What pharmacists need to know about vaping and vaping-related lung illness

Abstract

Thousands of lung injuries and several deaths have prompted U.S. officials to urge Americans to stop using e-cigarettes, especially those that contain tetrahydrocannabinol (THC). While much is still unknown about vaping-related lung illness, here’s some information that will be useful to pharmacists who practice on the front lines or simply want to stay informed. CDC, FDA, and other medical organizations are urging the public to stop using e-cigarettes amid the growing number of lung injury reports and deaths from e-cigarettes. E-cigarette products are not regulated, and neither the devices nor the substances used in them are known to be safe. Pharmacists should advise individuals to refrain from using e-cigarette products at this time. According to Karen Hudmon, BSPharm, DrPH, pharmacists should be prepared to inform individuals about the signs and symptoms of acute vaping-related lung disease, which include cough, shortness of breath or chest pain, nausea, vomiting or diarrhea, and fatigue, fever, or abdominal pain. “Any patient who presents to the pharmacy with respiratory illness should be queried further,” said Hudmon, who is a professor of pharmacy practice at Purdue University College of Pharmacy in West Lafayette, IN. “Specifically, they should be asked about vaping and e-cigarette use or exposure within the last 90 days. In addition, patients who report vaping or e-cigarette use within the last 90 days should be asked if they are experiencing respiratory symptoms.” E-cigarette devices can be used for inhalation of a variety of substances, including THC—the psychoactive component of cannabis. It is estimated that nearly one in five teens who report having used e-cigarettes in the past also report having used an e-cigarette device to vape cannabis. They simply substitute the nicotine solution for THC or use both drugs simultaneously. Most patients who have become ill from vaping reported using THC. “Oftentimes, the cannabis products are also not regulated and could contain other harmful substances that, when inhaled, can cause damage,” said Michelle Chaplin, PharmD, BCACP, CDE, associate professor of pharmacy at Wingate University School of Pharmacy in North Carolina. “It is especially dangerous to combine unregulated products. Products that may be safe for ingestion or other use, such as vitamin E acetate, are potentially harmful when inhaled, and so at this time it is safest to not inhale these products.” When asking patients whether they smoke or use any form of e-cigarettes or vaping devices, Hudmon said that pharmacists have an opportunity to establish themselves as a resource for patients who are interested in quitting. The same evidence-based treatments used for tobacco smoking cessation, such as counseling from a health care provider and/or FDA-approved smoking cessation medications, can be used for patients trying to quit e-cigarettes. Chaplin said pharmacists are uniquely positioned within the community to assist patients with quitting. They can help adults who are using e-cigarettes as a tool to quit smoking to titrate off these products to reduce withdrawal symptoms, making them more comfortable while they are quitting. They can also help with behavioral changes to enhance their chances of quitting. “Based on some high nicotine content in e-cigarettes, it will be difficult for patients to stop using without assistance—similar to quitting cold turkey from cigarettes. To successfully avoid the products, patients will need help to quit and may need recommendations [on the use of medications for quitting],” Chaplin said.