A young man is lying in a room in the emergency department of the Haaglanden Medical Center with stomach pain. He is surrounded by equipment and has just been given a shot of pain relief. Now he can talk a little again. He points to his navel, it hurts around there. Blood has also been taken, perhaps an ultrasound will follow. The doctor asks if he smokes. “Never did that, I don’t drink either,” he says. “I tried a hookah once last year.”
There is a woman in the room opposite the young man, also with a stomach ache. But higher, near her midriff. The woman says that she could hardly breathe this morning. Now things are a little better – but not much. The doctor also asks her if she smokes. “I stopped a year ago, after thirty years.”
Doctors in the emergency departments of almost all Dutch hospitals are currently participating in a so-called VAP-ED study – a merger of vaping and Emergency Department. All patients aged twelve years and older who arrive at the ER in the next 24 hours will be asked if they would like to complete a survey about smoking, vaping and the use of snus (a bag of nicotine placed under the lip). Researchers want to know how many patients with sudden complaints use nicotine products and what impact this has on acute care.
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People who end up in the emergency room with shortness of breath often have the lung disease COPD, or they have problems with their heart or have recently had a stroke. Some have cancer, says ER doctor Nicole Kraaijvanger of the Leiden University Medical Center and initiator of the research. These all concern conditions and complaints that may be related to long-term smoking. In addition, patients also come in with wounds or broken bones that will not heal properly if they smoke or vape. Almost every doctor knows how great the damage is from nicotine use, “but something is only really true if you can also show it in figures.”
In addition, doctors have recently become concerned about a new group: young people who vape. According to the Trimbos Institute, a quarter of young people between the ages of twelve and sixteen have ever used a vape; 4 percent do so every day, and a third of them also smoke cigarettes. In the past two years, 23 young people who vaped ended up in hospital with a collapsed lung, lung bleeding or inflammation. Or they had an asthma attack that doctors could barely control, according to figures from pediatric pulmonologists. A larger group suffers from more vague complaints, such as a cough, fatigue, poor condition or concentration problems.
If people are open to this, we put the patient directly in touch with a smoking cessation organization
“Young people who vape do not end up in the emergency room en masse,” says Kraaijvanger, “but we do have to learn to ask whether young people vape. The teenagers will not tell us spontaneously.” While it is important to know, she emphasizes, “because otherwise we cannot make the link between complaints and vaping. And if we know, we can also help them quit.”
Because that is also what this 24-hour campaign is intended for: to advise adults and young people to stop smoking, vaping or using snus. “If people are open to this, a so-called warm referral follows,” says ER doctor Merel van Loon of the HMC. “We then put the patient directly in touch with a smoking cessation organization. We then fill in the details together so that care providers can quickly contact the patient.” According to Van Loon, this works much better than a leaflet, “which usually ends up in the trash bin.”
Medical instruments including a stethoscope, an oxygen saturator, a tongue depressor and a pen.
Photo Hedayatullah Amid / NRC
Nicotine
Unfortunately, her colleague hadn’t bitten a moment ago. A young man came in who had fallen. He said he had been smoking for three years, sometimes three cigarettes a day, sometimes a whole pack. “But he was not interested in a quit process, he did that on his own once.”
But quitting is not that easy, says Kraaijvanger. Nicotine is one of the most addictive substances, and young people are especially sensitive to it. The brain is still developing until the age of 25. Nicotine directly affects the reward system, causing young people to relax for a moment but become very dependent.
Vapes have very high nicotine concentrations, some contain as much as 25 packs of cigarettes worth of nicotine. “In addition, it contains nicotine salts,” Van Loon explains. “These salts ensure that the vapor irritates the throat less than when smoking cigarettes. As a result, young people inhale more deeply and the nicotine is absorbed into the body more quickly and in larger quantities.”
In total, approximately five thousand patients visit emergency rooms in the Netherlands every day. Kraaijvanger expects that several thousand will actually be able and willing to complete the questionnaire. The results of the study are expected within a month.
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