Electronic cigarettes (also called e-cigarettes or vaporizers) 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 entered the market, vaporizer use among youth was below 5%; however, these rates increased to nearly 21% in 2018. While these products have been marketed as smoking cessation tools, youth and young adults (the most common users) largely do not take up the cigarette habit. electronics for this reason.¹

Vaping may be considered less harmful to health than smoking tobacco, but the use of vaporizers and e-cigarettes can still be dangerous. Due to the relatively short period of their popularity, there isn’t a ton of solid safety data on these products; However, over the years, the impact of vaping has been increasingly linked to various lung injuries and other complications. To raise awareness about the risks and available data on the use of e-cigarettes and vaporizers, this article will provide an overview of what doctors and researchers have learned about the effects of vaping on lung health.

What are we inhaling?

While advertised as a safer alternative to smoking, vaping carries its own risks | Image credit: makcoud – stock.adobe.com

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

• Benzene: a volatile organic compound It is used in paints, varnishes, pesticides, air fresheners, disinfectant and cleaning products, pesticides, deodorants, fuel sources, automobile exhaust, and more.
• Acrolein: often used as a herbicide; It is known to have harmful and irreversible impacts on the lungs.
• Propylene glycol: artificial smoke in fog machines, antifreeze and paint thinners characterize this product, which is also a common additive in various foods.
• Diethylene glycol: also used in antifreeze products; Its toxic qualities have linked this chemical to lung diseases
• Cadmium: This metal is toxic and is present in traditional cigarettes, with known associations with respiratory diseases and respiratory complications.
• Other heavy metals such as lead, tin and nickel; Inhaling ultrafine particles can carry them deep into the lungs.
• Diacetyl: a chemical that has been linked to bronchiolitis obliterans (BO), also known as “popcorn lung“
• Carcinogens: Carcinogenic chemicals that are present in traditional cigarettes, as well as concoctions such as formaldehyde and ethanal.

These materials and their concentrations vary between products because the FDA has not yet issued any 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 tract condition that affects the smallest airways in the lungs. Whether as a result of infection or inhalation of toxic chemicals, these airways become damaged, inflamed, and even scarred. Several of the aforementioned e-juice chemical additives have been linked to popcorn lung.³

Symptoms may not develop initially; However, rash, night sweats, tiredness, fever, wheezing, and coughing or shortness of breath before or after exercise are signs that someone could be affected by this condition.

Currently, there is no cure available for popcorn lung. Affected people will need lifelong care to manage their symptoms and responses to treatment may vary. Additionally, this condition does not cure on its own and can be fatal without treatment.

It is important to start treatment as soon as possible and stop vaping after diagnosis.⁴ Prednisone and other corticosteroids can help control symptoms by relieving 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.

Collapsed lung

A collapsed lung, also known as primary spontaneous pneumothorax, is the result of a hole in the lung that allows oxygen to escape. This event can occur if someone suffers a knife or gun related injury, but also if air blisters in the lungs rupture. Air blisters are not alarming, according to Johns Hopkins Medicineand can occur naturally in taller, thinner people who experience a period of rapid growth during puberty. The rapid growth can cause blisters in the weakest spots of the lungs, but an affected person may not notice them until a rupture occurs. The process of smoking (and vaping) puts people at greater risk of breaking blisters and collapsing lungs.⁵

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

“At Johns Hopkins, we’re seeing a rash of collapsed lungs in younger people… We always ask them if they’ve been smoking and they often say, ‘No, I don’t smoke.’ But I do vape.’ “We now tell patients not to smoke or vape if they want to avoid another lung collapse and surgery in the future,” said Stephen Broderick, MD, a lung cancer surgeon at Johns Hopkins. in an online publication from Johns Hopkins Medicine.

lung cancer

There is not yet enough data to draw conclusions about the association 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 regard.⁶ Their research found that nicotine and other carcinogenic ingredients in vapes alter the ability of human DNA to repair itself and therefore make human cells more likely to undergo mutations or tumorigenesis. Additionally, they observed 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 that e-liquid aerosols have the same effect on human cells, they write that “it takes more than two decades 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 human cancers associated with e-cigarette aerosols over the next decade… based on these Based on the results, it is reasonable to conclude that there is a high probability that e-cigarette aerosol is a human carcinogen. Therefore, there is no reasonable basis for e-cigarette users to assume that e-cigarette aerosol does not cause cancer and is likely a dangerous step toward a variety of cancers.

Other research suggests that people who vape also develop cancer-associated molecular changes similar to those typically seen in cigarette smokers, primarily observable in oral tissue.⁷

Although there is a lack of data suggesting that vaping causes lung cancer, it is important to note that vaping is not without risks. Like traditional cigarettes, the safest way to avoid potential consequences is to limit exposure to vapor from e-cigarettes when possible or stop vaping altogether.

References

1. Fadus MC, Smith TT, Squeglia LM. The rise of e-cigarettes, pod mods, and JUUL devices among youth: Factors influencing use, health implications, and aftereffects. Alcohol and drug dependence. 2019;201:85-93. doi:10.1016/j.drugalcdep

2. What is in an electronic cigarette? American Lung Association. September 9, 2024. Retrieved 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 %20aromas%20and%20other%20chemical products

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 %20a%20other%20medications

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%20a,lung%20has%20no%20treatment%20long-lasting

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

7. E-cigarette users show genetic changes linked to cancer. Tobacco-related diseases research program. Accessed November 5, 2024.