A heart attack, collapsed lung, stroke or severe shortness of breath: emergency physicians see the consequences of nicotine use every day. But hard figures have not been available until now, says ER doctor Nicole Kraaijvanger of the LUMC. “We saw it every day, but we couldn’t put a number on it.”
Especially cigarettes
That is why on November 13 and 14 last year, research was carried out during 24 hours in 67 of the 78 emergency rooms in the Netherlands. During that period, 4,314 patients aged 12 years and older were helped. Of these, 2061 were willing and able to complete a questionnaire about their nicotine use.
The results show that 21 percent of ER patients use a nicotine product. Of this group, 86 percent smoked cigarettes, 9 percent used vapes, 9 percent smoked cigars or cigarillos and 5 percent used other nicotine products, such as snus and rolling tobacco. Ten percent of users indicated that they use multiple nicotine products at the same time.
According to Kraaijvanger, the figures themselves are not surprising: they correspond reasonably well with the figures for the entire Dutch population from the Trimbos Institute, although the user percentages in the ER appear to be somewhat higher. “What is particularly striking is that doctors already saw a link between nicotine use and the complaint in more than half of the patients. Sometimes it played a role, sometimes it even explained the complaints completely.”
193,000 ER visits
According to the treating physicians, the complaints of 7 percent of these patients were entirely attributable to nicotine use, especially lung problems. In addition, doctors judged that smoking or vaping use may or partly played a role in 44 percent of nicotine users, especially in lung problems. In one year, almost 26,500 people end up in the emergency room due to nicotine use. Smoking or vaping likely also played a role in another nearly 193,000 visits.
The actual number is even higher, Kraaijvanger thinks. “We were unable to provide the most serious patients with a questionnaire. People who come in with acute, life-threatening problems should not first be asked to participate in such a study about their smoking behavior.”
Robin ended up in intensive care because of vaping. His mother tells his story below: please note that the images can be experienced as intense.
Kraaijvanger never gets used to seeing patients in acute respiratory distress. “I regularly see people come in with a severe COPD attack. We know that this lung disease is in most cases caused by smoking.”
Gasping for breath
COPD (Chronic Obstructive Pulmonary Disease) is a chronic, incurable lung disease in which the airways are permanently inflamed and narrowed. It is a collective name for chronic bronchitis and emphysema, among other things. Patients are often short of breath, cough a lot and have less energy.
“During such an attack, patients come in extremely short of breath, sometimes with blue lips, gasping for breath. It is an intense image,” says Kraaijvanger. “Especially when you realize that this could possibly have been prevented by not smoking.” She believes it is important not to blame the smoker. “They often became addicted at a very young age and stopping is very difficult,” says Kraaijvanger.
In addition to insight into the pressure that nicotine use places on emergency care, the study also shows that the emergency room can play a role in quitting smoking or vaping. “We not only asked people about their smoking behavior, but also whether they were open to discussing it,” says Kraaijvanger.
Nearly 47 percent of nicotine users indicated that they were open to it. “Then you can explain what the consequences are and immediately refer someone to quit assistance. The chance that someone will actually start with such guidance is then seventeen times greater than if you only provide a brochure.”
