E-cigarettes and other Vaping Products
E-cigarettes typically contain nicotine, most also contain flavorings and other chemicals, and some may contain marijuana or other substances. They are known by many different names and come in many shapes, sizes and device types. Devices may be referred to as “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” “mods,” tanks, or electronic nicotine delivery systems (ENDS). Some e-cigarette devices resemble other tobacco products such as cigarettes; some resemble ordinary household items such as USB flash drives, pens, and flashlights; and others have unique shapes. Use of e-cigarettes is sometimes referred to as “vaping” or “juuling.” E-cigarettes used for dabbing are sometimes called “dab” pens.
E-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals (e.g., lead), volatile organic compounds, and cancer-causing chemicals. Additionally, some e-cigarette products are used to deliver illicit substances; may be acquired from unknown or unauthorized (i.e., “street”) sources; and may be modified for uses that could increase their potential for harm to the user.
Youth, young adults, pregnant women, as well as adults who do not currently use tobacco products should not use e-cigarettes. E-cigarettes containing nicotine have the potential to help some individual adult smokers reduce their use of and transition away from cigarettes. However, e-cigarettes are not currently approved by the Food and Drug Administration (FDA) as a quit smoking aid, and the available science is inconclusive on whether e-cigarettes are effective for quitting smoking.
The Rise of Vaping
The Rise of Vaping video offered by The Campaign for Tobacco-Free Kids provides relevant, youth-focused info on the rise of e-cigarettes like Juul and to prevent nicotine use.
This video can be used in classrooms, assemblies, trainings, conferences, summits, and anywhere else as a resource to help prevent youth and teen e-cigarette use. The video is intended mainly for middle and high school audiences.
Severe Lung Disease among People Who Reported Vaping
The North Carolina Department of Health and Human Services (NC DHHS) is investigating cases of severe lung disease among people who all reported recent vaping or dabbing (vaping products include nicotine, marijuana oils, extracts, or concentrates). NC DHHS is collaborating with the Centers for Disease Control and Prevention (CDC) and other state health departments as part of a national investigation.
As of 01/30/2020, 76 cases have been reported in individuals in North Carolina ranging in age from 13 to 72 years.
- Patients experienced severe respiratory symptoms including cough and shortness of breath. Patients also reported experiencing fever, fatigue, chest pain, nausea, vomiting, and diarrhea.
- Most cases have been hospitalized and have required respiratory support. No deaths have been reported in North Carolina.
Information for the Public
If you use e-cigarette or vaping products:
- Anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC, other cannabinoids) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer.
- See a healthcare provider right away if you have symptoms like those reported in this outbreak.
If you are an adult who uses e-cigarettes because you have quit cigarette smoking:
- Do not return to smoking cigarettes.
- If you continue to use e-cigarettes, carefully monitor yourself for symptoms and see a healthcare provider right away if you have symptoms like those reported in this outbreak.
If you are an adult who is trying to quit smoking:
- Contact your healthcare provider if you need help quitting tobacco products, including e-cigarettes.
- Use evidence-based treatments, including counseling and FDA-approved medications.
If you are concerned about your health after using an e-cigarette product, contact your health care provider, or you can also call your local poison control center at 1-800-222-1222.
CDC and FDA encourage the public to submit detailed reports of any unexpected health or product issues related to tobacco or e-cigarette products to the FDA via the online Safety Reporting Portal.
Information for Healthcare Providers
- Report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette or vaping product use within the past 90 days to your state or local health department. Reporting of cases may help CDC and state health departments determine the cause or causes of these pulmonary illnesses.
- Ask all patients who report e-cigarette or vaping product use within the last 90 days about signs and symptoms of pulmonary illness.
- If e-cigarette or vaping product use is suspected as a possible etiology of a patient’s severe pulmonary disease, obtain detailed history regarding: Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances – Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids – Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil) – Where the product(s) were purchased – Method of substance use: aerosolization, dabbing, or dripping – Other potential cases: sharing e-cigarette products (devices, liquids, refill pods, or cartridges) with others
- Determine if any remaining product, including devices and liquids, are available for testing. Testing can be coordinated with the local or state health departments.
- Consider all possible causes of illness in patients reporting respiratory and gastrointestinal symptoms and of e-cigarette product use. Evaluate and treat for other possible causes of illness (e.g., infectious, rheumatologic, neoplastic) as clinically indicated. Consider consultation with specialists (pulmonary, infectious disease, critical care, medical toxicology) as appropriate.
- Clinical improvement of patients with severe pulmonary disease associated with e-cigarette use has been reported with the use of corticosteroids. The decision to use corticosteroids should be made on a case-by-case basis based on risks and benefits and the likelihood of other etiologies.
- Lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the detection of lipid-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL) and lipid staining (e.g., oil red O). The decision about whether to perform a BAL should be based on individual clinical circumstances.
- Lung biopsies have been performed on some patients. If a lung biopsy is obtained, lipid staining may be considered during pathologic examination, and is best performed on fresh tissue. Routine pathology tissue processing (including formalin-fixation and paraffin-embedding) can remove lipids. Conducting routine tissue processing and histopathologic evaluation is still important. Consider consultation with specialists in pulmonary medicine and pathology to help inform any evaluation plan.
- Patients who have received treatment for severe pulmonary disease related to e-cigarette or vaping product use should undergo follow-up evaluation as clinically indicated to monitor pulmonary function.