Michelle N. Eakin, PhD, on the Health Effects of Vaping

A new trend among youth, known as vaping, has caused more than 500 cases of vaping-associated pulmonary illness (VAPI) and 7 VAPI-related deaths over the past few months.1

In response to this trend and its severe health effects, the American Thoracic Society (ATS) has published 2 documents about VAPI for health care providers and their patients.2,3 Chair of the ATS Tobacco Action Committee, Michelle N. Eakin, PhD, answered our questions about these documents and the health effects of vaping.

Dr Eakin is the chair of the ATS Tobacco Action Committee, is an associate professor of medicine in the Pulmonary and Critical Care Medicine Department at Johns Hopkins Medicine, and is codirector of the Johns Hopkins Adherence Research Center in Baltimore, Maryland.

PULMONOLOGY CONSULTANT: VAPI has made headlines recently, with the Centers for Disease Control and Prevention reporting more than 530 cases as of September 20, 2019. What are the clinical features of VAPI, and how can pulmonologists and other health care providers ameliorate their patients’ symptoms?

Michelle Eakin: Patients with VAPI present with a range of symptoms including shortness of breath, fever, cough, vomiting, diarrhea, headache, and chest pain. Symptoms typically worsen over a period of a few days to a few weeks. Diseases associated with VAPI include acute eosinophilic pneumonia, lipoid pneumonia, acute lung injury/acute respiratory distress syndrome (ARDS), acute and subacute pneumonitis, organizing pneumonia, and diffuse alveolar hemorrhage. Based on limited data to date, treatment with corticosteroids may improve symptoms. Patients with more severe symptoms may need to be managed in an intensive care unit.

PULM CON: No one knows the long-term effects of vaping, since vaping has sharply increased in popularity over the last few years. What other challenges might pulmonologists and other health care providers face as the popularity of vaping continues to grow among youth?

ME: Given that vaping is relatively new, we do not have a lot of data on long-term health effects. However, The National Academy of Sciences (NAS) concluded4 that e-cigarettes cause acute endothelial dysfunction, oxidative stress, changes in heart rate, and damage to DNA, which are associated with long-term poor health, such as cancer, heart disease, and other chronic conditions. Furthermore, e-cigarette users are at risk for developing nicotine dependence and addiction to these products. Research has shown that e-cigarette users are more likely to transition to combustible products or become dual users over time.5

PULM CON: What research is being done to better understand the long-term effects of vaping?

ME: The Population Assessment of Tobacco and Health (PATH) study6 is currently being conducted by the National Institutes of Health and the US Food and Drug Administration to examine the impact of e-cigarettes on the public’s health. There are currently nearly 50,000 people participating to understand the process of initiation to different tobacco products, examine biomarkers, and evaluate impact on health over time.


Published in partnership with American Thoracic Society



  1. Potts M. Cases of vaping-related lung injury rise to 530 [published online September 20, 2019]. Consultant360.
  2. Carlos WG, Crotty Alexander LE, Gross JE, et al. Vaping associated pulmonary illness (VAPI) [published online September 18, 2019]. Am J Respir Crit Care Med
  3. Carlos WG, Crotty Alexander LE, Gross JE, et al. ATS health alert—vaping associated pulmonary illness (VAPI) [published online September 18, 2019]. Am J Respir Crit Care Med
  4. Public Health Consequences of E-Cigarettes. The National Academies of Sciences, Engineering, and Medicine. Published January 23, 2018. Accessed September 24, 2019.
  5. Kasza KA, Borek N, Conway KP, et al. Transitions in tobacco product use by U.S. adults between 2013-2014 and 2014-2015: findings from the PATH Study wave 1 and wave 2. Int J Environ Res Public Health. 2018;15(11).
  6. US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, Food and Drug Administration, Center for Tobacco Products. The Population Assessment of Tobacco and Health (PATH) Study. Updated July 29, 2019. Accessed September 24, 2019.