There’s good news and bad news when it comes to youth vaping. The good news is that use of tobacco – and e-cigarettes in particular – dropped among adolescents in the past year. Unfortunately, 2.25 million adolescents still use tobacco products, and e-cigarettes lead the list. That’s bad news for kids’ lungs.
“I wouldn’t take this drop to mean we’re out of the woods. Millions of kids are still vaping and even more are exposed secondhand,” says Devika Radhika Rao, M.D., Pediatric Pulmonologist at Children’s Medical Center Dallas, part of Children’s Health℠, and Associate Professor at UT Southwestern. “But we are doing a better job of getting out the message that e-cigarettes are dangerous, and it’s making a difference.”
A national leader in treating and studying lung injuries caused by vaping and e-cigarettes, Dr. Rao was invited to provide clinical guidance to the Centers for Disease Control and Prevention on the signs, symptoms and management of children with severe lung injury from vaping. In this Q&A, she describes how to spot vaping-related lung injury and how to help.
How common is vaping among adolescents and how does it correlate with lung health issues?
About 1.63 million middle and high school students currently use e-cigarettes – and nearly 40% vape almost every day. The more often kids vape and the longer they use vape products, the greater their risk for common conditions like asthma, bronchitis, and cases of severe lung disease leading to hospitalization.
What are the signs of vaping-related lung injury?
The main thing to look for is asthma-like symptoms like coughing, wheezing and shortness of breath. A change in exercise tolerance or sports performance is also a sign. Some kids are mistakenly treated for pneumonia, when in fact they have lung injury from vaping.
If a patient does not say they have respiratory symptoms or in fact denies using vape products, there may be other clues. A change in academic performance can be a sign of vaping because nicotine addiction affects concentration. Vaping products can also cause gastrointestinal side effects, like abdominal pain, nausea and cramping. These are reasons to ask about vaping and any lung concerns. A teen might not realize their lung function is low – or might not connect certain symptoms to vaping – until we ask. Many, if not most, teens will not tell the truth when asked if they are vaping.
What are the implications of vaping on lung development?
We truly don’t know yet. E-cigarettes are fairly new, and we barely have a decade or so of research. Unlike with regular combustible cigarettes, the long-term effects of e-cigarettes aren’t well characterized.
How do you approach the management of vaping-related lung diseases in pediatric patients?
A key step is to encourage kids to quit vaping to prevent further lung damage and give the lungs a chance to recover. A great resource for patients is the Truth Initiative. It has a lot of content geared toward teens. Several medical organizations also have excellent information. The American Academy of Pediatrics (AAP) has youth tobacco cessation toolkits and a guide for clinicians. There also may be resources available through local health departments.
For young people who are moderately to severely dependent on nicotine, AAP recommends considering medication – varenicline, bupropion and nicotine replacement therapy after consultation with a physician. It’s also helpful to incorporate counseling because vaping is associated with mental health disorders, like anxiety and depression.
Managing lung disease typically involves using medicines like bronchodilators or corticosteroids to open the airways or reduce inflammation. Oxygen therapy and even mechanical ventilation may be needed for severe illnesses like e-cigarette or vaping product use-associated lung injury (EVALI).
What role do parents and environmental factors play in adolescent vaping?
Last year, I spoke at an elementary school about the dangers of tobacco and vaping products. In a class of fifth graders, everyone knew what a vape was. Kids are exposed to e-cigarettes through older friends, family members, advertising and social media. Kids are targeted with clever marketing and enticing marketing strategies. Vape products look attractive and come in attractive flavors.
Parents can help teach kids about the harms of e-cigarettes, starting with asking, “Have you heard about vaping or e-cigarettes, and what do you know about them?” The idea is to have an open, nonjudgmental conversation. If they discover their child is vaping, they can set up an evaluation with their primary care provider and then, if needed, get referred to a pulmonary specialist.
How can providers most effectively engage with families to prevent and address vaping among youth?
Providers should screen everyone age 11 or older for use of e-cigarettes and other tobacco products and counsel patients about the dangers. If a patient already vapes, find out if they’re ready to quit. If they aren’t ready to quit, it’s still important to provide information on the harms, and to follow up with any intention to quit at the next visit. Parental buy-in can also be very helpful.
Motivational interviewing is a good way to hone in on a patient’s concerns. For example, a clinician can state: “You’re concerned that using this product is causing a lot of arguments with your parents. That sounds stressful.” This approach can help get the gears turning in their head about quitting.
If a patient is motivated to quit, providers should be ready to share resources and recommend interventions to help. Information provided online by the American Academy of Pediatrics, The Truth Initiative, the American Lung Association, and local health departments can be passed along to patients and their families.
Why Children’s Health: Expert lung care
The Pediatric Pulmonary Medicine Program at Children’s Health is dedicated to raising awareness about the dangers of vaping and lung disease among young people. We focus on helping to prevent nicotine addiction and sharing vital information on the signs and symptoms of vaping-related illness. Our team provides diagnostic workups, including comprehensive pulmonary function testing, as well as expert care for pediatric lung conditions.