Although electronic cigarettes, also known as e-cigarettes, have been available in the U.S. market since 2007, use of them has exploded in recent years, even as traditional cigarette use decreased.
That’s especially true in the youth population. A 2018 report revealed e-cigarette use grew 78 percent among high schoolers and 48 percent among middle schoolers between 2017 and 2018. According to the report, 1 in 5 high school kids and 1 in 20 middle school kids use some form of e-cigarette. More youths use e-cigarettes than traditional cigarettes.
Vaping – so called because users inhale a vapor created when the e-cigarette’s liquid is heated – originally was marketed as a safer alternative to traditional cigarettes. However, recent evidence is showing that’s not the case.
According to the Centers for Disease Control and Prevention (CDC), as of Oct. 22, 2019, 1,604 cases (based on complete reports received) of e-cigarette, or vaping, product use associated associated lung injury (EVALI) have been reported to the CDC from 49 states (all except Alaska), the District of Columbia, and one U.S. territory. Thirty-four deaths have been confirmed in 24 states. Visit this CDC webpage for the latest information.
Despite having fewer toxic chemicals than traditional cigarettes, e-cigarettes still contain harmful ingredients that can cause damage.
“Some variables seem to increase the risk of having acute lung injury due to e-cigarette use,” says Jared Chiarchiaro, MD, a pulmonologist at UPMC and assistant professor of medicine and associate fellowship director for Clinical Education, Pulmonary and Critical Care Medicine at the University of Pittsburgh Department of Medicine.
With the rise in cases, it’s important to know the risks of vaping.
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What Are E-cigarettes?
Electronic cigarettes, or electronic nicotine delivery systems (ENDS), include a variety of items, including vape pens, e-pipes, e-hookah, and e-cigars. They are battery-powered and can take a variety of shapes and sizes.
ENDS contain an e-liquid that is heated to create a vapor that the user inhales. The liquid can include nicotine, along with other substances such as propylene glycol and vegetable glycerin.
Many e-cigarettes also contain flavoring, which youths identified as a main factor in their use according to the 2018 report.
“Some of the packaging, and the different flavors like candy or bubble gum – it just seems that they’re marketed to younger people,” Dr. Chiarchiaro says.
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What Are the Short-Term Risks of Vaping?
Hospitals are linking cases of acute lung injury or acute respiratory distress syndrome to vaping. The condition is an inflammatory reaction that occurs in both lungs and can be caused by infection or inhalational exposures, according to Dr. Chiarchiaro.
E-cigarette emissions include chemicals such as diacetyl that are linked to severe lung damage.
“It can be relatively mild, where someone’s in the hospital and they’re on oxygen and just need to be monitored and can recover with some supportive care,” Dr. Chiarchiaro says. “But it can be very severe, where people end up on mechanical ventilation in intensive care units.”
What causes this damage?
Although there is not one specific identified cause for the lung injuries linked to vaping, Dr. Chiarchiaro identifies some risk factors:
- The voltage or wattage used: The voltage or wattage of ENDS varies. Some ENDS allow for users to adjust how hot the e-liquid burns. The higher the voltage, the hotter the liquid burns. The hotter the liquid burns, the more likely it can burn into formaldehyde, a carcinogen that also may be related to inhalational conditions.
- The liquid cartridge: Some users are refilling the ENDS’ nicotine-based cartridge with other substances, such as cannabis oil. Dr. Chiarchiaro warns that those substances may not be meant to be used in that way.
- The method of use: More experienced users may be more likely to use a higher voltage and may use the product for a longer period of time, Dr. Chiarchiaro says. That might put people more at risk.
What are the symptoms of acute lung damage?
Patients typically experience symptoms that include:
- Rapidly developing shortness of breath
- Dry cough
- Gastrointestinal illnesses
Those symptoms can be related to other respiratory conditions. Physicians typically make the diagnosis by using patient history, chest imaging, and exclusion of other causes.
