Vaping, e-cigs and tampered cartridges info for health professionals

Vaping & e-cigs
Health professional resources

Children’s Minnesota is providing information and resources for health care professionals about vaping among children and young adults.

If you need to consult a specialist, call Children’s Minnesota Physician Access.

Vaping usage

In the past five years, vaping has become increasingly popular among teenagers. Teens often consider vaping aerosols different than smoking combustible products so asking a teenager if they smoke is not sufficient in identifying if there is a vaping concern.

A significant number of eighth-graders in Minnesota report recent experience with vaping, with that number substantially growing by eleventh grade, highlighting the importance of asking all teenagers questions specific to vaping during their appointment and, as a result, providing appropriate guidance.

Teenagers commonly categorize their vaping behaviors into nicotine-based, THC or CBD-based, and so-called flavor-only liquids–often called “zero nic” by sellers, or by the type of device (e.g. mods, carts, or disposables). This is why it’s important to familiarize yourself with the terminology and typical devices to help teenagers feel comfortable when they seek medical options.

Having parents present for the questions can also pose a barrier, similar to typical HEADSS exam questions in adolescent medicine. Ensuring time for discussion during HEADSS exam related questions, or having a medical assistant or nurse ask the patient during rooming intake or pulmonary function testing can be very helpful.

Useful resources for professionals

Dr. Leslie’s series on vaping @drleslie on Tik Tok @doctorleslie_ on Instagram

Vaping terminology and pictorials

MDH Dictionary (PDF file)
CDC Ecigarette or Vaping Products Visual Dictionary (PDF file)
The 2020 National Youth Tobacco Survey
Includes e-cigarette-use specific burden data
The Minnesota Department of Health Vaping of THC among adults in MN (PDF file)
Notably, vaping THC (marijuana) –containing products is more common among younger, male adults with lower education status in the Twin Cities Metropolitan Area

Treatment options

For patients who vape, treatment depends on the scope of the problem. In all settings, empowering youth to make educated choices is crucial. Discussion surrounding which substances have been inhaled, how much and how often as well as screening for signs of dependence can further guide treatment.

Identifying undertreated anxiety or depression is also important. It is not uncommon for teens to endorse vaping as a coping mechanism for stress. Engaging in counseling that specifically addresses future stress management tactics is encouraged, often with the help of a therapist proactively. Having a plan to manage stress and anxiety through new coping skills relies on mental health referral for planning and management.

To date there remains no FDA approved nicotine replacement therapies for minors nor tetrahydrocannabinol dependence pharmacotherapy. Nicotine replacement therapy has been utilized with caution on a case by case basis with risk/benefit assessment and ongoing monitoring by health care providers. It is strongly encouraged to include non-pharmacotherapy based counseling in the management plan of chemical dependence.

Helpful sites on substance use

Our educational page for parents and teens
Teaches families about the dangers of vaping, terminology and devices.
Living Now
Behavioral health resources to help children through challenges in life.
Know the Truth MN
Educates and empowers youth, parents and educators to take a stand against substance use.
Clear Way Minnesota
Independent nonprofit organization that reduces tobacco use through research, action and collaboration.
Minnesota Teen and Adult Challenge
Services for people struggling with drug, alcohol, and other life-controlling addictions.
Quit Partner
Free and confidential way to quit smoking or vaping.

EVALI treatment

E-cigarette or Vaping Product Use- Associated Lung Injury (EVALI) is thought to be associated primarily with THC- based illicit vaping products and likely the presence of Vitamin E acetate. Symptoms of EVALI have been well described. Initial fever, loss of appetite, gastrointestinal distress and cough are common, but dyspnea upon mild exertion is also quite prevalent.

For further description of presentation, please see the following articles:

Evans ME, (Griffiths, A as member of CDC-Lung Injury Response Clinical Working Group), et.al.
Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use-Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge –UnitedStates, December 2019. MMWR Morb Mortal Wkly Rep 2020;68:1189-1194.
Jatlaoui TC, (Griffiths, A, as member CDC-Lung Injury Response Clinical Working Group), et.al. CDC
Update: Interim Guidance for Health Care Providers for Managing Patients with Suspected E-cigarette, or Vaping, Product Use–Associated Lung Injury –United States, November 2019. MMWR Morb Mortal Wkly Rep 2019;68:1081-1086.
Siegel DA, (Griffiths, A, as member of CDC-Lung Injury Response Clinical Working Group), et.al.
CDC Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury –United States, October 2019. MMWR Morb Mortal Wkly Rep 2019;68:919-927. Also republished in:Am J Transplant, 2019 December; 19(12):3420-3428.
MDH: Vaping Associated Lung Injuries: Info for Health Professionals

Confirmation of EVALI and the ruling out of other possible causes is important as systemic steroids are conventionally prescribed for treatment. The article from The Lancet below was one of the most comprehensive reviews of presentation and treatment of EVALI stemming from the 2019 outbreak. The abstract is available for public access and providers may gain full access to the article through their usual literature repositories and subscriptions.

Blagev DP, Harris D, Dunn AC, Guidry DW, Grissom CK, Lanspa MJ. Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study. Lancet. 2019 Dec 7;394(10214):2073-2083.

The article reviews EVALI treatment protocols (see Figure 1 in article) that are in line with our general approach at Children’s Minnesota but should not be applied to individual patients without physician consultation and thorough evaluation.

Children’s Minnesota is a leading national voice in raising awareness about the dangers of vaping.