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Vaping Trend Worries Health Care Providers

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It is common knowledge that smoking cigarettes is harmful to health, but what about the electronic versions, commonly called e-cigarettes?

Electronic nicotine delivery systems, or e-cigarettes, have been in the United States since around 2007, and while they have enjoyed continued growth in popularity, there is little known about their long-term effect on health.

“With less than ten years of data on e-cigarettes, we just don’t know enough about their impact on health, but there are some concerning trends and research, especially related to their chemical makeup,” said Jason Brown, PA-C, hospitalist for Samaritan Pacific Communities Hospital.

E-cigarettes use an “e-liquid” containing nicotine and a variable mixture of flavorings, vegetable glycerin, propylene glycol and other ingredients. This liquid is heated to its boiling point by an atomizer, giving off a large plume of vapor that is inhaled, which is why smoking e-cigarettes is called vaping.

“The chemicals people are inhaling are a concern because they are unregulated and can vary from brand to brand, so little is known about their contents,” said Charlie Cory, respiratory therapist at Samaritan Pacific Communities Hospital (SPCH).

While nicotine levels could be lower than traditional cigarettes, which is good, the chemical mixture being inhaled has been shown to contain other cancer-causing chemicals, such as formaldehyde and heavy metals that can stick in parts of the lungs.

“Heating the oils and flavorings to the boiling point and then taking that substance into your lungs causes a coating to form on your lungs. If we don’t know what that substance is, can it really be a good idea to coat our super-sensitive lung tissue? I don’t think so,” said Cory.

Of special concern is the flavoring added to the electronic device. E-cigarettes come with flavoring cartridges of many varieties, such as cinnamon, raspberry, mint and butter. One ingredient, Diacetyl, can have alarming consequences.

In a 2015 study by Harvard researchers, 39 out of 51 e-cigarette brands studied contained Diacetyl, a chemical used to add a buttery flavor to products, such as popcorn, caramel and dairy products. The American Lung Association has called for a ban of the ingredient because workers in a microwave popcorn factory who were exposed to the chemical developed bronchiolitis obliterans, now called popcorn lung, a debilitating lung disease.

“Popcorn lung is deadly, and we don’t know what other chemicals could be in those devices that could cause harm as well. What we do know is that the flavorings are often what attract new users to vaping, especially children and youth, and that is a big concern,” said Brown.

In a 2016 report by the U.S. Surgeon General, use of e-cigarettes grew 900-percent among high school students in the four years from 2011 to 2015.

“It is alarming that children and youth are using these devices in growing numbers,” Brown noted. “We know that most addictions begin in children between the ages of 12 and 17, and when manufacturers are using attractive flavors to hide the nicotine, I worry that we will have more young people addicted to nicotine, which could be a gateway to cigarette smoking, drug use and lifelong health issues.”

Cigarette smoking can cause debilitating diseases, such as cancer, chronic obstructive pulmonary disease (COPD) and heart disease. To quit smoking, some turn to e-cigarettes, but Cory and Brown say they have not seen whether this method works.

“We just don’t have enough data yet to know whether exchanging e-cigarettes for traditional ones helps people quit smoking,” said Cory. “However, if you are trying to quit smoking, there are proven methods that do work, such as cessation classes and group support, medications and tips and techniques to get past the cravings. I’ve seen those techniques work and would recommend them to smokers trying to quit.”

Brown says it may be another decade before conclusive evidence is available to make sound decisions about vaping.

“It is possible that vaping is less harmful when compared to traditional cigarette smoking, but without the data to prove it and without the chemical compounds regulated, we can’t know for sure,” he said. “Until we know more, I would tell my patients to avoid vaping and keep it away from children,” Brown said.

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