taking a deep breath. This method is favored by experienced vapors looking to produce larger vapor clouds and experience more intense flavors. Some users may engage in “discreet puffing,” where they simply draw on the e-cigarette without inhaling, allowing them to enjoy the flavor and oral sensation without the inhalation of vapor. E-cigarette users also have access to a broad range of flavors and customizable features such as airflow and wattage.
E-cigarette use among adults is increasing, and currently, more than 4% of adults vape.13 In adults, there are two main categories of individuals who transition to vaping:
- First-time users.
- Traditional smokers who transitioned to vaping either as an alternative to smoking or as a means to stop smoking.
Research supports this analysis, with 39% of e-cigarette users also being current cigarette smokers, 37% being former smokers, and 23% having never smoked before. It is estimated that 3 in 10 vaping adults also smoke cigarettes. Known as dual use, this form of tobacco use results in greater exposure to toxins and worsens respiratory outcomes compared to using either product alone. The prevalence of using e-cigarettes is highest among those who identify as non-Hispanic White, American Indian/Alaskan Native, and multiracial.14 Vaping prevalence seems to increase with education levels, with surveys showing that 2% of vapers had less than a high school education, 3% were high school graduates, and 3% had some college education. However, the prevalence was lowest among those who graduated from college, at just 1%. Within the adult population, 11% of 18–24-year-olds have reported using an e-cigarette, making them the largest consumers in the country.15 In this age group, usage between men (11%) and women (10%) is quite similar. However, for adults ages 24-44, usage is higher in men (7%) than women (5%).
One of the primary reasons adults turn to vaping is to quit smoking traditional cigarettes.16 Many smokers turn to e-cigarettes to reduce their dependency on tobacco, as vaping provides similar hand-to-mouth action and nicotine delivery without the combustion of tobacco. For some, vaping is a step-down approach, gradually reducing nicotine levels to eventually quit smoking altogether. Many adults also believe that vaping is a safer alternative to smoking traditional cigarettes. Public health messages and advertising often highlight that e-cigarettes contain fewer harmful chemicals than combustible tobacco products. The perception of reduced harm motivates some adults to switch to vaping as a less risky way to satisfy their nicotine cravings. For other adults, vaping is a social activity.16 It can be part of social gatherings and a way to bond with friends or colleagues who vape. The recreational aspect of vaping is enhanced by the availability of various flavors, which can make the experience enjoyable beyond just nicotine consumption. E-cigarettes are often more convenient and discreet than traditional cigarettes. They do not produce the same lingering odor as tobacco smoke, making it easier for users to vape in environments where smoking may be frowned upon or prohibited. The wide range of available flavors is another reason adults choose to vape. Like smoking, some adults vape to cope with stress and anxiety. The act of vaping, like smoking, can be calming for some individuals, providing a sense of relaxation and momentary escape from stressors.
In 2023, e-cigarettes emerged as the most used tobacco product among middle and high school students.17 More than 35% of students have tried an e-cigarette at least once, and it is believed that approximately 5-7% of the middle school and high school student population are currently vaping. The prevalence of youth vaping varies by race and ethnicity, with non-Hispanic multiracial students (20%) and non-Hispanic White students (18%) vaping the most.18 In contrast to gender disparity in vaping, e-cigarette use is higher in females (11%) compared to males (8%). Among students who have ever used an e-cigarette, a significant 46% reported current use, indicating a strong pattern of continued usage once initiated. Of those students who currently vape, 25% use them every day, highlighting a concerning trend towards habitual use.
There are many factors associated with youth vaping. One significant factor is product advertising that targets youth. In 2021, 70% of middle school and high school students reported exposure to e-cigarette marketing. Most students reported seeing e-cigarette ads or promotions in retail settings, as well as on the internet, television, streaming services, movies, or in print media. Of the students who used social media, 75% of students had seen e-cigarette and vaping-related posts or content on their feeds. This pervasive marketing contributes to the normalization and appeal of vaping among young people.
