Vaping implications for prehospital clinical care

We are beginning to see the initial correlations with COPD that vaping has on our patients’ overall health and respiratory disease exacerbation

A quick online search of “vaping hazards” will direct you toward a number of articles and fact sheets addressing the growing hazards associated with this tobacco-less smoking trend. In fact, more articles and fact sheets are being produced at a rapid rate, as we learn more about this illustrious alternative to cigarettes and traditional smoking

Research and data, however, seem premature to give us a true prognosis on the long-term, chronic effects of this habit. That’s not to say that what we’ve learned so far should be taken lightly. Its long-term impact on EMS interactions – while yet to be seen – are shaping-up to follow the pathway of other chronic respiratory illnesses. 

Initial implications 

Early research is helping to paint a clinical picture on what the implications for long-term vaping may look like.
Early research is helping to paint a clinical picture on what the implications for long-term vaping may look like. (Photo/Flickr via

Will we be responding to long-term vaping patients with the same volumes and mindset as we do with chronic obstructive pulmonary disease (COPD) patients? Or, will this follow along more of a toxic inhalation route? While the jury is still out regarding the future, early research is helping to paint a clinical picture on what the implications for long-term vaping may look like, and it doesn’t mean that we should start to dismiss patients with an active vaping lifestyle just yet. 

Johns Hopkins article posted five vaping facts that we need to know from the standpoint of the user, as well as from the understanding of the clinical provider: 

  1. Vaping is less harmful than smoking, but it’s still not safe 

  2. Research suggests vaping is bad for your heart and lungs 

  3. Electronic cigarettes (e-cigarettes) are just as addictive as traditional ones 

  4. E-cigarettes aren’t the best smoking cessation tool 

  5. A new generation is getting hooked on nicotine 

Prehospital impact of vaping 

Some of the growing concerns about vaping include emphysema and bronchitis combining to result in COPD, exacerbated asthma, or even long-term toxic inhalation hazards. A Penn State article outlined that some studies have found toxic chemicals, such as formaldehyde and an antifreeze ingredient, in vaping products. It also noted that vapor exhaled by e-cigarette users contains carcinogens and is a risk to nearby non-users, just like secondhand tobacco smoking. 

Because this is such a new trend – only on the market for the past decade or so – it may take another decade’s worth of use before we begin to see it’s long-terms effects on our prehospital patients. Considering the growing dangers behind it, however, it is fair for us to plan for a new-age of COPD patients; who may present differently because of the products used to make these vaping solutions. 

Keep your CPAP masks in stock, as a Harvard study reported that 39 of 51 vaping product samples tested contained diacetyl, a chemical that destroys the lungs’ bronchioles and leads to pulmonary scar tissue production. Additionally, many of the artificial flavors found in these products are derived from chemicals that are equally as toxic as diacetyl, when inhaled. 

Bronchodilators, positive pressure and steroids 

Normal capnograph waveforms, downward slopes, and “rolling hills” ... that’s what I would anticipate seeing in patients suffering from an obstructive respiratory problem. Even if there’s wheezing present, we’re not as likely to anticipate bronchospasm, compared to an issue with overall lung tissue surface area. As a result, vaping patients experiencing respiratory distress – or even COPD-like symptoms – may benefit more from positive pressure and steroids, rather than bronchodilators. Sure, there can be incomplete alveolar emptying present (e.g., “shark fin” waveforms), but obstructive patterns mimic more of the aforementioned, rather than the traditional asthmatic presentation. 

What we’ve often associated with 50-60 year old patients as a result of long-term cigarette smoking, may become the new disease of 30-40 year olds. As such, the “blue bloater” and “pink puffer” findings synonymous with COPD may now translate into a new generation of colorful descriptions that revolve around the toxic inhalation hazards of vaping ... and may outline the findings that we’ll be tasked with acutely – or even emergently – by treating as prehospital clinicians. 

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