E – Cigarette – Why do we forget to document in the medical notes?

Sir,

In Ireland, a survey carried out by the HSE showed that in 2015 the smoking prevalence was 19.2% and the prevalence of e- cigarette use was 4.7%1. A charts review of 20 consecutive medical patients from the respiratory ward in Beaumont Hospital were examined. Out of those 20 patients aged between 30 and 65 years old, 12 (60%) patients were male. Four (20%) patients were non-smokers. Ten (50%) patients were current smokers and 6(30%) patients were documented as being ex-smoker. Interestingly there were no documentation of the use of e-cigarettes in any of the 20 charts. There are now more smokers who want to quit using e-cigarettes than conventional NRT (Nicotine Replacement Therapy) and they tend to use e-cigarettes as a partial substitute for tobacco.

Smokers who switch to e-cigarettes remain addicted to and continue to use nicotine. Long term health effects are currently unknown; in particular, use of inhaled nicotine, propylene glycol or other constituents may cause damage to the lung or other adverse effects. Promotion to and use by young people could result in nicotine addiction among young people. Smokers who attempt to quit using e-cigarettes without support from the smoking cessation service may be less likely to quit successfully than if they had accessed to smoke cessation service.

The involvement of the tobacco industry in e-cigarette market is perhaps the factor that caused greatest distaste and concern among health professionals. Long recognised as a pariah industry, their involvement in a product that provides a potential route out of smoking challenges much conventional wisdom that tobacco industry has no part to play in the solution to the problem it has created2.

Reflecting on our findings which we discussed with the hospital committee, Beaumount Hospital will soon implement a section to document e-cigarettes use in the medical notes. Healthcare professionals often forget that a smoking history should include the use of e-cigarettes and it is therefore important to increase their awareness that e-cigarettes are being commonly used. This is because many patients who still uses e-cigarettes have the illusion of being a non smoker or ex-smoker.

M Kooblall, D Nash

Correspondence

Minesh Kooblall, Respiratory Department, Beaumont Hospital , Dublin 9

Email: mineshamnch@gmail.com

References

  1. http://www.hse.ie/eng/about/Who/TobaccoControl/Research/Smoking_in_Ireland_2015_Summary.pdf (accessed 8 august 2016)
  2. John Britton, Ilze Bogdanovica, Richard Ashcroft and Ann McNeill. Electronic cigarettes, smoking and population health.Clin Med (Lond).2014 Aug; 14(4): 334-7