Nearly 26,500 patients per year end up in the emergency department (ED) with complaints caused entirely by nicotine. This is evident from the so-called VAP-ED study – a combination of vaping and emergency department – which was carried out in mid-November in almost all emergency departments in the Netherlands. For 24 hours, doctors asked patients aged 12 and over to complete a questionnaire about smoking, vaping and the use of snus (a bag of powdered nicotine that is placed under the lip).
The most important question: how many patients in the emergency department use nicotine and what does that mean for the pressure on acute care? We see what we already thought, says ER doctor Nicole Kraaijvanger of the Leiden University Medical Center and initiator of the study: that pressure is considerable.
In a larger group (44 percent), doctors say: nicotine plays a role, but is not the only cause
During the study day, 4,314 people arrived at the emergency departments, of whom 2,061 completed a questionnaire. It showed that 434 people used a nicotine product, or 21 percent. Throughout the Netherlands, 1.8 million people visit an emergency room every year, which means that approximately 378,000 patients who use nicotine end up in the emergency department.
The doctors see two groups. In a small group (7 percent), their complaints are caused entirely by nicotine use, for example lung problems such as COPD – equivalent to 26,500 people per year. In a larger group (44 percent), doctors say: nicotine plays a role, but is not the only cause. Think of cardiovascular problems, neurological disorders and infections. This equates to almost 193,000 people every year.
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Higher age limit
Kraaijvanger emphasizes that these numbers are probably on the low side. “We could of course not survey patients with a stroke or heart attack, so only people who were not seriously ill completed the questionnaire.”
Most patients in the study appear to smoke cigarettes (86 percent). In addition, 9 percent use vapes, 9 percent cigars or cigarillos and 5 percent use other nicotine products, such as rolling tobacco, snus or heat sticks (where tobacco is heated in an electronic device instead of burned).
The study also shows that young adults aged 18 to 24 use nicotine most often. They mainly smoke cigarettes, but relatively often combine them with vapes. Young people between the ages of twelve and eighteen are more likely to start vaping and then switch to cigarettes or consume a combination of the two.
Last week it was announced that the coalition wants to increase the age limit for purchasing nicotine-containing products from 18 to 21 years. To the delight of doctors, says Kraaijvanger. “We now see, for example, that eighteen-year-olds at schools buy nicotine products for younger students. That will soon become more difficult.”
Focus on prevention
Doctors would prefer to see a smoke-free generation. “Then you agree that young people from a certain year of birth may never buy nicotine products. That is also much easier to enforce.”
During the study, emergency room doctors asked almost all patients if they wanted to quit smoking, vaping or using snus. Almost half of the people were interested in being referred to quit help. According to Kraaijvanger, it is important to focus more on prevention. “So that acute care remains sustainable in the future.”
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