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Are E-Cigarettes Safe? A Closer Look Vaping

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In recent weeks, there have been numerous news media reports linking vaping (the use of electronic cigarettes or “e-cigarettes”) to serious lung damage and multiple deaths. A closer look at these reports suggests that some of these cases may involve certain vaping cartridges or liquids – possibly from the black market – that contain THC (the chemical in marijuana that causes intoxication), along with a vitamin E additive. Vitamin E can become toxic when heated up in vaping devices, but vitamin E usually isn’t present in nicotine-based e-cigarettes sold commercially.

According to the Centers for Disease Control and Prevention (CDC), 1,479 cases of lung injury associated with vaping have been reported in 49 states and 1 U.S. territory, and 33 deaths have been confirmed in 24 states as of Oct. 15, 2019. While the exact cause of the lung injury is not known, all reported cases have a history of nicotine-based e-cigarette use, and in most of these cases, patients report also recently having used e-cigarettes containing THC.

In short, it’s unclear whether standard, nicotine-based e-cigarettes played a role in the reported deaths and lung damage. Either way, the media coverage has prompted new conversations about the safety of nicotine vaping and concerns that teenagers are becoming addicted to it. In many cases, teens begin vaping without ever smoking traditional cigarettes, highlighting the fact that vaping isn’t only being used to kick the smoking habit. That said, recent evidence suggests that e-cigarettes help people quit smoking traditional cigarettes, though their addiction to nicotine continues in the majority of cases.

What are E-cigarettes?

E-cigarettes first hit the U.S. market in 2006, and many people were excited to try vaping as an alternative to traditional cigarettes. As part of Lung Cancer Awareness Month in November, we examine the science on vaping and what research says about its risks.

First, a clarification: the terms “vaping” and “e-cigarettes” generally mean the same thing. The term “e-cigarette” more commonly refers to the smaller, often cigarette-shaped and in some cases disposable “pens” or cartridges that are commonly sold at chain retail stores. There are other vape products that are larger handheld devices, which have a refillable tank that accepts nicotine-based liquid that often is sold in bottles at specialty vape shops. Both styles of devices use batteries to heat up nicotine juice, or “e-juice,” until it produces a vapor, which is then inhaled by the user.

Recent Research

UAB Medicine health behaviorist Kathleen F. Harrington, PhD, MPH, CTTS, an associate professor in the UAB Division of Pulmonary, Allergy, and Critical Care Medicine, has been monitoring the news reports about vaping with e-cigarettes and research on their safety. She points to numerous studies that have slowly been revealing the negative impact vaping has on a person’s health, but she agrees that more research is needed about its long-term health effects.

“What is known about their short-term effects on the body indicates negative impact on the pulmonary and cardiovascular systems,” Dr. Harrington says. “Inhaling the e-cigarette vapor has an immediate inflammatory effect on the airways. The cardiovascular effects – increased blood pressure and heart rate – are due to tobacco-derived nicotine. Some of the flavorings that are added to vape liquid have been linked to greater inflammatory response.”

New health concerns about e-cigarettes are being reported almost daily, including recent reports connecting their use to seizures and immune system dysfunction. The National Academy of Sciences found that e-cigarette use is linked to blood vessel damage and increased risk of heart attack.

In addition to these pulmonary and cardiovascular effects, recent studies highlight nicotine addiction among teens and how e-cigarettes can be a “gateway” drug. At least one in four high school students uses e-cigarettes, and research suggests that teens who use these products are more likely to move on to traditional cigarettes.

How Vaping Affects the Body

Vaping involves inhaling an aerosol mist that is created upon heating up liquid e-juice, which is mostly composed of nicotine, flavorings, a propellant (usually glycerin and/or propylene glycol), and additives. Traditional tobacco cigarettes contain nicotine and thousands of other chemicals, many of which are toxic.

Dr. Harrington says the levels of nicotine and other chemicals vary considerably among different e-cigarette makers. Some of these substances are known carcinogens but generally are found in much lower levels in e-cigarettes than in traditional cigarettes.

“While the nicotine in both products elevates blood pressure and heart rate, these effects continue longer after vaping than smoking,” she says. “Both products have an inflammatory effect on the airways and suppress natural immune responses, which increase the risk for respiratory infections.”

The greatest risk in both e-cigarettes and traditional cigarettes is long-term nicotine addiction, Dr. Harrington says. This is especially problematic for the developing brains of young people and because both products have short-term negative effects on the cardiovascular, respiratory, and immune systems.

“Smoking has well-documented, long-term health risks associated with it, such as heart disease, lung and other cancers, and COPD (chronic obstructive pulmonary disease), whereas vaping’s long-term health risks are unknown,” Dr. Harrington says. “Given the reduced toxin composition in vapor compared to smoke, the risks associated with vaping are considered to be less. However, until further research is completed, it is difficult to discuss the comparative risks of the two products.”

Potential Dangers of Vaping

There is no question that traditional cigarettes are dangerous. An estimated 85% of lung cancer cases are related to smoking, and 11% involve secondhand smoke. Smokers are 10 times more likely to develop lung cancer, and smoking is a major contributor to heart disease, as well.

Although some experts consider vaping to be less harmful than smoking, the science is still out about the extent of long-term health effects, as it hasn’t adequately been studied over many years as smoking has been.

“There are fewer toxic chemicals in e-cigarette liquid than in cigarette smoke,” Dr. Harrington says. “This is primarily because most of the toxins in tobacco cigarette smoke come from the combustion process. Generally, the potentially toxic substances in e-cigarette liquid are found in lower quantities compared to the levels found in cigarette smoke. Cardiovascular effects are present in both products when nicotine is present, but the negative health effects from e-cigarettes appear to be lower in the short term.”

However, it cannot be said that vaping is “safer” than cigarette smoking. E-cigarettes contain many of the same harmful chemicals as cigarettes, including nicotine and carcinogens. In addition to the chemicals found in cigarettes, other harmful components have been found in e-cigarette juice and aerosol, including heavy metals and added illicit substances, such as THC.

Advice on Quitting

Leading medical associations do not recommend using e-cigarettes to quit smoking. The American Medical Association, American Thoracic Society, National Academy of Sciences, and the American Academy of Pediatrics instead recommend proven smoking cessation therapies, such as counseling, in addition to nicotine replacement products or certain short-term medications that help ease nicotine cravings. Counseling and products that help you quit can be accessed through your own physician or the 1-800-QUIT-NOW line, a free resource that provides counseling and nicotine patches for those who qualify.

An older study found that twice as many people returned to smoking after using e-cigarettes compared to those who used nicotine replacement products, such as patches. A newer study that provided all smokers with counseling on quitting found that while almost twice as many quit with vaping than with traditional nicotine replacement, 80% of those using e-cigarettes to quit were still using them one year later, therefore maintaining their nicotine addiction.

“For anyone who chooses to try vaping to quit smoking, I would advise that they include a way to reduce reliance on e-cigarettes in their quitting plan,” Dr. Harrington says. “For smokers interested in switching to vaping for a ‘safer’ alternative, I would make sure they understand that safer is not the same as safe, and the potential for long-term harm is unknown. For the current vaper, I would advise reducing nicotine content, not using flavored products, and developing a plan to quit altogether. For tobacco users, a personalized quit plan – with help from someone who has expertise in tobacco cessation counseling – can greatly improve their odds of overcoming their nicotine addiction and improving their future health.”

Click here to learn more about quitting smoking or vaping or to make an appointment with a UAB Medicine doctor to help you kick the nicotine habit for good.