In recent news, researchers have found that the liquid used in e-cigarettes, when heated, reacts to form irritating chemicals called acetals, formed from chemicals used to flavor and perfume foods and other commercial products. While many are considered safe to eat and touch, inhaling flavor compounds at this level could be concerning and acetals can irritate airways and prompt an inflammatory response in the respiratory system.
Also in recent news, eight Wisconsin teens were hospitalized with severe lung damage that doctors suspect could be due to vaping.
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.
Nevertheless, e-cigarette vapor still contains potentially toxic chemicals, since, according to NPR, the FDA does not require e-liquid manufacturers to submit or list all the ingredients in their products. The cartridges can contain different levels of nicotine that teens may not be aware of.
Due to vaping being a more recent 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."
Wassim Walid Labaki, M.D., pulmonologist, Michigan Medicine
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 know that e-cigarettes are not 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 benefito."
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 need to be fully established," says Labaki.
Erythropel, H.C. et al. (2019) Flavorant–Solvent Reaction Products and Menthol in JUUL E-Cigarettes and Aerosol. AJPM. doi.org/10.1016/j.amepre.2019.04.004.