Electronic cigarettes pose a serious health risk to patients

Nurses have the power to spread the word about the risks of e-cigarettes, according to Tiffany Klein, RN, BSN, Cancer Treatment Centers of America Atlanta.

Klein, who has a background in oncology and currently works on a pulmonology team, recently spoke to Oncology Nursing News® about her experience with e-smoking and vaping, and how the increase in these activities can affect patients. and nurses in various specialties.

Oncology Nursing News®: Could you provide an overview of your experience working with the lung team at CDC, Atlanta?

Klein: I started here at CTCA in urgent care, working with acute needs in oncology. I moved to intensive care here for a few years which allowed me to contact our thoracic surgeon and pulmonologist and have transitioned to working with him here for the past eight months or so. We focus primarily on lung screening programs: we focus on diagnostic procedures for biopsies to diagnose lung cancers, and then we also deal with lung diseases.

What are some of the safety issues or risks that your team has noticed regarding e-smoking?

One of the biggest things my [team] and I talk a lot is [how] there is an increased frequency of lung injury associated with these items. Above all [with] inhaled carcinogens. Many people, especially teenagers, buy these items online or abroad because they are easily accessible. And there’s been an increase in these items from China with substances that we don’t know about, or that actually promote a disease that we call lipoid pneumonia – it’s directly associated with inhaling vitamin oils E, which seems to flow from China as well. Other substances we notice in our members are pesticides, vitamin E oil and butane. I think we’ve seen an increase in people using marijuana oil as well as vapes – because it has no smell, you can hide it and you can get it easily online.

What these people don’t realize is that they don’t even really get any THC in the oils they get; they actually inhale butane, which raises their CO2 levels and makes them feel stoned. In reality, they’re just in a toxic state for a little while. [These] conditions which is favored hypersensitivity pneumonia. When we inhale substances that our body doesn’t like, the lining of the lungs and flames irritate and decrease your ability to breathe, leading to infection and acute respiratory distress syndrome (ARDS). We see a lot of these patients in intensive care, so they’re pretty safe. There is also the fact of talking about the use of marijuana. [Regarding] oils, 70% of our THC market is untested. So, at the end of the day, people don’t even really know what they’re inhaling.

With the pandemic, there have been many studies that have been published [shown that] the use of electronic cigarettes or vaping increases the incidence of COVID-19; it makes it easier for the virus to be transmitted, and then once you get the virus, you actually have an increased risk of the virus leading to severe progressive illness – those people who end up in intensive care and need intubation . To give you some numbers, e-cigarettes and vaping are promoted in the market as a safe alternative to cigarettes because they have fewer side effects, but there is a 59% increase in heart attack risk with e-cigarettes. -cigarettes or vaping use, and a 40% increase in heart disease and a 71% increase in stroke risk.

Has your team noticed an increase in the popularity of electronic smoking?

There was a study in October 2021 JAMA Pediatric Journal [that] showed that teenage marijuana vaping doubled from 2013 to 2020.1 And I think that’s directly related to the fact that it’s so easy to access it online, it’s so easy to get, easy to hide, easy to use without the smell

How might political or cultural attitudes help prevent a number of young people from continuing to put themselves at risk?

I think I think we need to change our marketing strategies [and[ implement some type of policy change so that what the commercials that these kids are seeing on TV aren’t focused as the “safe alternative to smoking cigarettes.” [We need] real education about what you inhale and what you get, so they can make as informed a choice as possible when they choose to take up this habit. We really need to focus on middle and high school aged children to help them stop using or try to stop them from using and we need stricter regulations on what is allowed in these oils, proper documentation on the packaging indicating exactly what is inside [the oils]and [listing[ the risk of each item that’s in it and what the risk of inhalation are. [We should also] increase marketing to the general population for just real education about what they are getting, what they are taking, and the associated risks, instead of promoting it as a “safe alternative”. I think we have enough data at this point to say that it really isn’t a safe alternative to cigarettes or regular use of old marijuana in its traditional form.

In your opinion, is there anything nurses can do to have an impact?

Especially with those focusing on pulmonology, I think we need to get out into the schools; doing presentations, education sessions, offering smoking cessation classes—we do that for adults, but we don’t really go to schools to do that. I feel like schools and parents would be open to that.

We don’t even know the long-term effects of a child taking nicotine at such a young age yet; 10, 11, 12 – the effects it has on their brain later on, their ability to learn. We don’t really know yet what it will do to them in 15 or 20 years. [People] need to be educated with the truth and find a way to stop it being promoted as the “cool” thing to do.

Oncology nurses, or nurses in general, are at the bedside looking after these people and seeing the reality of what it is. For example, I had a patient who was undergoing surgery where tissue oxygenation was very important, otherwise the outcome would fail the wrong way. The doctor himself is very attached to the prohibition of smoking and the absence of nicotine, because this decreases the oxygenation of the tissues and in no way promotes healing. [This patient] was so attached to her jewelry that I found it stuffed into her shirt. She was sneaking around and hiding him in the hospital.

So I think nurses have access to this stuff and have the experience of letting everyone know that it’s just not something as safe as everyone really thinks.


  1. Lim CCW, Sun T, Leung J, et al. Prevalence of cannabis vaping among adolescents: systematic review and meta-analysis of US and Canadian studies. JAMA Pediatr. 2022;176(1):42–51. doi:10.1001/jamapediatrics.2021.4102

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