Features
The Vaping Veil: Unmasking the dangers of E-Cigarettes
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK),
FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony.
FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow,
Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health and Section Editor, Ceylon Medical Journal
The so-called E-cigarettes come in many shapes and sizes and are known by several different names. They can look like cigarettes, cigars, pipes, pens, and even computer USB flash drives. They are also a fairly new product; a kind of new kid on the block. People sometimes find it hard to figure out what is in these devices and whether they are safe to use. This article is designed to provide some answers to the common questions asked regarding vaping.
E-cigarettes heat a liquid (called e-liquid, e-juice, or vape juice) and turn it into an aerosol or mist, sometimes called a “vapor” or “vapour”. When people use e-cigarettes, they inhale this aerosol into their lungs. The e-liquid in most e-cigarettes has nicotine, the same addictive chemical that is found in regular cigarettes, cigars, and other tobacco products. Nicotine levels are not the same in all types of e-cigarettes. Sometimes, product labels do not list the true nicotine content as well. Some e-cigarette brands have been found to contain nicotine even though they claim to be nicotine-free.
The assertion that vaping is a safe alternative to traditional cigarettes has become a pervasive, and dangerously misleading narrative. While e-cigarettes may lack the visible combustion of tobacco as seen in standard cigarettes, they introduce a complex cocktail of chemicals into the body, posing significant health risks that are, at minimum, comparable to those of smoking. This article aims to dismantle the “safer than thou” myth by examining the scientific evidence surrounding the harmful components of the currently available e-cigarette aerosols and their effects on human health.
Nicotine: The common denominator of addiction and harm
Both traditional cigarettes and e-cigarettes deliver nicotine, a highly addictive substance that plays a central role in the development of dependence. Nicotine’s effects extend far beyond addiction, impacting cardiovascular health, neurological function, and fetal development. There is evidence that nicotine harms the brain development of teenagers and if nicotine is used during pregnancy, it can also cause premature births and low birthweight babies.
Cardiovascular Risks:
Nicotine increases heart rate and blood pressure, constricts blood vessels, and contributes to the formation of arterial plaques or deposits that narrow the lumen. These effects elevate the risk of heart attack, stroke, and peripheral artery disease. While the long-term cardiovascular effects of vaping are still under investigation, studies have shown that e-cigarette usage leads to acute increases in heart rate and blood pressure, similar to those observed with traditional cigarettes. Studies have also shown that e-cigarette users have increased arterial stiffness.
Neurological Effects:
Nicotine affects brain development, particularly in adolescents, whose brains are still maturing. Exposure to nicotine during adolescence can impair cognitive higher functions, including memory, attention, and learning. It also increases the risk of developing mood disorders and addiction to other substances.
Fetal Development:
Nicotine exposure during pregnancy is associated with preterm birth, low birth weight, and sudden infant death syndrome (SIDS). E-cigarettes are not a safe alternative for pregnant women seeking to quit smoking.
Beyond Nicotine: The toxic cocktail of E-Cigarette aerosols
E-cigarette aerosols contain a complex mixture of chemicals, many of which are known to be harmful.
Carbonyl Compounds: The heating of e-liquid generates carbonyl compounds, including formaldehyde, acetaldehyde, and acrolein. These substances are known carcinogens and respiratory irritants. Formaldehyde, in particular, is a known human carcinogen and is linked to nasal and nasopharyngeal cancers. Acrolein is a potent irritant that can damage the lungs and contribute to chronic obstructive pulmonary disease (COPD).
Volatile Organic Compounds (VOCs): E-cigarette aerosols contain VOCs, such as benzene, toluene, and xylene. These substances are associated with respiratory irritation, neurological damage, and cancer. Benzene, a known carcinogen, is a particular concern.
Heavy Metals: E-cigarette aerosols can contain heavy metals, including nickel, chromium, lead, and cadmium. These metals can accumulate in the body and cause a range of health problems, including respiratory damage, neurological disorders, and cancer. Nickel and chromium are known carcinogens.
Flavouring Chemicals: Flavouring chemicals, such as diacetyl, are added to e-liquids to enhance their appeal. Diacetyl is used to create a buttery flavour. However, it is linked to bronchiolitis obliterans, a severe and irreversible lung disease also known as “popcorn lung.” Other flavouring chemicals, such as cinnamaldehyde and vanillin, can also cause respiratory irritation and inflammation.
Ultrafine Particles: E-cigarette aerosols contain ultrafine particles that can penetrate deep into the lungs, causing inflammation and damage. These particles can trigger asthma attacks and exacerbate existing respiratory conditions. The size of these particles is comparable to those found in cigarette smoke, and their deep lung penetration is a major source of concern.
Propylene Glycol (PG) and Vegetable Glycerine (VG): These are the base fluids in e-liquids. When heated, they can decompose into carbonyl compounds and other harmful substances. PGs can cause respiratory irritation and eye irritation, and VGs can cause lipid pneumonia.
Respiratory Health: A Shared Vulnerability
Both smoking and vaping pose significant risks to respiratory health.
Lung Inflammation and Damage: E-cigarette aerosols can cause inflammation and damage to the airways and lung tissue. Studies have shown that vaping can lead to airway hyperresponsiveness, increased mucus or phlegm production, and impaired lung function. These effects are similar to those observed with traditional cigarette smoking.
EVALI (E-cigarette, or Vaping, product use associated lung injury): The 2019 EVALI outbreak seen primarily in the United States of America and reported from all of its 50 states, highlighted the acute and potentially fatal respiratory risks associated with vaping. The outbreak was linked to vitamin E acetate, a thickening agent used in some e-liquids. However, even without vitamin E acetate, other compounds in e-liquids could also cause severe lung damage.
Increased Risk of Respiratory Infections: Vaping can weaken the immune system, making individuals more susceptible to respiratory infections. Studies have shown that e-cigarette users have an increased risk of developing pneumonia and other respiratory infections.
The Long-Term Unknowns: A real cause for concern
While the short-term health effects of vaping are becoming increasingly clear, the long-term consequences remain largely unknown. The relatively recent emergence of e-cigarettes means that the full extent of their health risks may not be apparent for even several decades. However, the available evidence suggests that vaping is not a harmless activity and that it poses significant health risks.
Cancer Risk: The presence of known carcinogens in e-cigarette aerosols raises concerns about the long-term risk of cancer. While studies on the carcinogenic effects of vaping are still ongoing, the evidence suggests that e-cigarettes may increase the risk of lung cancer and other cancers.
Cardiovascular Disease: The long-term effects of vaping on cardiovascular health are also a concern. Chronic exposure to nicotine and other harmful substances in e-cigarette aerosols may increase the risk of heart disease and stroke over time.
Epilogue: The dreadful illusion of safety
The notion that vaping is a safer alternative to smoking as it is thought to be less harmful is an extremely dangerous misconception. E-cigarettes deliver a complex cocktail of harmful chemicals that pose significant risks to respiratory, cardiovascular, and neurological health. While the long-term effects of vaping are still being investigated, the available evidence suggests that it is not a harmless activity. The “safer” label attached to vaping is a marketing ploy that obscures the true dangers of these products. It is crucial to recognize that vaping is not at all a safe alternative to smoking and that the best way to protect your health is to avoid both traditional cigarettes and e-cigarettes.