October is National Healthy Lung Month supported by the American Lung Association. The ALA was originally founded in 1904 to fight tuberculosis. This 115 year old voluntary organization now sees its mission to promote lung health and prevent lung diseases through education, advocacy and research. The ALA has been hugely successful in creating awareness of the dangers of tobacco use through traditional smoking, making this the #1 preventable death in the United States. Most recently, the ALA, healthcare professionals, media outlets and the government have become aware of the dangers of electronic cigarettes and popularity of vaping. An electronic cigarette (e-cigarette) is a handheld, battery operated vaporizer of oils that simulates smoking. It offers many of the same behavioral aspects of combustible cigarette smoking without inhaling burning tobacco. Instead, the user inhales a vapor. E-cigarettes have been available in the US since 2003, however recently a significant number of lung related illnesses and several deaths has placed the vaping craze squarely in the gunsights of many.

E-cigarette pods contain as many as 600 ingredients including nicotine, tar and lead; releasing over 7000 chemicals, 69 of which are known carcinogens. One pod has been found to contain as much nicotine as 20 cigarettes. (Yes, a whole pack). The ALA has made a clear statement that “the inhalation of harmful chemicals can cause irreversible lung damage and lung disease.” In addition, other additives include:

• Acetone: nail polish remover
• Acrolein: a weed killer herbicide linked to acute lung injury, COPD, asthma and cancer
• Aldehydes: embalming fluids known to cause lung disease and cardiovascular disease
• Arsenic: the main ingredient in rat poison
• Naphthalene: mothballs
• Methanol: rocket fuel
• Propylene Glycol: a humectant

It is estimated that there are 8000 e-cigarette flavors available. Many of these are fruity, sweet, minty or candy flavored, making them much more palatable and popular. Secondhand e-cigarette smoke can be as damaging as that of regular cigarette smoke. In 2016, the US Surgeon General found E-cigarette emissions contain nicotine, benzene (found in car exhaust) and heavy metals like nickel, tin and lead. The emissions themselves are not actually a vapor, but rather an aerosol which contain tiny chemical particles.

Vaping and E-cigarette use has been marketed as a safe alternative to actual smoking. E-cigarette companies claim their target market is the 1,000,000,000 adult smokers worldwide and the 70% of those who want to quit smoking traditional cigarettes. They say they have not marketed to any other population segment but have taken steps to combat youth access such as age restrictions on purchases and other retail controls, flavor restrictions, shutting down social media footprints and tech-based locking devices. However, the ALA and the FDA agree that e-cigarette use among our youth is reaching epidemic proportions. E-Cigarettes are more popular among teens than any other form of tobacco use. 39% of teens report e-cigarette use by someone close to them, 31% cite the range of flavors available for its popularity and 17% believe it is less harmful than combustible tobacco cigarettes. Some brands look like USB drives or other high-tech devices and using them carries a certain cachet among teens. As of 2018, 95% of e-cigarettes are manufactured in China so there is no FDA oversight on this process. The flavors and humectants used are FDA approved but not for inhalation.

The recent cases of severe vaping-related illness have ramped up health concerns. The Centers for Disease Control reports the number of severe lung injuries is now approaching 1,100 with 18 deaths reported in 15 states. This has become an issue of grave importance to healthcare executives and front-line doctors and nurses as well as legislators. The state of Massachusetts upheld a 4 month ban on e-cigarettes in September, making it the first state to impose a ban The symptoms look like an infection or the flu but are antibiotic resistant. Most of those affected are recovering within a few days, but some are requiring ventilation or intubation. Many of these illnesses are being related to THC use (tetrahydrocanninol). Medical marijuana users are being urged to discuss their vaping use with their providers as most, but not all problems are being related to illegal products. Problems could also be related to new additives or toxins in the oils or devices themselves. There is uncertainty if this has happened before and gone unnoticed or under-reported. Health and Human Services Secretary Alex Azar has said the Food and Drug Administration will soon issue guidance on how to take flavored vaping products off the market. It is expected that e-cigarette/vaping companies will take legal action to forestall this this possible ban.

NHS Solutions’ healthcare executives are facing this issue. Our Interim Healthcare Leaders are available now with expertise in a wide range of specialties, across the clinical and allied spectrum of healthcare leadership. The issue of smoking is not new but the advent of this e-cigarette epidemic is one that will be tackled with the same enthusiasm and know-how that our clients have come to appreciate and rely on. Contact us for your next Interim Healthcare Leadership need or if you are interested in your next career step as an Interim Healthcare Leader.


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