The good news is that smoking in the USA is on the decline, especially among teenagers. The bad news is that the number of teenagers who “vape” or use e-cigarettes continues to increase. When first introduced, e-cigarettes were touted as a harmless aid in the struggle to stop smoking cigarettes. Many people found that they just traded one addiction for another due to the nicotine content in available vaping liquids. Ever eager to please, the manufacturers of those early vaping liquids, or “vape juice,” soon turned to making nicotine-free flavored liquids that produced nothing more than harmless water vapor. Age requirements to purchase non-nicotine products generally do not exist, and vaping quickly became a teenage fad of epic proportion.
From the beginning, medical professionals have been leery of the claims that only harmless water vapors were entering the lungs of those vaping, but data to support this was nonexistent. Around 2014, the first study data on the effects of vaping began to appear, with more studies being published each year. Unfortunately for vapers, the news isn’t very good, since all of the scientific data strongly suggests that vaping can lead to lung damage.
One of the most unsettling things about vaping is that the consumer gets scant information about what vape liquids contain, other than flavoring and nicotine. Nicotine strength varies from brand to brand and can be much stronger than the nicotine ingested when smoking a regular cigarette. With or without nicotine, vaping liquids contain a variety of chemicals that become toxic when heated and inhaled. The makers of vaping liquids continue to advertise the safety of their products by telling consumers that their liquids are pure enough to drink. This is true, except these liquids aren’t ingested; rather, they are heated and inhaled into the lungs.
Vaping liquids have a water base to which the chemical flavorings (and nicotine) are added. Flavoring compounds vary tremendously in the number and concentration of chemicals, most of which are not disclosed to the consumer. To enhance vaporization as well as flavor, chemicals such as propylene glycol, glycerin and diacetyl must be added. The end result is a chemical soup with even greater potential for harm once it is heated, since the majority of these chemicals and their byproducts have never been tested on human lungs. The Center for Tobacco Regulatory Science and Lung Health at the UNC School of Medicine has developed a database of vaping and e-liquid ingredients which includes the toxicity of over 300 different brands and flavors. One of the metrics reported in this database is the LC50 or the lethal concentration of a substance required to kill 50 percent of the population. The lower a liquid’s LC50, the more toxic it is. Current entries in this database range from the highest LC50 of 5.99714, to the lowest LC50 of 0.00238. The most toxic flavors are those that contain vanilla and/or cinnamon in any concentration. Sadly, these flavors are also the most popular.
So what are the actual health issues associated with vaping? The most damaging lung issue related to vaping to date is popcorn lung. First discovered in the early 2000s, popcorn lung is a chronic and irreversible condition that causes inflammation, scarring and narrowing of the smallest lung airways, or bronchioles. It is caused by inhaling the chemical diacetyl, a harmless food additive used back then for adding butter flavoring to microwave popcorn. Workers in the popcorn factory started having severe, unexplained respiratory problems that were finally diagnosed as bronchiolitis obliterans. Bronchiolitis obliterans is a rare disease most often seen in babies with respiratory syncytial virus, and in adults who work around hazardous chemicals, have rheumatoid arthritis or have had lung transplants. Since this disease is not contagious, medical investigators started looking closely at potential causes in the popcorn factory. Before long, it was determined that the constant inhalation of the diacetyl in the butter flavoring was the culprit. Diacetyl had never been tested for lung safety, but once it was shown to be harmful, popcorn makers removed it from their butter flavorings. These factories also initiated strict respirator requirements to protect their workers.
The majority of vape liquid manufacturers, however, still rely heavily on diacetyl to enhance the flavor and “mouth-feel” of their products. The number of teenagers and young adults presenting with bronchiolitis obliterans symptoms, but with no other respiratory issues, is growing. The numbers will continue to grow, since symptoms sometimes take months and even years to develop. Studies are finding that the common denominator among these patients is vaping. Earlier this year, the American Lung Association issued a statement that using e-cigarettes or vaping, especially with flavored liquids, can cause popcorn lung. A recent study published by the American Academy of Pediatrics reports that five cancer-causing chemical toxins have been found in the urine of teenagers who vape.
Is vaping really that bad for you? Vaping is certainly safer than smoking cigarettes, but that can hardly be seen as an endorsement of these products. Lung damage, regardless of how it happens, is permanent. The best and safest thing to inhale remains clean air.
Alene Payne, MS, RPC/RRT, is the manager of Cardiopulmonary Services at Vidant Beaufort Hospital.