If you are experiencing these severe symptoms and are worried you might have lung damage related to vaping, you should contact your physician or visit the emergency department.
How is acute lung damage treated?
Treatment for patients exhibiting lung damage associated with vaping includes:
- Monitoring and oxygen support
Who is most at risk of vaping?
Although e-cigarettes can potentially harm any user, groups most at risk include:
- Youths: Nicotine can harm brain development in young people and cause addiction. A January 2018 report by the National Academies of Science, Engineering, and Medicine concluded that youths who use e-cigarettes are more likely to use traditional cigarettes later.
- Young adults: Nicotine can harm brain development, which continues into your 20s.
- Pregnant women: Nicotine is toxic to unborn babies and can damage the health of pregnant women and their developing babies.
- Adult nonsmokers: Nicotine can cause addiction if you’re a nonsmoker who begins vaping.
- People with existing lung diseases: If you have a structural lung condition like emphysema, use of e-cigarettes could worsen it.
- People with cardiovascular diseases: If you have a condition like coronary artery disease, cerebral vascular disease, peripheral vascular disease, or high blood pressure, vaping can cause damage.
Can e-cigarettes help traditional smokers quit?
The FDA does not approve vaping as a way for people to stop smoking. Other methods, like nicotine replacement therapy, are recommended.
Dr. Chiarchiaro advises talking to your doctor about other methods to quit smoking before trying e-cigarettes. You also can call the national hotline, 1-800-784-8669 (1-800-QUIT-NOW), for help.
“There are some really well-tested methods to help people stop smoking,” Dr. Chiarchiaro says.
What Are the Long-Term Risks of Vaping?
Because of how recently e-cigarettes became popular, little research exists about the long-term effects of vaping.
Dr. Chiarchiaro says some smaller studies are measuring how quickly lung conditions such as emphysema can develop from using e-cigarettes, compared to traditional cigarettes.
Similar questions exist about vaping’s potential to cause lung cancer and cardiovascular disease. E-cigarettes do contain potential cancer-causing substances.
“If we extrapolate this to other inhalational lung diseases, the inhalational damage in the lung could either acutely or over time cause scarring in the lung,” Dr. Chiarchiaro says. “And that scarring sometimes does result in more chronic debilitating lung disease. I think time will tell on that in association with vaping.”
Resources and Further Reading
American Cancer Society, What Do We Know About E-cigarettes? (https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/e-cigarettes.html)
American Lung Association, E-cigarettes (https://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html)
Centers for Disease Control and Prevention, Transcript of August 23, 2019, Telebriefing on Severe Pulmonary Disease Associated with Use of E-cigarettes (https://www.cdc.gov/media/releases/2019/t0823-telebriefing-severe-pulmonary-disease-e-cigarettes.html)
Centers for Disease Control and Prevention, About Electronic Cigarettes (E-Cigarettes) (https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html)
Karen A. Cullen, PhD; Bridget K. Ambrose, PhD; Andrea S. Gentzke, PhD; Benjamin J. Apelberg, PhD; Ahmed Jamal, MBBS; Brian A. King, PhD, Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students – United States, 2011-18, Morbidity and Mortality Weekly Report (https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm)
Rana M. Jaber, Mohammadhassan Mirbolouk, Andrew P. DeFilippis, Wasim Maziak, Rachel Keith, Thomas Payne, Andrew Stokes, Emelia Benjamin, Aruni Bhatnagar, Ron Blankstein, Anshul Saxena, Michael J. Blaha, Khurram Nasir, Journal of the American Heart Association, Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013–2014 (https://www.ahajournals.org/doi/full/10.1161/JAHA.117.008178)
National Academies of Science, Engineering, and Medicine, Public Health Consequences of E-Cigarettes (https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf)
National Institutes of Health, What We Know About Electronic Cigarettes (https://smokefree.gov/quit-smoking/ecigs-menthol-dip/ecigs)
U.S. Food and Drug Administration, Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS) (https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends#references)
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