MUSC doctors notice more vaping among teens as they launch study

As doctors in the MUSC Shawn Jenkins Children’s Hospital’s emergency department see more signs that patients have been vaping, they’re focusing on what might help teenagers kick the unhealthy habit.

“We see the inflammation. Some of these kids, you can see it on X-ray, you can see the chronic inflammation. And it looks like a 70-year-old smoker,” said Keith Borg, M.D., Ph.D.

Borg said it’s unclear if there are more kids vaping or doctors are simply more aware of it these days, but either way, one of the fellows on his team - a doctor who’s finished medical school and residency and is getting even more training – has launched a study. It involves vaping education and whether seeing ultrasounds of the lungs affects young people’s behavior.

 

That fellow, Kaitlyn Boggs, M.D., said when kids from 12 to 18 come into the emergency department for non-respiratory problems – she’s focusing on people who either don’t vape or haven’t vaped enough to have problems from it – the team asks if they and their parents would like for the child to be part of the study.

When the answer is yes, the next step is for the patient to fill out a confidential survey. “They talk about whether they have ever tried vaping before, quantifying how much they have vaped, how dangerous they think it really is, and behaviors and thoughts around vaping,” Boggs said.

“Then I ultrasound their lungs.” An ultrasound is a radiation-free way to get images of the lungs. 

“Then some get to look at their ultrasound and some don’t. It’s randomized, like a flip of the coin,” Boggs said. That randomization gives researchers a basis for comparison. 

The vapers who get to look at the ultrasounds may see some early changes to their lungs, Boggs said. The images can help researchers, as well, by showing them how vaping-related problems start and progress.

And the study doesn’t end there. “I always tell parents, the goal of this study is to, regardless of their children’s vaping status, educate them about the harms of vaping. So I bring up pictures of EVALI and lung ultrasounds of EVALI and how dangerous it can be,” she said, referring to e-cigarette and vaping-associated lung injuries. 

According to the American Lung Association, EVALI includes “a growing number of severe lung illness cases related to using e-cigarette and vaping products.”

Boggs hopes that viewing what vaping can do will be an eye-opener. “So they are able to visibly see, when they look at their own ultrasound and then they look at the ultrasound of someone who has EVALI, the difference between the two.”

 

Afterward, the patients do another survey and get follow-up texts at two weeks and two months. “None of the patients I'm enrolling has any evidence of ALI (vape associated lung injury). They're all asymptomatic. So that's kind of our goal - do we have any lung findings on these kids before they kind of go down that path, or where is the tipping point? Is it going to be that really heavy vapers are going to have more lung changes? Do they not have any lung changes?”

Those are important questions at a time when young people in the U.S. use e-cigarettes, or vapes, more than any other tobacco product. They are not safe, according to the Centers for Disease Control and Prevention, “especially for children, teens and young adults.” They’re also addictive and may affect parts of the brain involved in “attention, learning, mood and impulse control.”

Boggs knows the stakes may be high for some young vapers and early intervention has the potential to change their habits. So she started getting kids signed up for the study in August and plans to keep enrolling them through next summer. 

The information the study team collects will help doctors and families across the country who are looking for more information about vaping. Boggs said the National Use Tobacco Service found that more than 2 million teens currently vape. “And 25% of those are actually daily users,” she added.

Borg, who has worked in pediatric emergency medicine for 20 years, said some of those users have key misconceptions about e-cigarettes. “I think people equate vaping as like, ‘It's not tobacco, it's safer.’ But we're seeing the effects much faster. I mean, within years, not decades.”