Product accessibility is another contributing factor.19 Some brands of disposable e-cigarettes are cheaper than regular cigarettes, making them more accessible to youth. In addition, students often obtain e-cigarettes from others. Among middle and high school students who used e-cigarettes in 2021, 32% got them from a friend, 31% bought the products themselves, 28% had someone else buy the products for them, and 21% had someone offer the products to them.20 These methods of acquisition highlight the ease with which youth can access e-cigarettes, further perpetuating their use. The availability of flavored products plays a crucial role in attracting young users. The novelty incites curiosity, and studies show that most youth who vape first start with a flavored product. Current reports suggest that 90% of youth vapers reported using flavored e-cigarettes.21 Social influences also heavily impact youth vaping. The most common reason middle and high school students have given for trying an e-cigarette is that a friend had used it. Youth also report vaping because a family member used them. Peer pressure and social dynamics significantly contributed to the initial experimentation and continued use of e-cigarettes among youth.
Traditional cigarettes have long been recognized for their high addiction potential, with around 60-80% of smokers developing a dependence on nicotine. While e-cigarettes were initially marketed as a less addictive alternative, when comparing them to nicotine gum, emerging data suggests that they can be equally addictive for certain demographics. Studies have shown that a significant proportion of e-cigarette users develop dependence similar to that seen with traditional tobacco products – approximately 91% of conventional cigarette users, 80% of disposable e-cigarette users, 83% of pod-based e-cigarette users, and 82% of mods and other e-cigarette users showed signs of nicotine addiction.22 Additional clinical studies into the smoking habits of different types of smokers suggest that e-cigarettes may even be more addictive than traditional cigarettes.23 Results revealed that those who exclusively used e-cigarettes were more nicotine dependent, more likely to use an e-cigarette in the first 30 minutes after waking, and found it more difficult to refrain from vaping in places where it was not allowed. A possible factor to this may be the availability of e-liquids with higher concentrations of nicotine and more advanced devices capable of producing large volumes of vapors, both of which deliver significantly higher doses of nicotine when compared to traditional cigarettes. Market research also points to a heightening dependence as high-nicotine products continue to dominate e-cigarette unit sales. Products with a nicotine strength of 5% or more made up 81% of total e-cigarette unit sales. In addition, the price of high-nicotine products has decreased or stayed the same, while the price of low-nicotine products has increased in recent years, further promoting its sales.24
Among teenagers, there has been a drastic decrease in teenagers smoking traditional cigarettes, with prevalence dropping from 70% in 1991 to 28%.25 The decrease is largely a response to exhaustive work done by physicians, advocacy groups, and lawmakers. However, addiction rates to vaping are on the rise for three main reasons:
- Inaccurate advertising that markets vape pens and other such devices as safer.
- Marketing targeted at teenagers.
- The age group’s biological propensity to become dependent.
During adolescence, the brain’s reward systems are more sensitive to addictive substances like nicotine. The exposure during this age can permanently alter brain development, establishing stronger connections between nicotine use and pleasure and increasing the susceptibility to addiction.25 The method of nicotine delivery in e-cigarettes also contributes to the high addiction rates.23 With adjustable settings, users can absorb higher concentrations of nicotine at a time, resulting in a more substantial and immediate nicotine “hit.” The rapid and potent delivery increases the likelihood of dependency. Nicotine addiction is further reinforced through behavioral conditioning. Cues associated with vaping, such as certain activities, environments, or social situations, become linked with the rewarding effects of nicotine. These cues can evoke cravings and contribute to relapse even after periods of abstinence. Stress and mental health issues can also drive people to use nicotine, using it as a coping mechanism, leading to dependence. The ritualistic and behavioral aspects of vaping, like the hand-to-mouth action and the act of exhaling vapor, can become ingrained habits that contribute to addiction.
