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Vaping and E-Cigarettes Add to Lung Disease

FRANKFORT You’ve seen them in stores and on billboards on the side of the road, and heard about them on the radio. Electronic cigarettes, or e-cigarettes, seem to be everywhere these days. Despite their popularity, their long-term health impact is unknown.

E-cigarettes are devices that deliver an aerosol to the user by heating a liquid that usually contains nicotine, flavorings, and other chemicals. It can also contain marijuana extracts and other substances. E-cigarettes are often called “vapes,” and users refer to e-cigarette use as vaping.

This year, a curious cluster of cases in Wisconsin and Illinois started an investigation into lung injury associated with vaping. Hospitals noticed clusters of young and otherwise healthy adults being admitted with shortness of breath, cough, chest pain, and gastrointestinal symptoms such as diarrhea, nausea, and weight loss. All patients had reported using an e-cigarette, or vaping, in the days and weeks prior to becoming ill.

Those local investigations sparked a national investigation into what the CDC is calling “e-cigarette, or vaping, product use-associated lung injury (EVALI).” The Kentucky Department for Public Health is working closely with healthcare providers, local health departments, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), and other states to gather information about this outbreak.

As of November 7, 2019, there are at least 2,051 confirmed and probable cases of lung injury associated with vaping across 49 states (all except Alaska) plus the U.S. Virgin Islands. There have been 39 confirmed deaths. Most of the cases have occurred in youth and young adults. This may be because young people are more likely to use e-cigarettes than older adults.

Vaping Related Deaths in Kentucky

In Kentucky, there are currently 14 probable and confirmed cases of vaping-related lung injury.

The majority of cases have involved vaping marijuana extracts, or THC, but approximately 15 percent of cases have been identified in people who used only nicotine. There is no single e-cigarette device, ingredient, or constituent that has been identified that is common among all cases. At this time, the CDC and Kentucky Department for Public Health are recommending that no one use e-cigarettes.

Healthcare providers may encounter barriers when discussing vaping with patients. One, patients may believe that e-cigarettes are a way to quit using tobacco products. Two, patients using marijuana or THC in their e-cigarettes may not believe that these products can be addictive. And three, patients may believe that their own particular device is safe and see no need to quit. Here are some talking points to address these issues:

E-cigarettes are not FDA-approved as a way to help people quit using tobacco. In fact, adults who use e-cigarettes are more likely to continue using other tobacco products than to quit. Patients interested in quitting should go to or call 1-800-QUIT NOW for free help.

Despite the popular impression that marijuana use is entirely safe, people can become dependent upon it and suffer mentally, emotionally, and physically. For assistance in finding treatment for unsafe marijuana use, refer patients to for a variety of types of substance abuse treatment.

Finally, if patients refuse to quit using their vaping device, advise them to closely monitor themselves for symptoms of illness, such as cough, shortness of breath, nausea, diarrhea, and fatigue. If patients note any of those symptoms, they should contact their healthcare provider immediately.

Healthcare providers should report suspected cases of EVALI to the Kentucky Department for Public Health.

Elizabeth Anderson-Hoagland is the supervisor in the Health Promotion Section at the Kentucky Department for Public Health. She was a policy analyst with the Kentucky Tobacco Prevention and Cessation Program for seven years. As part of her position, she focuses on a variety of issues related to youth tobacco use, including 100% Tobacco Free School policies and TRUST, a tobacco retailer underage sales training initiative.