Vaping risks: known and unknown

Electronic cigarettes (also called e-cigarettes or vapes) were introduced in the US in the mid-2000s and became increasingly popular with the arrival of flavored products, such as Juul in 2015. Before these came to market, vape use was among young people less than 5%; However, these percentages increased to almost 21% in 2018. Although these products have been marketed as smoking cessation aids, youth and young adults – the most common users – are largely not adopting e-cigarette habits for this reason.¹

Vaping can be considered less harmful to health than smoking tobacco, but using vapes and e-cigarettes can still be dangerous. Due to the relatively short timeframe of their popularity, there is not much robust safety data on these products; However, over the years, the impact of vaping has increasingly been linked to various lung injuries and other complications. To increase awareness of the risks and available data on e-cigarette and vaping use, this article will provide an overview of what doctors and researchers have learned about the effects of vaping on lung health.

What do we inhale?

Vape pens are battery-powered devices that heat the “e-liquid” into an inhalable aerosol made up of a variety of chemicals. Nicotine remains present in many vaping products, meaning vaping still carries an addiction risk just like traditional cigarettes. Here you will find a plethora of other toxic chemicals or metals that have been identified in regular e-cigarettes and flavored e-cigarettes²:

• Benzene: a volatile organic compound used in many paints, varnishes, pesticides, air fresheners, disinfectants and cleaning products, pesticides, deodorants, fuel sources, car exhaust and more
• Acrolein: often used in weed killer; which is known to have harmful and irreversible effects on the lungs
• Propylene glycol: artificial smoke in smoke machines, antifreeze and paint solvents characterize this product, which is also a common additive in various foods
• Diethylene glycol: also used in antifreeze products; its toxic properties have linked this chemical to lung disease
• Cadmium: This metal is toxic and present in traditional cigarettes, with known associations with respiratory disease and breathing complications
• Other heavy metals such as lead, tin and nickel; inhaling ultrafine particles can deliver them deep into the lungs
• Diacetyl: A chemical associated with bronchiolitis obliterans (BO), also called “popcorn lung”
• Carcinogens: Cancer-causing chemicals present in traditional cigarettes and concoctions such as formaldehyde and ethanal

These materials and their concentrations vary by product, as the FDA has not yet issued standards for e-cigarettes or conducted an official review of their components.

Potential risks

Popcorn Lung

Popcorn lung, or BO, refers to a rare respiratory disease that affects the smallest airways in the lungs. As a result of infection or inhaling toxic chemicals, these airways become damaged, inflamed and even scarred. Several of the above chemical additives to e-liquid have been linked to popcorn lung.³

Symptoms may not develop initially; However, rashes, night sweats, fatigue, fever, wheezing, and coughing or shortness of breath before or after exercise are all signs that someone could be suffering from this condition.

Currently, there is no cure available for popcorn lung. Affected individuals will require lifelong care to control their symptoms and treatment responses may vary. Furthermore, this condition does not heal on its own and can be fatal without treatment.

It is important to start treatment as soon as possible and stop vaping as soon as the diagnosis is made.⁴ Prednisone and other corticosteroids can help manage symptoms by relieving inflammation. Patients may also benefit from inhalers or inhaled forms of medication such as albuterol to both dilate the bronchi and reduce shortness of breath or wheezing. In more severe or extreme cases, steroids, oxygen, or even lung transplantation are recommended.

Collapsed lung

A collapsed lung, also called a primary spontaneous pneumothorax, is the result of a hole in the lung through which oxygen can escape. This event can occur if someone suffers a knife or firearm-related injury, as well as if air sacs in the lungs rupture. According to him, air bubbles are not alarming Johns Hopkins Medicineand may occur naturally in taller, thinner individuals who experience rapid growth during puberty. Rapid growth can cause blisters to form at weaker points of the lungs, but an affected person is unlikely to be aware of this until a rupture occurs. The process of smoking (and vaping) puts people at greater risk of blister rupture and lung collapse.⁵

Shortness of breath, difficulty breathing and/or sharper chest or shoulder pain may indicate this. A collapsed lung can heal on its own after rest and treatment with oxygen; However, severe cases require a chest tube to drain leaking oxygen from the body and surgery may be necessary to repair the hole directly.