Vaping poses various risks to both short-term and long-term health, stemming from factors such as chemical exposure, nicotine content, and potential impacts on mental health. Short-term health risks of vaping include throat and mouth irritation, coughing, nausea, and dizziness. Long-term health risks are more concerning and may include respiratory issues, lung damage, and cardiovascular problems. While research is still underway, chronic inhalation of vapors has been associated with a 30 – 60% increased risk of breathing issues, respiratory infections, and other health complications such as lung damage.26 E-liquids themselves also carry certain risks. While their ingredients are generally recognized as safe for ingestion, their safety when inhaled as vapors is less clear. Overheating e-liquids can lead to the formation of harmful compounds such as formaldehyde, acetaldehyde, and acrolein, which are known carcinogens and respiratory irritants. These substances, especially acrolein, have also been associated with increased blood pressure, elevated risk of arrhythmias, endothelial dysfunction, oxidative stress, and increased platelet aggregation and adhesion. Continued exposure to these harsh chemicals through vaping may increase the potential for both respiratory and cardiovascular diseases.
There are also serious health concerns regarding nicotine use, a substance well-documented for its adverse health effects. Not only is it highly addictive, but it increases the risk of future addiction to drugs. Nicotine has the potential to impact mental health, altering mood, cognition, and behavior. It can lead to amplified irritability, anxiety, and stress. The addictive nature of nicotine may also exacerbate underlying mental health conditions such as depression and anxiety disorders. Nicotine also harms brain development, which continues until the age of 25.27 This can lead to diminished cognitive function, reduced attention span, impulse control problems, mood disorders, and learning disabilities. Acute nicotine poisoning can be toxic, especially among young children and adolescents who accidentally ingest, breathe, or absorb vaping liquid through their skin or eyes. High concentrations of nicotine in a single dose can lead to symptoms such as nausea, acidity, vomiting, increased heart rate, seizures, and even death in severe cases. More than 80% of calls to US poison control centers for e-cigarettes are for children less than 5 years old.28
E-cigarette aerosol also can contain other substances that pose significant risks to human health.29 Among these are cancer-causing chemicals, which have been identified in certain e-cigarette products and their aerosols. These carcinogens are produced during the heating process and can be inhaled into the lungs, potentially leading to long-term health consequences. Heavy metals like tin, nickel, and lead have been detected, likely originating from the heating coils or other components of the device. Inhalation of these metals can contribute to respiratory issues and may even lead to systemic toxicity over time. Other tiny particles in the vapors may infiltrate deeply into the lungs, causing inflammation and impairing lung function. These particles, along with volatile organic compounds present in e-cigarettes, pose respiratory risks and can exacerbate existing lung conditions.
E-cigarettes have been associated with unintended injuries, mainly due to incidents involving defective batteries.30 These batteries, commonly found in cheaper rechargeable e-cigarette devices, may malfunction, leading to fires. In many cases, these incidents occur during the charging process. They can result in burns, lacerations, and damage to the face, hands, and other body parts. Some individuals have even experienced life-altering injuries as a result of e-cigarette battery explosions.
Lung Damage and Diseases
Lung damage refers to injury or impairment of the lungs’ structure and function, often resulting from exposure to harmful substances or conditions. In individuals who vape, lung damage can manifest in various ways, including inflammation, airway obstruction, reduced lung function, and respiratory symptoms. Prolonged vaping has been associated with the development of severe lung conditions, such as e-cigarette or vaping product use-associated lung injury (EVALI), chronic bronchitis, bronchiolitis obliterans, and even chronic obstructive pulmonary disease (COPD).31 Unaddressed, these conditions can cause irreversible lung damage, and in severe cases, individuals may experience respiratory failure and require lung transplantation to survive.
