A recent rash of vaping-related illnesses has sickened hundreds in the United States, sparked a sweeping public health investigation, and generated a flurry of legislative measures to curb the e-cigarette industry.
But in exam rooms, the illnesses have prompted a less-noticed but equally significant shift: Doctors, particularly pulmonologists, are asking patients whether they vape, even when they’re not presenting symptoms of the mysterious illness.
“In the past, I would ask people, ‘Do you smoke? Do you use marijuana?’ Now, I add to my questions, ‘Do you vape?’” said Dr. Sean Callahan, a pulmonologist at University of Utah Health.
For decades, providers have asked patients about their smoking habits and drug use as a matter of course. But many did not consider making questions about vaping part of their standard protocol, even as the popularity of vaping has surged. Vaping wasn’t widely seen to be a cause of illness in healthy young people; it was also seen as an option for smokers trying to wean themselves off nicotine cigarettes.
But several providers told STAT the spate of vaping-related illnesses has led them to begin asking patients explicitly about their use of e-cigarettes.
“That is the most important change over the last couple weeks for me. … Do you vape? Do you Juul? Very bluntly. It’s part of what I ask now,” said Dr. Pnina Weiss, a pediatric pulmonologist and professor at Yale School of Medicine.
Another notable change: Pulmonologists have started fielding calls from patients, parents, and pediatricians seeking advice on how to quit vaping or help someone else do so.
There have been 530 confirmed or probable cases of serious lung injuries linked to vaping, according to data released by the Centers for Disease Control and Prevention last week. Eight deaths have been tied to the illnesses. Many of the cases — which span 38 states and one territory — have been in young men. Health officials haven’t found a culprit behind the illnesses and still aren’t certain whether they’re grappling with one or several conditions.
More than 1 in 9 high school seniors say they vape nicotine almost every day, according to preliminary data from an annual federally funded survey published last week in the New England Journal of Medicine. Health care providers and public health officials say that’s cause for concern, since many cases of nicotine addiction begin during adolescence.
But doctors say getting adolescents to speak openly about their vaping habits can be difficult. Some patients are reluctant to disclose they vape, particularly when they’re using THC. And many are often accompanied by their parents on doctors’ visits, making disclosure all the more unlikely in some cases.
“I’m trying to make a better point of asking family to get out of the room so I can ask more direct questions,” said Callahan, who has treated several cases of vaping-related illness.
“I don’t care what the answer is, but I need the truth,” he added.
Weiss said all but one of the patients she has asked — a young person who was in the intensive care unit with signs of serious lung injury — have said they don’t vape. But she’s not certain whether teens are always going to tell the truth.
Weiss said it’s worth considering whether there is a way to standardize questions about vaping during doctors’ appointments for patients of any age. That way, providers will know not only whether their patients use vaping devices, but also what substances they’re using with them.
“There’s nothing on my template right now that’s like, ‘Circle vaping.’… The more it can be systematized, the less likely people are to forget,’” she said.
Dr. Aaron Chidekel, a pediatric pulmonologist in Wilmington, Del., said he has been doing more nicotine addiction treatment in the past few weeks than normal. More patients — and parents — seem to now be contacting his office about how to stop vaping or help someone else quit. “The fear of this illness [might] enable newly or not-so-newly addicted teens to take on their nicotine addiction,” said Chidekel, who practices at Nemours/Alfred I. duPont Hospital for Children.
Callahan said he has had a handful of younger patients come into his clinic at the university or the local Veterans Affairs clinic, where he also practices, to ask about vaping. They were growing worried about how the habit might affect their long-term health.
“Thankfully, most of them have quit by the time I see them, because they’re scared,” he said.
Pediatricians, too, are reaching out for guidance. Some might have only limited experience helping kids stop vaping — and need to be prepared, Weiss said.
“They’re going to bear the brunt of a lot of smoking cessation counseling for these kids,” she said.