E Cigarette Dangers and Vaping Illness

Vaping, or the use of e-cigarette devices (vaping pens, ENDS – electronic nicotine delivery systems, etc) has become increasingly popular. In fact, e-cigarettes were the most used tobacco product among middle and high school students in the US, according to the 2024 National Youth Tobacco Survey. This survey reported that 1.63 million (5.9%) students currently used e-cigarettes (410,000 middle school and 1.21 million high school). Since 2010, more than 2000 cases of poisoning from e-cigarettes have been reported to Ohio Poison Centers.

The popularity of these products increased for a few reasons:

• They are commonly thought to be a safe alternative to smoking traditional cigarettes, but these products still pose concerning health risks.
• They carry no odor, which makes them easy to hide, and come a wide variety of attractive flavors including pink lemonade, pineapple ice, butterscotch, gummy bear and bubblegum.
• They have fewer negative side effects – less coughing, no bad taste, no dizziness -- which may be a risk factor for continued use of these products.
• While e-cigarettes are most often used with nicotine containing products, they are now widely used with THC (active component in cannabis or marijuana) and CBD oils as well.

Dangerous to young children

For younger children, the ‘e-juice’ used to refill the e-cigarette cartridges can be especially dangerous. The liquid to refill these devices comes in simple, small bottles of liquid without child resistant closures. Additionally, these small bottles can contain more nicotine than an entire pack of traditional cigarettes per teaspoon – this amount is more than enough to cause seizures in a small child. Drinking a small, half ounce bottle could be a fatal to a toddler.

Since these products have attractive flavors and aromas to a small child, it becomes tempting for small children to sample them, and a small mouthful might be enough to send a child to the hospital ICU. If you think your child has ingested one of the products, do not make them vomit (but note that they may vomit spontaneously) and call the poison center to get immediate advice from an expert.

Addictive to older children

It is important to remember that nicotine is highly addictive in all forms and is, in fact, one of the most addictive substances available. If adolescents and teenagers begin using these products, there is a concern they are starting a lifetime of nicotine addiction. Adolescent brains are still developing and vaping may have negative effects on addiction, cognition and emotional regulation. Vaping is also a risk factor for future cannabis or other illicit drug use.

The short terms effects of vaping are similar to other nicotine containing products and include a fast heart rate, high blood pressure, increased alertness and euphoria. Increased rates of chronic bronchitis have also been associated with vaping.

What is EVALI?

In 2019, the CDC, FDA, state and local health departments and other public health agencies announced the investigation of an outbreak of lung illness related to the use of e-cigarettes, now referred to as EVALI or E-Cigarette / Vaping Associated Lung Injury. This illness can be devastating, putting hundreds of previously healthy people in intensive care, on oxygen and using mechanical ventilators. Vaping-related illness initially mimics pneumonia, with onset over several days to months.

Symptoms of EVALI include:

• increasing shortness of breath
• cough
• wheezing
• chest pain
• coughing up blood
• fever
• chills
• fatigue
• muscle aches
• nausea
• vomiting
• diarrhea
• headache

EVALI has been more commonly associated with THC containing products and the additive vitamin E acetate. Another important risk factor for the development of EVALI is frequent use of vaping products (more than 5 times per day).

Flavoring additives have been banned by the FDA in nicotine devices. This may help, but this injury has been seen in other uses of these devices (TCH and CBD oils) that are not governed by the FDA. E-cigarettes or vaping devices of any kind are not safe for use by youth, young adults, or pregnant/breastfeeding women. Likewise, children should never be around any adults who vape due to potential harm from secondhand exposure

If you have any questions about e-cigarettes or vaping products, call the poison center at 1-800-222-1222.