E-cigarette or vaping product use-associated lung injury is a severe lung illness that emerged in 2019. Primarily affected individuals who reported vaping or using e-cigarette products heavily, the condition saw many hospitalizations and intensive medical intervention, including mechanical ventilation. Within the year, approximately 2500 patients were hospitalized, with 68 deaths – 15% younger than 18 years.32 Characterized by significant lung inflammation and injury, EVALI symptoms include shortness of breath, wheezing, coughing, chest pain, nausea, vomiting, and fever. These symptoms often develop rapidly and progress to severe respiratory distress, necessitating urgent medical attention. Investigations into the cause of EVALI identified vitamin E acetate as a potential culprit, as it was found in lung fluid samples from affected individuals.31 Vitamin E acetate is a thickening agent used to increase the viscosity of vape oils. While considered safe for topical or oral use, vaporized vitamin E acetate undergoes chemical changes and breaks down into harmful byproducts, such as acetaldehyde and other volatile organic compounds. These byproducts can deposit in the lungs, causing irritation, inflammation, and damage to delicate structures of the lungs, such as the alveoli, where oxygen and carbon dioxide are exchanged.
Chronic bronchitis is characterized by persistent inflammation of the bronchial tubes, the central airways that carry air to and from the lungs. One of its hallmark features is excessive mucus production, leading to a chronic cough that may persist for months or years. The persistent cough is often accompanied by wheezing, chest tightness, and shortness of breath. The compounds within the vapors, which include irritants and toxic compounds, agitate the airways and trigger inflammation. Prolonged exposure to these irritants can worsen bronchial inflammation and heighten mucus production, leading to more severe coughing episodes, respiratory distress, and further lung injury. Vaping increases the risk of developing chronic bronchitis by an estimated 33%, exacerbating the symptoms of, and contributing to its progression.26 Bronchiolitis obliterans, also denoted as “popcorn lung,” is a serious but rare condition characterized by the inflammation and scarring of the bronchioles, the small airways in the lungs. The scarring leads to the narrowing or blockage of the airways, resulting in airflow obstruction and respiratory symptoms. The term “popcorn lung” originated from an outbreak of the condition among workers in microwave popcorn factories. They were exposed to high levels of diacetyl, a chemical used to impart the buttery flavor to popcorn. While diacetyl is the most well-known cause of bronchiolitis obliterans, it has also been associated with vaping. Researchers found that 76% of popular e-cigarette brands had e-liquids containing diacetyl. Research has also found two similarly harmful chemicals, acetoin and 2,3 pentanedione, present in 45% and 90% of the e-liquid flavors it tested.33 92% of the e-cigarettes had one of the three chemicals present.34 Chronic inhalation of these aerosolized chemicals has been linked to the development of bronchiolitis obliterans. The symptoms of bronchiolitis obliterans can vary but often include coughing, wheezing, shortness of breath, and fatigue.
Chronic obstructive pulmonary disease is a progressive lung disease that encompasses conditions such as emphysema and chronic bronchitis. While smoking remains the primary cause of COPD, vaping has been seen to increase the risk of developing COPD-like symptoms by over 62%.26 Chronic exposure to e-cigarette aerosols containing harmful chemicals can contribute to airway inflammation, tissue damage, and impaired lung function, like the effects observed in smokers with COPD. It is important to note that individuals with pre-existing respiratory conditions are particularly vulnerable to the harmful effects of vaping, as their compromised airways are more vulnerable to irritation and inflammation, making them more prone to experiencing exacerbated symptoms when exposed to vaping aerosols. Regular vaping can perpetuate the cycle of bronchial inflammation and mucus production, further worsening the symptoms of chronic bronchitis over time.
Lung Transplantation
In cases where lung damage progresses to a severe and irreversible stage, lung transplantation may be the only option to improve or restore respiratory function.35 On a global scale, 4,000 lung transplants are performed annually.36 Lung transplantation involves surgically replacing damaged lungs with healthy lungs from a donor. It may be a single lung or double lung. In a single lung transplant, only one diseased lung is replaced with a healthy donor lung. Single lung transplants are commonly performed in individuals with conditions that primarily affect one lung. This procedure allows for improved respiratory function while minimizing the risk of surgical complications associated with replacing both lungs. In a double lung transplant, both diseased lungs are replaced with healthy donor lungs. It is often preferred for individuals with bilateral lung disease or extensive lung damage. The success of lung transplantation varies from patient to patient, and hinges on multiple factors, including the patient’s overall health, severity of lung disease, presence of co-morbidities, and availability of suitable donor organs.
