Vaping Risks: Known and Unknown

Electronic cigarettes (also called e-cigarettes or vapes) were introduced to the US in the mid-2000s and have become increasingly popular with the introduction of flavored products such as Juul in 2015. Before they entered the market, young people were using vapes. below 5%; however, by 2018, these numbers had jumped to almost 21%. Although these products are marketed as smoking cessation tools, youth and young adults—the most common users—generally do not take up the habit of smoking e-cigarettes for this reason.¹

Vaping may be considered less harmful to health than smoking tobacco, but using vapes and e-cigarettes can still be dangerous. Due to the relatively short period of their popularity, there is not much reliable safety data available for these products; however, over the years, exposure to vaping has increasingly been linked to a variety of lung injuries and other complications. To disseminate information about the risks and available data about e-cigarette and vaping use, this article will provide an overview of what clinicians and researchers have learned about the effects of vaping on lung health.

What do we inhale?

Vape pens are battery-powered devices that heat “e-liquid” into an inhalable aerosol consisting of a variety of chemicals. Nicotine is still present in many vaping products, meaning vaping still carries the same risk of addiction as traditional cigarettes. Listed here are many other toxic chemicals or metals that have been found in regular and flavored e-cigarettes.²:

• Benzene: volatile organic compound used in paints, varnishes, pesticides, air fresheners, disinfectants and cleaners, pesticides, deodorants, fuel sources, automobile exhausts, etc.
• Acrolein: Often used in weed killers; they are known to have harmful and irreversible effects on the lungs
• Propylene glycol: Artificial smoke in smoke generators, antifreeze and paint thinners contain this product, which is also a common additive in various foods.
• Diethylene glycol: also used in antifreeze; its toxic properties have linked the chemical to lung disease
• Cadmium: This metal is toxic and is present in traditional cigarettes, with a known link to respiratory illnesses and breathing complications.
• Other heavy metals such as lead, tin and nickel; Inhalation of ultrafine particles can cause them to travel deep into the lungs
• Diacetyl: The chemical that causes bronchiolitis obliterans (OB), also called bronchiolitis obliterans.popcorn lungs»
• Carcinogens: Cancer-causing chemicals found in traditional cigarettes as well as in blends such as formaldehyde and ethanal.

These materials and their concentrations vary by product because the FDA has not yet issued any standards for e-cigarettes or formally tested their components.

Potential Risks

Popcorn Light

Popcorn lung, or PO, is a rare respiratory disease that affects the tiny airways of the lungs. As a result of infection or inhalation of toxic chemicals, these airways become damaged, inflamed, and even scarred. Many of the above-mentioned chemical additives in e-liquid are linked to popcorn inhalation.³

Symptoms may not initially develop; however, skin rashes, night sweats, fatigue, fever, shortness of breath, coughing, or shortness of breath before or after exercise are all signs that someone may have this condition.

There is currently no cure for popcorn lung. Affected people will require lifelong care to manage symptoms, and response to treatment may vary. Additionally, the condition will not cure on its own and can be fatal without treatment.

It is important to start treatment as soon as possible and stop smoking after diagnosis.⁴ Prednisolone and other corticosteroids may help manage symptoms by reducing inflammation. Patients may also benefit from inhalers or inhaled forms of medications such as albuterol to dilate the bronchi and reduce shortness of breath or wheezing. In more severe or extreme cases, steroids, oxygen, or even a lung transplant will be recommended.

Lung collapse

Lung collapse, also known as primary spontaneous pneumothorax, occurs as a result of a hole in the lung through which oxygen escapes. This event can occur if someone is injured by a knife or gun, or if air bubbles in the lungs burst. According to experts, air bubbles are not a cause for concern. Johns Hopkins Medicineand can occur naturally in taller, thinner people who experience a period of rapid growth during puberty. Rapid growth can cause blisters to form on weak areas of the lungs, but the affected person will likely not notice this until a rupture occurs. The process of smoking and vaping puts people at higher risk of ruptured blisters and collapsed lungs.⁵

Shortness of breath, difficulty breathing and/or sharp pain in the chest or shoulder may indicate this event. A collapsed lung may heal on its own with rest and oxygen treatment; however, severe cases require the placement of a chest tube to drain leaking oxygen from the body, and surgery may be required to directly fix the hole.

“At Johns Hopkins University, we see a rash of collapsed lungs in young people… We always ask if they smoke, and they often say, ‘No, I don’t smoke.’ But I smoke a vape.” We now advise patients not to smoke or vape if they want to avoid recurrent lung collapse and surgery in the future,” said Stephen Broderick, MD, a lung cancer surgeon at Johns Hopkins University. in an online post from Johns Hopkins Medicine.

Lung cancer

There is still not enough data to draw conclusions about the link between vaping and lung cancer, although the ingredients in e-liquid have a known link. Report published in Journal of Cancer Biology has achieved some success in this regard.⁶ Their study found that nicotine and other carcinogenic ingredients in vapes alter the ability of human DNA to repair itself and thus increase the likelihood of mutations or tumorigenesis in human cells. In addition, they observed that more than 20% of mice that survived 54 weeks of e-liquid aerosol exposure (equivalent to at least 3 years of e-cigarette smoking for humans) developed lung adenocarcinoma, and more than 50% developed precancerous a form of urothelial hyperplasia of the bladder. While the authors acknowledge that their animal study does not mean that e-cigarette aerosols have the same effects on human cells, they write: “It takes more than two decades for a lifelong tobacco smoker to develop cancer. Electronic 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 human cancers associated with e-cigarette aerosols for another ten years… based on these results, it is reasonable to conclude that there is a high probability that the aerosol Electronic cigarettes are carcinogenic to humans. Thus, e-cigarette users have no reasonable basis to assume that e-cigarette aerosol does not cause cancer, and this is likely a dangerous step towards various types of cancer.

Other studies show that people who vape also develop molecular changes associated with cancer that are commonly seen in cigarette smokers, and are mainly seen in oral tissue.⁷

While there is no evidence to suggest that vaping causes lung cancer, it is important to note that vaping is not without risks. As with traditional cigarettes, the surest way to avoid potential consequences is to limit your exposure to e-cigarette vapors whenever possible or avoid vaping altogether.

Links

1. Fadus M.K., Smith T.T., Scella L.M. Rising popularity of e-cigarettes, pod devices, and JUULs among youth: Factors influencing use, health consequences, and downstream consequences. Drug Alcohol Depends. 2019;201:85-93. doi:10.1016/j.drugalcdep

2. What’s in an electronic 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 %20flavors%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. Bronchiolitis obliterans, symptoms, diagnosis and treatment. 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% 20reply from%20to%20other%20medicines

5. What does vaping do to your lungs? Johns Hopkins Medicine. As of 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%20often %20added%20to lungs%20%20no%20long-term%20treatment

6. Tan M.S., Tan Y.L. Can vaping e-cigarettes cause cancer? J Cancer Biol. 2021;2(3):68-70. doi:10.46439/cancer biology

7. Genetic changes associated with cancer have been observed in e-cigarette users. Research program for tobacco-related diseases. As of November 5, 2024