Mary Jo Henry, ARNP, joins St. Luke’s Chief Medical Officer, Dr. Dustin Arnold, to discuss the recent surge in vaping-related illnesses.
Dr. Dustin Arnold
Chief Medical Officer
UnityPoint Health – St. Luke’s Hospital
Mary Jo Henry
Tobacco Treatment Specialist
UnityPoint Clinic Multi-Specialty
Dr. Arnold: This is LiveWell Talk On…E-Cigarettes and Vaping. I’m Dustin Arnold, Chief Medical Officer at UnityPoint Health – St. Luke’s Hospital. E-Cigarettes or electronic nicotine delivery systems, sometimes referred to as ENDS, E-N-D-S, are battery operated devices that allow the user to inhale a vapor produced from a cartridge filled with a liquid solvent typically containing nicotine, propyl ethylene, glycol, or vegetable glycerin, or other chemicals and added flavorings. They are promoted as less harmful alternatives to traditional cigarettes, a way to bypass smoke free laws. While the long term health risks of using these products are being exposed to them, second hand or unknown recent deaths due to infection from e-cigarettes have sparked concern around the world. Here to tell us more about vaping and e-cigarette use is Mary Jo Henry, Tobacco Treatment Specialist with UnityPoint Multispecialty Clinic. Welcome.
Mary Jo: Thank you.
Dr. Arnold: You know, patients, and people ask me, these e-cigarettes, “is this a healthy alternative to smoking?” and my initial response is “the healthy alternative to smoking is to not smoke,” and as there is no healthy alternative and it’s probably good just to inhale oxygen into your lungs, or air, room air, how that is. But, how, how can these e-cigarettes be harmful, other than the obvious?
Mary Jo: Right, well, if it’s okay, I’d like to start talking about the many different kinds because I think it’s confusing for people.
Dr. Arnold: Yeah, please do, because I’m a little confused on that too.
Mary Jo: Yeah, there’s thousands of different devices and there’s new ones coming out daily. There’s the pods, those are like Juuls, they have a disposable cartridge that’s filled with vaping liquid. And then there’s mods which is a modified pod and that can be modified to allow using other substances in it, like we’ve been hearing about the THC being used in them. And there’s all different kinds of mods, some of them include vape pens, tanks, hookahs and hookah pens, just to name a few. But, despite all of the different variations, they all contain four basic parts, and you mentioned a couple of them. The battery, the cartridge or the tank, or the chamber that holds the e-liquid, an atomizer, which heats the liquid into an aerosol, and then a mouth piece that allows the user to inhale the heated aerosol, or the aerosol. They’re all considered tobacco products because they, most of them have nicotine. Okay and even ones that don’t have nicotine, or say they don’t have nicotine, tests have shown a lot of times they do have nicotine in them. Nicotine’s a drug, or like a medication, and so, they’re all nicotine delivery systems. Nicotine’s a very addictive drug, so they’re all a drug delivery system.
Dr. Arnold: So, they all are basically a liquid that’s converted to–
Mary Jo: Aerosol.
Dr. Arnold: Aerosol, or a gas inhaled, and then subsequently exhaled. Well, why is it seems like the puff of smoke, if you will, is tremendous compared to just a good old fashioned lung dart Old Gold filter, do you know why that is?
Mary Jo: Yeah, it’s the nicotine that they use is different in a regular cigarette it’s a free base nicotine, and in these pods and mods it’s a nicotine salt, and so it’s much more concentrated, and that’s how they get the big plumes of the smoke, or of the vapor. And there’s kind of a trend, with a certain group, I think it’s called Chasing the Cloud, where that is the goal, is to be able to expel the most amount of vapor that you can.
Dr. Arnold: Wonderful. That’s something that people should strive to do right?
Mary Jo: To not do.
Dr. Arnold: Yeah, or not do, just making sure there. Little bit of sarcasm. Well, they’re gaining popularity with teenagers and younger people, despite what the company says, they do not think the Bubble Gum flavor is directed to the forty year old that wants to quit smoking, that sounds a little counterintuitive, but why do you think it’s so popular with the youth? Mary Jo: Well, some studies that have been done, and asked youth, and sadly it’s not starting in high school, it’s starting in middle school. A good percentage of middle schoolers have used some form of e-cigarettes, but when you ask them, in these studies when they’re asked why they use them, they’ll say, well some say, one of the reasons is because other people do, either family or friends, and they’re curious, they want to find out about them. They think that it’s less harmful, or harmless, they think it’s a harmless vapor. And less harmful, at least less harmful than smoking so they think it’s a better alternative. And then, I think, the biggest reason is because the tobacco and e-cigarette companies are targeting our youth, they’re marketing to them.
Dr. Arnold: Like I said, the Bubble Gum flavor’s not intended for the forty year old.
Mary Jo: Or the Captain Crunch, or I’m sorry the Cinnamon Toast Crunch, or the Sour Patch Kids. And their packaging, when I see them in the stores, and the convenience stores, you can hardly tell the difference, they are packaged to look very similar to these candies, fruits, or juice boxes that they use.
Dr. Arnold: So, this is my naïve-ness, but, there’s no open flame, like a cigarette, so it’s actually all enclosed, so that probably makes concealment a little bit easier.
Mary Jo: Yeah, that’s another reason they cite using them, is that they’re easy to hide. And they’re so many different kinds, and most of them don’t look like something that, or at least a lot of them don’t look like something that you could inhale from. I mean, the vape pens, yes, and then there’s the e-cigarettes, Blu, I think is one brand, you know, that kind of looks like, is shaped like a cigarette, but there’s the Juul that looks more like an SD drive.
Dr. Arnold: For a computer?
Mary Jo: Right.