The pre-operative protocols of lung transplantation are extensive.37 Before surgery, the patient undergoes a thorough evaluation to assess their overall health and suitability for transplantation. This evaluation includes an in-depth medical history review, physical examination, laboratory tests, imaging studies, and pulmonary function tests. The patient may also undergo psychological evaluation and counseling to ensure readiness for the procedure. Once a suitable donor organ becomes available, the transplant team evaluates compatibility based on factors such as blood type, size match, and tissue compatibility. Once the donor’s lung is procured, surgery is scheduled as soon as possible. The surgery itself is a delicate process. The surgeon must precisely remove the diseased lung by carefully dissecting and dividing blood vessels, airways, and surrounding tissues. As the healthy lungs are implanted into the recipient’s chest cavity, the donor lung’s blood vessels and airways must be accurately aligned and sutured to the recipient’s circulatory and respiratory systems.
Postoperative care includes pain management, immunosuppression therapy, respiratory support, and physical rehabilitation to promote recovery and regain function.36 The patient must also be closely monitored for complications such as infection or organ rejection, which vary between 50% rejection within the first year and 45% rejection 5 years post-transplant.38 Patient outcomes and prognosis following lung transplantation depend on both the success of the transplant procedure and aftercare. While lung transplantation can significantly improve respiratory function and quality of life for many individuals, it is not without risks and challenges. In general, the one-year survival rate following lung transplantation is around 80-85%, with survival rates gradually declining in the years following transplantation. Other complications of a transplant relate to immunosuppression therapy, which can increase the risk of infections due to the weakened immune system, the potential development of certain cancers, and various side effects such as kidney damage, hypertension, and diabetes.
Diagnosing vape-related lung conditions requires specialized testing, such as pulmonary function tests, imaging studies, and laboratory tests.39 The process typically begins with a thorough clinical evaluation that encompasses a detailed medical history review and physical examination. Patients may present with respiratory symptoms such as coughing, shortness of breath, chest pain, and fatigue, which may raise suspicion for vaping-related lung disease. Pulmonary function tests are then done to assess lung function and capacity, thereby determining lung injury. These tests are non-invasive and measure parameters such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and diffusion capacity (DLCO). Abnormalities in these parameters may indicate obstructive or restrictive lung disease. They can help in the diagnosis and monitoring of vaping-related lung conditions. Imaging studies, including both chest X-rays and computed tomography (CT) scans, help evaluate lung structure and identify abnormalities. Chest X-rays may reveal signs of inflammation, fluid accumulation, or lung tissue damage, while CT scans provide more detailed images of the lungs. This allows for the discovery of subtle changes associated with vaping-related lung disease.
Bronchoscopy may be performed to evaluate airway inflammation, rule out infections, and assess for other lung abnormalities.39 In this procedure healthcare providers insert a flexible, thin tube (bronchoscope) either through the nose or mouth and into the airways. Healthcare providers can visually inspect the airways and collect samples for further analysis through bronchoalveolar lavage (BAL) or lung biopsy. Laboratory tests, including blood tests and sputum analysis, may be conducted to find markers of inflammation, infection, or other systemic abnormalities. In cases of suspected EVALI, laboratory testing may also include the analysis of vaping products or lung fluid samples for the presence of harmful substances, such as vitamin E acetate or THC. Treatment options focus on managing symptoms and preventing further lung damage.40 Treatment may also include several medications to reduce inflammation and improve airflow, and supplemental oxygen therapy.41 In cases of acute lung injury or inflammation associated with vaping, corticosteroids may be prescribed to reduce inflammation in the lungs and alleviate symptoms. These medications suppress the immune response and reduce swelling in the airways. Antibiotics may be administered if bacterial pneumonia is suspected or as empiric therapy for severe respiratory infections. To improve airflow in conditions such as COPD, bronchodilators may also be given. These drugs relax all the muscles around the airways, so it is easier to breathe. Short-acting bronchodilators, such as albuterol, may be used as rescue medications for acute symptoms, while long-acting bronchodilators may be prescribed for ongoing symptom management. In cases where vaping-related lung damage leads to impaired oxygenation of the blood, supplemental oxygen therapy may also be prescribed to ensure adequate oxygen levels in the body. Oxygen therapy can help alleviate symptoms of hypoxemia (low blood oxygen levels) and improve overall oxygen delivery to tissues and organs.
