Does smoking and vaping worsen a new diagnosis?

Smoking and Vaping Worsen New Medical Diagnoses

Both smoking and vaping significantly worsen outcomes for patients with new medical diagnoses and should be discontinued immediately to reduce morbidity, mortality, and improve quality of life. 1

Impact on New Medical Diagnoses

Cardiovascular Effects

• Smoking and vaping both induce oxidative stress, promote inflammation, and establish a prothrombotic state that can worsen cardiovascular conditions 1
• E-cigarettes and vaping have similar negative effects on cardiovascular function as traditional cigarettes 2
• These effects can accelerate disease progression in newly diagnosed cardiovascular conditions

Respiratory Effects

• Both smoking and vaping impair respiratory function through:
  • Abnormal ciliary function
  • Increased airway permeability
  • Decreased phagocytic clearance by macrophages 1
  • Risk of developing e-cigarette or vaping product use-associated lung injury (EVALI) 1

Metabolic Effects

• For patients with newly diagnosed diabetes:
  • Smoking and vaping products increase risk of diabetic ketoacidosis and hyperglycemic ketosis 1
  • Cannabis use in combination with smoking/vaping is associated with hyperemesis syndrome in adults with type 1 diabetes 1

Specific Risks by Product Type

Traditional Cigarettes

• Most harmful form of tobacco/nicotine use 1
• Established risk factor for worsening respiratory disorders, cardiovascular diseases, and muscle function 3
• Causes underlying damage that reduces oxygen delivery and ventilatory reserve 1

E-cigarettes and Vaping

• Should not be characterized as harmless 1
• Associated with:
  • Cardiovascular and respiratory system health risks 1, 2
  • Potential for EVALI, which can require hospitalization 1
  • Similar effects on lung and cardiovascular function as traditional cigarettes 3

Cannabis Products

• Increased THC concentrations in modern products pose specific concerns 1
• Delta-8 THC products have reported adverse effects with health implications for people with diabetes (e.g., vomiting) 1
• Combined use with tobacco products may compound risks 1

Clinical Approach to Patients Who Smoke/Vape with New Diagnoses

Assessment

• Directly ask about use of all smoking and vaping products 1
• Screen for signs of EVALI in patients who vape and present with respiratory symptoms:
  • Fever, cough, shortness of breath
  • Gastrointestinal symptoms (nausea, vomiting) 1
• Evaluate for comorbidities that could increase risk for severe disease 1

Management

1. Advise immediate discontinuation of all smoking and vaping products 1
2. Provide cessation support and resources 1
3. For patients with respiratory symptoms who vape:
   • Consider chest imaging if clinically indicated 1
   • Rule out other etiologies (influenza, pneumonia) 1
   • Monitor oxygen saturation 1

Follow-up

• Schedule follow-up appointments to monitor cessation progress 1
• Connect patients to community services for ongoing support 1
• Monitor for improvement in the newly diagnosed condition 1

Common Pitfalls to Avoid

1. Believing e-cigarettes are safe alternatives: Despite marketing claims, e-cigarettes are not harmless and should not be recommended as a safe alternative 1, 4

2. Failing to address all forms of smoking/vaping: Patients may not volunteer information about all products they use; direct questioning about specific products is necessary 1

3. Overlooking combined product use: Many patients use multiple products (traditional cigarettes, e-cigarettes, cannabis) which may have compounding effects 1

4. Missing EVALI diagnosis: Be vigilant for symptoms of EVALI in patients who vape and present with respiratory or gastrointestinal symptoms 1

5. Accepting unsubstantiated claims: Unsupported claims that vaping and nicotine can be protective against certain conditions have proliferated on social media but lack scientific evidence 1