Health Risks of Vaping

by Luis G. de Jesus, MD

Vaping is the act of inhaling and exhaling the aerosol, commonly called vapor, produced by an electronic cigarette (e-cigarette) or similar nicotine-delivery device. A vaping device usually consists of a mouthpiece, a cartridge for containing the e-liquid or e-juice, and a heating component powered by a battery.

The aerosol, often mistaken for water vapor or tobacco smoke, consists of fine particles containing varying amounts of chemical products usually a propylene glycol or vegetable glycerin-based liquid with nicotine and flavoring. Many other chemicals such as toxicants, carcinogens or heavy metals, of varying composition and concentration may be present in different products. It does not contain tobacco.

Started in 2004 and introduced in the US in 2007, the use of e-cigarette is now global and widespread. In recent years, e-cigarette use by youth and young adults has increased at an alarming rate with a 900% increase from 2011 to 2015. Among youths in the US, it is now more common than the use of conventional tobacco products, including cigarettes, cigars, chewing tobacco, and hookahs. A combination of nicotine, a highly addictive drug, and flavorings made e-cigarette very attractive to young people.

The medical reasoning for its use is as a nicotine replacement therapy to quit cigarette smoking. Some, however, use it solely for recreational purpose.

Is e-cigarette use an effective method of smoking cessation?

One can argue that smoking cigarettes is more harmful than using e-cigarette. However, is it an effective smoking cessation treatment to justify its “medical” use? In a study, “Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016” published on July 2018, there is no evidence for its efficacy. More than 90% continue to smoke after vaping for one year. Ironically, the chance of quitting smoking was even lower for those who use e-cigarette (9.4%) compared to smokers who do not use it (18.9%).

Is e-cigarette use safe for recreational use?

1) It contains nicotine, a highly addictive chemical. A Report of the Surgeon General in 2016 on e-cigarette use noted the harm nicotine causes on the developing adolescent brain. The brain of teens and young adults, compared with older adults, is more susceptible to the effects of nicotine exposure. Addiction, priming the brain for use of other addictive substances, reduced impulse control, deficits in attention and cognition, and mood disorders are some of the effects. Ironically, many of today’s youth who are e-cigarette users could in fact become tomorrow’s cigarette smokers.

Ingestion of e-cigarette liquids containing excessive amounts of nicotine particularly among young children can cause acute toxicity and possibly death.

2) The act of inhaling aerosol and exposure to harmful chemicals can damage the lung. Simply the act of inhaling aerosol may lead to inflammation within the lung that can lead to lung damage by triggering local immune response. In addition, a growing body of evidence indicates that the chemicals in these products such as solvents, flavorings, and toxicants may be causing dangerous risks. According to the American Lung Association, using e-cigarettes, particularly the flavored varieties, can cause popcorn lung, a condition of lung damage with tissue and airway scarring and narrowing.

3) The battery and heating component can malfunction. FDA warns that e-cigarettes can explode and seriously injure people. Although they appear rare, these explosions are dangerous. Uniform safety standards are lacking to enforce all manufacturers to make safer devices.

E-cigarette use has the reputation of being harmless. More and more studies are showing that it has potential significant health risks particularly to youth and young adults. For people who do not smoke, do not start vaping. For people who smoke, there are many other more effective ways to quit smoking including counseling, medications, and nicotine-replacement therapies in patches and gums.