Pulmonary rehabilitation programs are generally recommended to improve respiratory function, enhance exercise tolerance, and optimize overall quality of life.42 These programs typically include supervised exercise training, education on lung disease management, breathing techniques, and psychosocial support. For those who vape, cessation is a critical component of treatment. Quitting can help prevent further lung damage, reduce respiratory symptoms, and improve overall lung health. Healthcare providers may offer cessation counseling, support groups, and pharmacotherapy such as nicotine replacement therapy to assist their patients. Nutritional support and counseling are also vital to address any dietary needs and promote optimal health. Psychosocial support, including mental health services, can help patients handle the emotional and psychological impact of their condition. Ongoing education on lifestyle modifications, smoking cessation, and avoiding respiratory irritants is crucial to prevent further lung damage. Regular follow-up appointments are necessary to adjust treatment plans as needed and to monitor for potential complications, such as respiratory infections or the need for supplemental oxygen.
When caring for patients with vaping-related conditions, there are several considerations that must be considered, including ethical considerations, effective communication strategies, patient education, and participation in cessation programs.43 Ethical dilemmas include addressing issues such as patient autonomy, informed consent, and the balance between beneficence and nonmaleficence. This is especially pertinent when dealing with teenage users who are not yet of legal age to make autonomous healthcare decisions. Nurses should advocate for patient rights, ensuring treatment decisions align with ethical principles and professional standards. Effective communication is essential in nursing care, particularly when discussing sensitive topics such as vaping-related illnesses. Nurses should employ empathetic listening, clear explanations, and nonjudgmental language to establish trust and facilitate open dialogue with patients and their families. They should also provide information about the dangers of vaping, such as nicotine addiction and lung damage, treatment options for illnesses, and support services available to promote informed decision-making and collaborative care.
Nurses should also actively participate in vaping cessation programs by assessing patients’ readiness to quit, providing counseling and behavioral interventions, and connecting them with appropriate resources.44 Nurses can also collaborate with interdisciplinary teams to develop personalized cessation plans tailored to patients’ needs and preferences. They can offer ongoing support and follow-up to monitor progress and address barriers to quitting. Given the evolving nature of vaping trends and health impacts, nurses should engage in continuous education to stay informed on the latest evidence, regulatory updates, and best practices in vaping-related care. Whether participating in professional development opportunities, attending conferences, or utilizing online resources, any effort to enhance their knowledge and skills can help address vaping-related issues proactively and effectively.
Vaping poses significant challenges to public health, particularly among teenagers and young adults. Since its commercialization in 2006, vaping has been marketed as a safer alternative to traditional cigarettes, yet the health risks associated with it are substantial. E-cigarettes may deliver nicotine differently, but they still contribute to high addiction rates, especially among youth, due to factors like peer pressure, the appeal of flavored products, and the misconception of reduced harm. The health risks of vaping are severe and varied, including addiction, lung damage, and diseases such as EVALI, chronic bronchitis, and bronchiolitis obliterans. These conditions can result in long-term health complications and, in some cases, necessitate lung transplantation. Managing and treating vaping-related conditions demands a multidisciplinary approach involving case management, regular monitoring, pulmonary rehabilitation, and psychosocial support. Effective communication with patients and families is essential, as is providing comprehensive education on the dangers of vaping, available treatment options, and cessation strategies. Ethical considerations are paramount, particularly when dealing with teenage users who cannot make autonomous healthcare decisions. Nurses must navigate these challenges while respecting patients’ rights and promoting their well-being. Continued education on vaping trends and health impacts is vital for healthcare professionals to stay informed and effectively address this public health issue.
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