To Vape or Not to Vape?

The downsides of e-cigarettes have recently come into sharp relief as several teens and adults have been hospitalized with severe lung damage doctors suspect is linked to vaping. In fact, in August, the first death from a mysterious lung illness possibly linked to vaping has prompted the Centers for Disease Control and Prevention to work with state and local health departments to investigate the outbreak of vape-related illness.

An e-cigarette is a battery-powered nicotine delivery system, which Wassim Walid Labaki, M.D., pulmonologist at Michigan Medicine, worries may be doing more to create nicotine dependencies for the approximately 10.8 million Americans (more than 3 million are middle or high school age) that vape.

The cartridge, filled with liquid containing nicotine and occasional flavorings, has an atomizer that heats the liquid, creating a vapor when the smoker inhales. Pod mod devices are a type of e-cigarette with replaceable cartridges (i.e. pods) that are popular among teens given their small size, portability and easy use.

Other attractive vaping features include the fact that e-cigarettes don't involve burning of tobacco like traditional cigarettes, so they don't generate harmful combustion products like tar and carbon monoxide. And when compared to traditional cigarettes, they also contain lower levels of carcinogenic compounds.

However, researchers have found that the liquid used in e-cigarettes, when heated, reacts to form irritating chemicals called acetals. Acetals are formed from alcohol and aldehydes, which are used to flavor and perfume foods and other commercial products. While many are considered safe, inhaling them at this level could be concerning and cause airway irritation, prompting an inflammatory response from the respiratory system.

Because vaping is a relatively new trend, there is essentially no data regarding the nature or severity of long-term health effects of e-cigarette usage. According to Labaki, e-cigarettes were first introduced to the United States in 2006 and it often takes many years, if not decades, for conditions such as cardiovascular disease, chronic lung disease and cancer to develop.

However, short-term usage can result in respiratory symptoms like chronic cough and mucus production. E-cigarettes can also explode, which can cause significant burn or even fracture injuries.

Also troubling, Labaki says studies show that people who smoke e-cigarettes are more likely to start smoking traditional ones when compared to those who haven't. This particularly affects adolescents and young adults, and could be linked to the development of a nicotine addiction for those that vape.

"These trends are quite concerning to me, especially with how young these people are, since the effects of tobacco smoking on your health are detrimental," says Labaki.

E-cigarettes as a way to quit smoking

But what if the e-cigarette is being used as a way to quit smoking traditional cigarettes? Can they be beneficial? If they are, are they still discouraged from being used? Labaki says the answer might be a little more complicated than yes or no, but that the fact remains that e-cigarettes are not currently approved by the FDA for smoking cessation.

"The role of e-cigarettes in helping to quit traditional cigarettes remains unclear," says Labaki. "To date, there have been conflicting results in clinical trials and observational studies, with only some showing a benefit."

Labaki says FDA-approved nicotine replacement therapies such as skin patches, chewing gums, lozenges, nasal sprays, oral inhalers, and oral medications like Chantix or Zyban, should be the first-line therapies for smoking cessation.  They should ideally be used in conjunction with a tobacco cessation counseling program.

"In instances where these first-line therapies have consistently failed in those trying to quit cigarette smoking, e-cigarettes could be tried as long as the user understands that the efficacy and safety of these devices still needs to be fully established," says Labaki.

Telephone-based quit-smoking programs are available free of cost by calling the national tobacco quitline: 1-800-QUIT NOW (1-800-784-8669). For more information, visit www.smokefree.gov.