While the severe lung disease and related deaths that have been associated with the use of e-cigarettes give pause to some users, two UCLA Health pulmonologists caution that beyond the immediate concerns about illness, vaping poses longer-term threats in the form of nicotine addiction and potential lung damage.
Vaping involves heating a liquid — typically containing nicotine or cannabis, as well as flavorings and other substances and additives — to produce an aerosol that is inhaled through a battery-powered device. E-cigarettes have grown into a multi-billion-dollar industry since hitting the U.S. market in 2007, with a particular appeal to youth. The U.S. Centers for Disease Control and Prevention (CDC) recently estimated that one-in-four high school students vape.
By early November 2019, the CDC had received more than 2,000 reports from 49 states of vaping-associated lung injuries, as well as more than three-dozen confirmed vaping-related deaths. The same month, the agency identified vitamin E acetate, a chemical additive in the production of e-cigarette products, as a likely culprit, though it warned that additional chemicals could also be involved.
Eric Hamberger, MD, a UCLA pediatric pulmonologist, says he became concerned about rising e-cigarette use among his patients well before the recent rash of illnesses. “Whether this outbreak turns out to be an isolated incident or continues indefinitely, we need to worry about the long-term effects on the lungs of kids and young adults,” Dr. Hamberger says. “Any addictive substance that you inhale has the potential to cause harm.”
Kathryn Melamed, MD, a UCLA adult pulmonologist, points out that many of the health effects of e-cigarette use are yet to be determined. “Vaping is still relatively new, so we don’t have data on the long-term risks,” Dr. Melamed says. “It took decades before we fully understood the effects of cigarettes, because cancer and lung-related illnesses such as emphysema and chronic obstructive pulmonary disease develop over many years. It could be that the risks and long-term outcomes of e-cigarettes will be different from those of traditional cigarettes, but it’s too early to know.”
Dr. Melamed notes that e-cigarettes were initially seen as a potentially effective smoking-cessation tool — a way to wean smokers off their presumably more toxic tobacco-cigarette habit. But the evidence on that point is mixed. A large clinical trial published in 2019 found that smokers who switched to e-cigarettes were nearly twice as likely to remain off tobacco a year later as smokers who used traditional nicotine-replacement products in their effort to quit. But the same study found that 80 percent of the e-cigarette group was still vaping, indicating they had traded one addiction for another.
Whether e-cigarettes are safer than traditional cigarettes is beside the point for a generation of youths who have increasingly become targets of e-cigarette marketing, with the multitude of appealing flavors and devices that come in attractive, sleek designs that bear no resemblance to traditional cigarettes and are easy to conceal. Dr. Hamberger says too many teens and young adults believe the habit to be relatively harmless.
“Comparing the safety of e-cigarettes and traditional cigarettes makes sense when we’re talking about long-term adult smokers who want to switch to something that’s probably safer, but it’s not a useful comparison for a child or teenager who isn’t a regular cigarette smoker and isn’t trying to switch,” he says. “Kids today have access to more information than any prior generation, and they’re smart about seeking it out. We need to do a better job of getting the word out that even if we don’t know everything yet about long-term effects, there are many known reasons not to vape.”
Click here to view a #UCLAMDChat webinar with Dr. Eric Hamberger about vaping,