Objectives Vaping has increased significantly in Canada over the past 2 decades, particularly among adolescents and young adults. While vaping was once thought as a smoke cessation or harm reduction strategy, many younger individuals start with vaping. Devices that allow mixing, including the third and fourth generation vapes, contain a vast array of chemicals. Nicotine, cannabis, solvents and over 1000 potential flavoring compounds can lead to various respiratory complications. In 2020, the United States Centers for Disease Control and Prevention highlighted the link of vitamin E acetate, an oil-based additive used in some products, to the vaping-related deaths of adolescents and young adults. Current research and clinical experiences show that wheezing, a common symptom of asthma, is frequently observed in adolescents and adults who vape. We used data from a pulmonary function testing (PFT) reference laboratory within Alberta Health Services for Edmonton and Northern Alberta. Our aim was to evaluate the prevalence of patients with a history of vaping who are referred to PFT laboratory to investigate for ‘query asthma’, and review the use of respiratory medications at the time of referral.
Method Data was collected from routine data fields completed on a patient’s first visit to the PFT laboratory affiliated with University of Alberta Hospital and Stollery Children’s Hospital over 24 months from January 2020 to December 2021. We extracted age, reason for referral, history of inhalant exposure, type of inhalant product, and use of respiratory medications. Ethics approval from University of Alberta research ethics board and operational approval from Alberta Health Services were obtained prior to data collection. ‘Query asthma’ refers to patients with suspicion of asthma and without evidence of variable expiratory airflow limitation on objective testing.
Results Among the 82 patients who reported a history of past or current vaping, 18 had ‘query asthma’ as the reason for referral to the PFT laboratory. Mean age was 33 ± 10 years; range 21–55 years. Respiratory medications were used by 8 patients prior to undergoing testing at the PFT laboratory. Salbutamol was the most common medication.
Conclusion Our findings suggest a possible overuse of asthma medications among patients who vaped. The prescription of non-indicated medications can expose patients to unnecessary adverse effects and incur costs to healthcare system. Ensuring testing prior to initiating asthma treatment or confirming the diagnosis in patients already using asthma medications is vital to reduce the potential for overdiagnosis. In patients who vape, the overdiagnosis of asthma may lead to an under-recognition of vaping as a contributing factor to their symptoms. It is plausible that those patients who continue to vape are more likely to remain symptomatic and develop further complications associated with vaping. The overdiagnosis and overtreatment of asthma are a concern with active vapers, particularly in adolescents and young adults. Routine assessment for vaping by clinicians and PFT laboratory staff is recommended. A better understanding on the impact of vaping and diagnostic labels among health administrators and regulatory bodies can also help reduce health spending in the long term.
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