I entered "well-controlled" into the 5-year-old's electronic medical record, but I wasn't referring to her good behavior.
I was simply checking in with her mom during the child's kindergarten physical and was pleased to hear that my patient's asthma hadn't flared up for many months. She rarely needed her rescue inhaler and her respiratory condition was now considered to be in good control.
While reviewing medications and running through the standard asthma checklist, I asked mom if there was any exposure to cigarette smoke in the home. She reported that no one really smoked in the house, but when her brother-in-law visited, he used a type of e-cigarette known as a vaporizer or vape pen.
BIL was confined to the basement at these times, but the vaporizer was about to be completely banned from the home. Mom confided that on a recent visit to the pulmonary doctor, the specialist "freaked out" when she found out that her vulnerable asthmatic patient was exposed to any type of cigarette at all.
Why the concern with e-cigarette exposure and use in young people? First, let's look at the number of youthful users of these battery-powered devices that deliver "vapor" or aerosolized nicotine and additives.
Surveying the personal use of cigarette alternatives in 2013 and again in 2014, the Centers for Disease Control and Prevention report that use of e-cigarettes tripled among American youth in just one year, bringing the total number of U.S. middle school and high school-age users up to 2.4 million.
"Youth use of tobacco in any form is unsafe," according to CDC expert opinion in its Morbidity and Mortality Weekly Report. The group goes on to state, "Nicotine exposure during adolescence, a critical window for brain development, might have lasting adverse consequences for brain development, causes addiction, and might lead to sustained tobacco use."
Scientific studies on the potential health effects of e-cigarettes are ongoing. In a study in the journal Nicotine & Tobacco Research, Dr. Leon Kosmider and his team of investigators find that vapors generated by e-cigs expose users to toxic carbonyl compounds, including the recognized carcinogens formaldehyde and acetaldehyde.
While some proponents try to promote e-cig use as a potentially less toxic experience than traditional "combustible" tobacco smoking, the CDC reminds us of a fact that should be more than obvious, namely, that aerosol from these electronic nicotine delivery systems is "not as safe as clean air."
In their scientific review of e-cigarettes published in the American Heart Association journal Circulation, California researcher Dr. Rachel Grana and colleagues explain that while e-cigarettes don't release smoke, users still exhale, exposing non-using bystanders to exhaled aerosol.
"Although data are limited," the authors comment, "it is clear that e-cigarette emissions are not merely 'harmless water vapor,' as is frequently claimed, and can be a source of indoor air pollution."
The CDC has particular concerns about indoor use of these electronic devices and the possible risk of passively exposing children, pregnant women and other nonsmokers to secondhand nicotine, a psychoactive chemical known to be harmful to humans and irritating to the airways, as well as to other potentially harmful vapor components.
An additional concern, according to Dr. Elizabeth Durmowicz of the U.S. Food and Drug Administration, is the risk of accidental exposure of children to e-cigarette products. In her article in Tobacco Control, the researcher reports that high concentrations of nicotine are toxic, with the lethal nicotine dose for children a fraction of that for adults.
Nicotine is well-absorbed by the lungs, skin, and gastrointestinal tract, and ingestion of e-liquid or skin exposure to a large volume of e-liquid can lead to injury or death in young children.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.