Dr. Arnold: So, comparing a cigarette to an e-cigarette, you said, what’s the relationship of nicotine?
Mary Jo: Well, one cartridge, one Juul cartridge equals a pack of cigarettes, so that’s twenty cigarettes. So, one cartridge is twenty cigarettes.
Dr. Arnold: And how long does one cartridge last?
Mary Jo: Depends on how often they’re using them, so I mean, it depends how often they’re vaping, is how long it lasts.
Dr. Arnold: Okay, so there’s not a specific number of vapes per, it would be variable depending on how deep you vaped, or inhaled?
Mary Jo: So, I guess the comparison is that one cartridge is equal to twenty cigarettes, so if someone smoked a pack a day, or if someone smokes half a pack a day, it’s kind of the same way how fast that cartridge will run out.
Dr. Arnold: Alright, well that makes sense I guess. But, I think this vaping related lung injury that’s being reported and observed is over a thousand cases now.
Mary Jo: It’s going up daily!
Dr. Arnold: Yeah, it is. And part of that is the awareness, so physicians are contacting the CDC for a reporting standpoint. However, it’s scary because of the unpredictable nature of it. If I start smoking today, I will have risk factors for heart disease, and lung disease, and emphysema and lung cancer, and everything else that goes with that, but it will be over time, it won’t be one pack of cigarettes, but it could be one Juul and you’re in the intensive care unit, this is the inhalation injuries and that I think they’re working rather quickly. I was just reading some articles this morning that they are starting to narrow down the nature of the injury and the treatment for that, but still, it’s still a risky situation, very unpredictable. What can, do you have any wisdom for parents when they are talking to their kids about this, other than simply, don’t do it? I mean when I was seventeen I felt pretty invincible and I didn’t think things applied to me, that one would expect to apply.
Mary Jo: Right, and that continues, as part of adolescence, but they do listen even if you, we as parents don’t feel like they’re listening, I think they do listen to what parents have to say, and so making sure that they understand it is not just a harmless vapor, that there are thousands of chemicals in there and a lot of them are known to cause illness, long and short-term health consequences, and then revisiting it. Don’t have the talk once and then expect it to impact them, revisiting it and talking to them, and using those teachable moments “Well, I saw your friend was vaping, are you doing that too?” or “I hope you know how harmful that is…we don’t want you to be one of the very unfortunate ones, and end up in the hospital in the intensive care.”
Dr. Arnold: You know, I was reading the articles this morning, that the most recent is virtually all men, and all young males have been affected by this. But that could just be the marketing and selection bias, it might necessarily be more of a predisposition to males as opposed to females, or young against old. Have you read anything to the contrary?
Mary Jo: Well, not so much on this current stuff, although I did hear, I think it was today actually on the news, that the most recent injury was a sixty year old woman. But the research I think was done in either 2014 or 2016 and then comparing it to 2018. 1% of middle and high school girls when asked said they had used some product and 4% of boys. And then in 2018 that had gone from 19% or gone to 19% in girls and in females and 23 or 24% in males.
Dr. Arnold: Okay, wow, so it is increasing from that stand point.
Mary Jo: And there is a little bit more predominance of male use than females, so that would stand to reason that injuries are occurring a little more frequently with the male than the female.
Dr. Arnold: So, what, the Turkish hookah, what exactly is that? How does that compare to the e-cigarette?
Mary Jo: Well, it is still considered an e-cigarette because it is a tobacco product, and you know, I think most of the hookahs are heated with an aerosol, but some of them might be burning too.
Dr. Arnold: Okay, so an actual flame.
Mary Jo: Right, right. And the actual burning versus the heating is the reason that initially, and we still think there may be some benefit from heating rather than burning. Okay, some harm reduction with use of e-cigarette versus a burning cigarette, because we know that that burning has a lot to do with the damage that it causes, and injuries that it causes.
Dr. Arnold: I think it’s pretty good advice that if you can’t spell the chemical, you probably shouldn’t inhale it in your lungs. That might be a good take home point for people. So, as we wrap up, one last question, why did you become a pulmonary specialist? How did you, you’ve been there, worked there as long as I’ve known you, the last fifteen years, but how’d you get started in that?
Mary Jo: Well, I never made a conscious decision to get into pulmonary, I made a conscious decision to be a nurse and I knew, I went to my local, or enrolled in the associate degree program at my local community college, and I had tried a few other things, I’d done some clerical, you know, work and retail, and that wasn’t for me. When I got into the nursing program it was like I knew I had found my career and my niche. So I made a decision to become a nurse and I also made a decision to advance my education, I didn’t want to stop with an associate degree. I had had the opportunity to when I was younger, I was involved with March of Dimes as a youth, and as a part of that, when I was in junior high I came to the University of Iowa, or I went to the University of Iowa and had a tour of the neonatal intensive care unit and I knew enough, that that was a pretty special place. So when I decided I was gonna become a nurse and I was gonna advance my education that was my goal, was to get to the University of Iowa, and I did. When I moved, went there and started interviewing for jobs as a new graduate, I had three or four to choose from and I ended up, not because of a burning desire to work with pulmonary patients but more, a number of other reasons that’s where I landed and I liked it and I’ve stayed with it.
Dr. Arnold: Yeah. You’ve been doing it as long as I’ve known you. It’s been about fifteen years. So, that’s really great information Mary Jo, and I’m glad you’re here today. Thank you for taking the time out of your busy clinic and away from those pulmonary patients to talk about this interesting and evolving topic. That was Mary Jo Henry, Tobacco Treatment Specialist with UnityPoint Clinic Multi-Specialty. For more information visit unitypoint.org. If you have a topic you’d like to suggest for our LiveWell Talk On… podcast shoot us an email at firstname.lastname@example.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.