Electronic cigarettes, created initially to assist with smoking cessation, have been a point of controversy for some time. Recently, the rash of lung injuries associated with the use of e-cigarettes has placed this “safer” alternative in the headlines again.  But what exactly are e-cigarettes, and how were they originally thought to be a safer delivery method for nicotine?  According to Chun et al. (2017), “Electronic cigarettes (e-cigarettes or e-cigs) are designed to heat and aerosolize mixtures of vegetable glycerin, propylene glycol, nicotine, and flavoring additives, thus delivering nicotine by inhalation in the absence of combustion.”  The lack of combustion was thought to be a safer option than cigarettes and was thought to aid current smokers in their efforts to quit smoking.

Unfortunately, these products are not being used for smoking cessation.  A study was completed by Fairchild, Bayer and Lee (2019) which evaluated the use of nicotine replacement products (patches and gums) versus e-cigarettes/vaping. Only 9% of participants who used nicotine replacement products continued smoking cigarettes after a year, while 80% of users in the e-cigarette group stopped smoking cigarettes, but continued to vape (Fairchild, Bayer, and Lee, 2019).  An unintended side effect of e-cigarettes is that a new younger generation of nonsmokers have adopted vaping habits (Clapp, Peden, Jaspers, 2019). Fairchild, Bayer, and Lee (2019) found that between 2017 and 2018, e-cigarette usage increased 48% in middle school children and 78% in high school students. Additionally, the use of e-cigarettes in children was found to lead to use of cigarettes (Fairchild, Bayer, and Lee (2019).

How dangerous are electronic cigarettes?  A 2017 study published in the American Journal of Physiology identified the damage e-cigarettes inflict on the lungs.  Some of these toxic effects include decreased inhaled nitric oxide, development of respiratory symptoms in adolescents, and cytotoxicity of the lung (Chun, Moazed, Calfee, Matthay and Gotts, 2017). This leads to airflow impairment, altered lung development, and decreased resistance to pathogens. The Centers for Disease Control and Prevention (CDC) have reported 2,290 lung injury cases and 47 deaths linked to vaping as of November 21, 2019, and those numbers are expected to grow (Corum, 2019). [Note: The New York Times will continue to update the vaping injury and death tracker in the website listed in the Corum (2019) reference at the end of this blog]

The CDC (2019) has identified the use of THC and vitamin E acetate laced additives to play a significant role in the recent outbreak of lung injuries.  Because they have not been able to conclusively identify other chemicals that may contribute to e-cigarette and vaping associated lung injury (EVALI), the CDC recommends consumers discontinue the purchase of any e-cigarette. Products containing THC or any additive not intended for use by the manufacturer should never be added to vaping devices.  While the beneficial qualities of electronic cigarettes are being disputed, the risk of harm greatly outweighs the potential benefits. Those seeking an aide to quitting smoking should consider a safer, alternate route.

 

References

Corum, J. (2019, October 1). Vaping Illness Tracker: 2,290 Cases and 47 Deaths. Retrieved December 3, 2019, from https://www.nytimes.com/interactive/2019/health/vaping-illness-tracker.html.

CDC. (2019). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products.  Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Chun, L. F., Moazed, F., Calfee, C. S., Matthay, M. A., & Gotts, J. E. (2017). Pulmonary toxicity of e-cigarettes. American Journal of Physiology – Lung Cellular and Molecular Physiology, 313(2), L193-L206. doi:10.1152/ajplung.00071.2017

Clapp, P. W., Peden, D. B., & Jaspers, I. (2019). E-cigarettes, vaping-related pulmonary illnesses, and asthma: A perspective from inhalation toxicologists. Journal of Allergy and Clinical Immunology, doi:10.1016/j.jaci.2019.11.001

Fairchild, A.L., Bayer, R., and Lee, J.S. (2019). American Journal of Public Health. 109(7), 1000-1006.  Retrieved from https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2019.305107