Dear Dr. Eva,

I am worried about the recent news on deaths from vaping. I have two teenage nephews that vape, and, according to them, so do most of their friends. They think it’s much safer than smoking. What do you think?



Dear Concerned,

I’m concerned too.

In case there are readers who don’t know, vaping means inhaling vapor from heated oil containing nicotine, THC (the active ingredient in marijuana), and other chemicals. This is done using electronic cigarettes (“e-cigarettes”) and other vaping devices.

As you may have read or heard in the news, we are in the midst of a small epidemic of serious lung disease related to vaping. Since April of this year, more than 450 cases have been reported in 33 different states, and at least five people have died.

The main signs of vaping-related lung disease are cough, shortness of breath, chest pain, and feeling exhausted. Some patients have fever, weight loss, and gastrointestinal symptoms such as nausea, vomiting, or diarrhea. In some cases, symptoms appear over a few days, while in others the illness develops over several weeks. Shortness of breath can become so severe that hospitalization is needed. In a review of cases published in the New England Journal of Medicine, most hospitalized patients needed oxygen and one-third needed a ventilator (mechanical breathing machine). Images of affected patients’ lungs look similar to those of patients with bacterial or viral pneumonia, but tests have not shown any evidence of infection and antibiotic treatment has not helped. It is believed that this illness is a reaction to one or more of the chemicals in vaping oils.

Because no specific vaping device or type of vaping oil has been shown to cause this illness, everyone who uses any type of e-cigarette or other vaping device is considered at risk. However, the Food and Drug Administration (FDA) warns that there is greater danger for people who vape THC. About 80% of cases of vaping-related lung disease have occurred in people who reported vaping THC products. In the other 20% of cases, patients reported vaping only nicotine products. One-quarter (25%) of samples of vaping fluid used by sick patients included THC and also contained a chemical called vitamin E acetate. Vitamin E acetate is a form of vitamin E, an oil-based vitamin. Inhaling any form of oil is known to irritate the lungs. Vitamin E acetate is suspected to be a cause of this illness, but it is only a theory at this point and there may be other causes as well. So far, it is not known why vitamin E acetate is being added to vaping oils.

Right now, I can’t say that vaping is safer than smoking, only that neither one is safe. Anyone considering using e-cigarettes to cut back on smoking or stop smoking would be smarter to choose another method. Nicotine containing gums and patches have been shown to be safe and effective for smoking cessation. Medically, vaping has never been recommended for any reason other than reducing or stopping cigarette smoking. Now more than ever, it’s clear that vaping should be avoided.

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Dr. Eva Hersh, MD
Dr. Eva Hersh, MD
Eva Hersh is a family physician. Send your comments and questions to her by email at