How can nurses caring for smokers counsel patients on quitting smoking when many are using vaping as an alternative to cigarettes? Is vaping an appropriate alternative? — Name withheld on request

Counseling smokers on how to quit is difficult — many institutions hold classes specifically to assist smokers with this achievement and assist with managing tested alternatives such as nicotine gums or patches. But to address vaping as an alternative: No, it is not appropriate. 

First, vaping does not alleviate the dependence on nicotine. And contrary to what many of the vaping manufacturers wish us to believe, it is not just nicotine in the oil formulation. There are other chemicals, including THC in some cases that are questionable at best. 

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Second, the vaping solution is an oil formulation. This means that the inhaled smoke is actually aerosoled oil droplets. This can lead to lipoid pneumonia, which is occurring in greater frequency than ever before. Lipoid pneumonia related to inhaled oils is known as exogenous lipoid pneumonia, which occurs when the oils are inhaled. Once in the lung, the substance causes an inflammatory response that can be severe, depending on the type of oil and length of exposure.

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Third, vaping smoke is meant to be exhaled. However, in many cases, especially among younger users, they are smoking where it is not allowed — such as in schools — so they swallow the vapors instead of exhaling. In time, this may lead to increases in esophageal and GI cancers as well as pulmonary cancer. 

Since this is such a new smoking option, as oncology nurses, we should be aware of who is vaping, how much is used, and document its use. Making other caregivers aware of this issue will assist in caring for the total patient. — Rosemarie A. Tucci, RN, MSN, AOCN