Vaping - Seeking Clarity in a Time of Uncertainty

As of October 28, 2019, 49 states have reported more than 1600 possible cases of severe pulmonary disease related to vaping—the inhalation of a heated, aerosolized solution—to the Centers for Disease Control and Prevention (CDC).1 To date, 34 deaths have been attributed to e-cigarette, or vaping, product use–associated lung injury (EVALI). This has resulted in a recommendation from the CDC that the public avoid the use of e-cigarette products, a proposed federal prohibition on certain products and flavors, and much uncertainty on the part of patients and clinicians. In the midst of this uncertainty, it is important to try to provide some clarity.

Vaping is typically associated with the use of nicotine e-cigarettes, although it is not a uniform process and involves a variety of devices, substances, and practices, each of which can cause vaping-related harms. Specifically, “closed-system” vaping devices have self-contained e-liquids (cartridges or pods) and are not meant for modifications (eg, JUUL), whereas “open-system” vaping devices can be modified, allowing users to insert a range of e-liquids, including cannabinoids. The health effects of vaping are likely to vary depending on the device, the substance being vaped, and the amount and type of exposure. For well-established nicotine e-liquids, vaping has been shown to deliver substantially lower concentrations of toxic substances per puff than conventional cigarette smoking.2 However, this may not apply to modified e-liquids, and little is known about the health effects of vaping cannabinoids.

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