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Breaking down the vaping crisis

November 22, 2019

In a very short time frame, vaping has gone from one of the fastest growing trends to one of the most controversial and scary topics, showcased night after night on the evening news.   As in all crises, the facts of the problem tend to end up mixed with misinformation, and it becomes difficult to know the truth about the situation.  Even though we do not yet know the exact cause of the vaping crisis, we recommend that everyone avoid vaping altogether.

Let’s explore what we do and do not know about vaping.

What is vaping?

“Vaping” is the term commonly used for e-cigarettes or vape pens.  These devices work by heating a liquid which usually contains nicotine, flavorings, and other chemicals, which together become an aerosol.  The person using the device then inhales and exhales the aerosol, just like someone who is smoking a cigarette.  E-cigarette devices have also been used to deliver marijuana and other drugs.  Much like second-hand smoke, bystanders are susceptible to breathing in the vaping aerosol.

How prevalent is vaping?

Vaping is particularly popular among teenagers and young adults.  In 2017, more than 13% of students in high school admitted to having used an e-cigarette at least once, and at least 12% vape on a daily basis.  Between 2017 and 2019, vaping amongst high school students more than doubled.

According to a poll by Reuters, around 10.8 million people in the United States are engaged in vaping, and more than half of them are younger than 35.  The trend of vaping has seen a swift uptake in recent years.

How many people have died from vaping?

As of November 13, 2019, there have been 42 confirmed deaths from vaping in the United States.  The CDC has reported 2,172 cases of e-cigarette, or vaping, product use associated lung injury (EVALI) in 49 states.

What is causing the death and lung injury?

Studies are ongoing, but the CDC reports that there is no definite culprit at this time.  A comparison of EVALI patients has found Vitamin E acetate in all cases, which leads many researches to suspect Vitamin E acetate may be the cause of the damage to the lungs.   However, Vitamin E acetate is used in many supplements and skin care products without any ill effect.

Previous research has found that Vitamin E acetate can severely affect the normal functioning of the lungs.  The same problem might be happening after the Vitamin E acetate is heated as part of the vaping process.  The investigation will continue until a definite cause can be determined.

Why is Vitamin E acetate used in e-cigarettes?

Vitamin E acetate tends to be found in e-cigarette cartridges that contain THC oil, a product of cannabis.  It is commonly used to thicken the vaping juice in THC e-cigarette cartridges.  E-cigarettes that use THC tend to work slightly differently than non-THC e-cigarettes.  Most non-THC cartridges do not contain Vitamin E acetate.

Do e-cigarettes contain nicotine?

Most e-cigarette cartridges do contain nicotine, which is a highly addictive drug used in cigarettes and other tobacco products.  According to a study from the CDC, 99% of e-cigarettes in the United States contain nicotine, even if it is marketed as containing 0% nicotine.  In many cases, one e-cigarette cartridge is treated as the equivalent of one pack of cigarettes because it carries the same amount of nicotine.  Nicotine, however, is the cause of addiction, not the cause of EVALI lung damage.

What are the dangers associated with vaping?

There are many potential dangers related to vaping.

  1. Brain development

    Since so many teenagers are engaged in vaping, there is a concern with nicotine consumption. Previous studies have shown that nicotine can harm the development of an adolescent brain, which continues to develop until around age 25.  Nicotine can harm the parts of the brain used for attention, learning, mood, and impulse control.  Additionally, the exposure to nicotine can also increase the risk of becoming addicted to other substances.

  2. Lung damage

    Just like regular cigarettes, e-cigarettes deliver chemicals and particles directly into a person’s lungs. The ingredients of each product may vary, and may include chemicals related to lung disease or cancer, and heavy metal particles, in addition to nicotine.  These can interact with the air sacks in the lungs and potentially cause permanent damage, a risk any time particles are breathed into the lungs.

  3. Susceptibility to influenza

    There seems to be a correlation between vaping and having complications with influenza or other respiratory issues. Many times, severe influenza symptoms or respiratory infections cover up the EVALI problems and lead to a delay in treatment.  People who vape may have a greater risk of other complications which share the same symptoms as EVALI, such as coughing, shortness of breath, chest pain, fever, fatigue, and even hazy spots on an X-ray.

Are e-cigarettes safer than regular cigarettes?

We are uncertain at this time.  For at least some cases of vaping, it appears that vaping can damage lungs at a much faster rate than regular cigarettes.  It is still unclear whether that problem persists across different product lines or if it is specific to certain chemical ingredients.

However, the problems associated with smoking should not be forgotten.  Each year, around 7-8 million smokers across the world—including almost 500,000 in the United States—die because of tobacco use, and people who smoke tend to die at least 10 years sooner than nonsmokers.  Today there are more than 16 million adults who are living with a disease caused by smoking.

These numbers are staggering compared to e-cigarette complications.  In addition, a review from Public Health England even indicates that smoking tobacco is much more dangerous than vaping.  Ultimately, e-cigarettes expose people to fewer harmful chemicals, including the burned plant smoke that comes from smoking cigarettes or marijuana.

Since vaping has only become widely popular in the last couple of years, it is difficult to determine the long-term health effects.  Comparing e-cigarettes to regular cigarettes is difficult at this point in time.  Nevertheless, there are definitely chemicals causing major health concerns about vaping.  Those chemicals need to be identified and removed as soon as possible.

Are e-cigarettes a regulated product?

Since August, 2016, the Food and Drug Administration (FDA) has been able to regulate e-cigarette products, including the manufacturing, marketing, and sale of e-cigarettes.  Many regulatory powers are held at the state level, including the ability to including e-cigarettes in smoke-free policies, restrictions of buying age, and pricing.

What is Perry doing about vaping?

Our primary care providers and staff are engaged in reporting all cases of EVALI and educating about how to identify vaping-related complications.  The pulmonary rehab program has expanded to serve more people with lung diseases, including those caused by vaping. 

Most importantly, we are encouraging teenagers and parents to be aware of the risks associated with vaping.  Until a cause has been found for the 42 deaths and e-cigarette products have been corrected, it is important to avoid vaping or second-hand vaping altogether, and instead opt for the path of life-long health and wellness.

If you have engaged in vaping and are experiencing any symptoms – including coughing, shortness of breath, chest tightness – we recommend consulting with a primary care provider as soon as possible.