“At Johns Hopkins, we see a collapsed lung rash in younger people… We always ask if they’ve smoked, and they often say, ‘No, I don’t smoke. But I do vape.’ Now we are telling patients not to smoke or vape if they want to avoid another lung collapse and surgery in the future,” said Stephen Broderick, MD, lung cancer surgeon at Johns Hopkins. in an online message from Johns Hopkins Medicine.

Lung cancer

There is still not enough data to draw conclusions about the link between vaping and lung cancer, although e-liquid ingredients have known associations. A report published in Journal of Cancer Biology has made some progress in this area.⁶ Their research found that nicotine and the other cancer-causing ingredients in vapes alter the ability of human DNA to repair itself, making it more likely that human cells will experience mutations or tumorigenesis. Additionally, they noted that more than 20% of mice that endured 54 weeks of e-liquid aerosol exposure (which translates to at least 3 years of vaping for humans) developed lung adenocarcinoma, while more than 50% developed a precancerous form of urothelial hyperplasia of the bladder. While the authors admit that their animal study does not mean e-liquid aerosols have the same effect on human cells, they write: “It takes more than 20 years for a lifelong tobacco smoker to develop cancer. E-cigarettes became popular just over eight years ago. If tobacco smoke carcinogenesis is a paradigm for e-cigarette carcinogenesis in humans, then we may not see the emergence of e-cigarette aerosol-associated human cancers for at least the next decade… based on these results, it makes sense to conclude that there is a high degree of probability that e-cigarette aerosol is carcinogenic to humans. Therefore, there is no reasonable basis for e-cigarette users to believe that e-cigarette aerosol does not cause cancer, and that it is likely a dangerous step towards a variety of cancers.

Other research shows that individuals who vape also develop similar cancer-associated molecular changes typically seen in cigarette smokers, especially noticeable in oral tissues.⁷

Despite the lack of data suggesting that vaping leads to lung cancer, it is important to note that vaping is not without risk. As with traditional cigarettes, the surest way to avoid the potential consequences is to limit exposure to e-cigarette vapor, if possible, or stop vaping.

References

1. Fadus MC, Smith TT, Squeglia LM. The rise of e-cigarettes, pod-mod devices, and JUUL among youth: factors influencing use, health implications, and downstream effects. Drug-alcohol dependent. 2019;201:85-93. doi:10.1016/j.drugalcdep

2. What is in an e-cigarette? American Lung Association. September 9, 2024. Accessed November 5, 2024. https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette#:~:text=E%2Dcigarettes%2C%20aka%20JUULs%20and,glycol%2C %20flavorings%20and%20other%20chemicals

3. Popcorn lung (bronchiolitis obliterans). Cleveland Clinic. March 16, 2022. Accessed November 5, 2024. https://my.clevelandclinic.org/health/diseases/22590-popcorn-lung-bronchiolitis-obliterans

4. Symptoms, diagnosis and treatment of Bronchiolitis obliterans. American Lung Association. Updated October 29, 2024. Accessed November 5, 2024. https://www.lung.org/lung-health-diseases/lung-disease-lookup/popcorn-lung/symptoms-diagnosis-treatment#:~:text=Bronchiolitis%20obliterans%20is%20an%20irreversible,not%20respond %20to%20other%20drugs

5. What does vaping do to your lungs? Johns Hopkins Medicine. Accessed November 5, 2024. https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-does-vaping-do-to-your-lungs#:~:text=Vaping%20and%20Popcorn%20Lung&text=Diacetyl%20is%20frequently %20added%20to,lung%20has%20no%20sustainable%20treatment

6. Tang MS, Tang YL. Can vaping electronic cigarettes cause cancer? J Cancer Biol. 2021;2(3):68-70. doi:10.46439/cancerbiology

7. E-cigarette users exhibit cancer-related genetic changes. Tobacco-related Disease Research Program. Accessed November 5, 2024.