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Does vaping count as smoking? Here's what doctors have to say

During your yearly physical — if you're diligent enough to go that consistently — it’s standard for your doctor to ask whether you smoke. For many years, this has seemed like a pretty straightforward question. The rise of vaping has complicated matters, though. Doctors typically haven’t told patients that vaping counts as smoking, or asked them specifically whether they vape, allowing the behavior to escape their notice. But amid an outbreak of a lung illness apparently related to vaping — which has affected at least 530 and killed seven people in the US, per the Centers for Disease Control — it’s suddenly pretty important for us to be honest with our doctors about vaping.

The tricky thing is, we’re not necessarily hiding it on purpose. Many people don’t consider vaping as smoking, thanks to some savvy marketing, most notably Juul’s “Make the Switch” campaign (now on the chopping block, ABC News reports), which markets vaping not as an equivalent to smoking, but a healthier alternative. That outlook began to shift as more reports of the lung illness emerge, but perhaps an even bigger issue is that in the doctor’s office, young people with active social lives tend to sanitize their realities. (I, for one, have definitely understated my drinking frequency when asked about it.)

While that may be fine if you’re relatively healthy, vaping is the one thing right now you probably shouldn’t be lying to your doctor about — and something you may even want to bring up yourself if your doctor doesn’t explicitly ask about it. For one thing, telling your doctor that you vape gives them the opportunity to underscore what a bunch of new research has shown so far: Using e-cigarettes, especially unauthorized ones, is short-term dangerous because no one has yet identified what substance in them has caused illness. It might be revealed, at some point, that your big-name vape is totally safe, but for now, you’re rolling the dice.

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Being upfront about your vaping habit can allow your doctor to inform you exactly about how it can affect your livelihood — including the less dire scenarios that can result, which are still pretty terrible, says Jamie Rutland, a pulmonary and critical care physician and professor at the University of California, Riverside School of Medicine. Even if it doesn’t end up giving you lung disease, vaping can cause a ton of inflammation in your airway, which may trigger an asthma attack or asthma exacerbation, according to Rutland. As a younger pulmonologist aware of the popularity of vaping among teens and adolescents, he asks patients specifically not only whether they vape, but what they vape with, and even asks to see the product — but notes this isn’t common practice among the primary care doctors you see for your annual physical.

And if you are in fact experiencing pulmonary symptoms, knowing whether you vape can help your doctor connect the dots, and make an accurate diagnostic assessment and appropriate treatment plan, Elisa Tong, an internal medicine physician at UC Davis Health (who also asks her patients whether they use electronic smoking devices), told Mic. That way, you no longer have to live with those symptoms. Plus, “since the contents of vapes are not regulated and we are just learning about the health harms of vapes, we rely even more on what the patient tells us.”

And now, to address a reality that generally stops most of us from blurting out behaviors that might warrant a lecture: It’s awkward and weird to disclose anything un-angelic and vaguely unhealthy in the fluorescent hell of a doctor's office. You might even be concerned about the legal implications of doing so if you use weed-based vapes. But ultimately (and ideally), your doctor is advocating for your health, Tong says. “Providers are not judges or law enforcement, and your medical record is confidential.”

Rutland adds that it’s important for a physician to know whether you use vapes containing tetrahydrocannabinol (THC, the compound in weed responsible for the high) in particular; most of the 373 patients with potentially vape-related severe lung diseases for whom the CDC has data used THC-containing vapes, “so one could conclude that maybe the THC products have something to do with the inflammation,” Rutland says. Many also used nicotine-based vapes, though, so it isn’t possible at this point to conclude whether only THC-based vapes or only nicotine-based vapes are to blame.

Rutland suggests viewing a conversation about your vaping habit with your doctor as educational rather than uncomfortable — an opportunity to learn what a vape cartridge contains and what exactly you’re inhaling into your body, as well as how choosing to do so could impact your health. And remember, your doctor isn’t your parent; they won’t send you to your room with a stern, “Don’t you ever vape again.” Instead, think of them as basically telling you, “‘Hey I’m your physician, and I need to know what you’re doing so I can better treat you and evaluate you," Rutland says.