Electronic cigarettes (also called e-cigarettes or electronic cigarettes) were introduced in the United States in the mid-2000s and have become increasingly popular with the emergence of flavored products such as Juul in 2015. Before they entered the market, e-cigarette use was common among young people. below 5%; however, these rates increased to almost 21% in 2018. While these products are marketed as a smoking cessation tool, teenagers and young adults, the most common users, are therefore largely not taking up the habit of e-cigarettes.¹

It may be thought that e-cigarettes are less harmful to a person’s health than smoking tobacco, but the use of e-cigarettes and e-cigarettes can still be dangerous. Due to the relatively short time frame of their popularity, there isn’t a ton of solid safety data available on these products; but over the years, the effects of vaping have become increasingly linked to a variety of lung injuries and other complications. To spread awareness about the risks and available data associated with e-cigarette and vaping, this article will provide an overview of what clinicians and researchers have learned about the effects of e-cigarettes on lung health.

What Do We Breathe?

Although advertised as a safer alternative to smoking, vaping comes with its own risks | image source: makcoud – Stock.adobe.com

Vape pens are battery-powered devices that distill “e-liquid” into an inhalable aerosol composed of multiple chemicals. Nicotine continues to be present in many vaping products, which means vaping still carries the same risk of addiction as traditional cigarettes. Listed here are numerous other toxic chemicals or metals commonly used and detected in flavored e-cigarettes.²:

• Benzene: a volatile organic compound Used in may paints, varnishes, insecticides, air fresheners, disinfectant and cleaning products, insecticides, deodorants, fuel sources, car exhaust and more
• Acrolein: Often used in weed killer; It is known to have harmful and irreversible effects on a person’s lungs
• Propylene glycol: Contained in artificial smoke in fog machines, antifreeze, and paint solvents, this product is also a commonly used additive in various foods.
• Diethylene glycol: also used in antifreeze products; toxic qualities have linked this chemical to lung disease
• Cadmium: This metal is toxic and is found in traditional cigarettes; They have known associations with respiratory diseases and respiratory complications.
• Other heavy metals such as lead, tin and nickel; inhaling ultrafine particles can bring them deep into the lungs
• Diacetyl: A chemical associated with bronchiolitis obliterans (BO), also referred to as “”.popcorn lung”
• Carcinogens: cancer-causing chemicals found in traditional cigarettes, as well as mixtures such as formaldehyde and ethanal

These ingredients and their concentrations vary between products because the FDA has not yet issued any standards for e-cigarettes or conducted a formal review of their ingredients.

Potential Risks

Popcorn Lung

Popcorn lung, or BO, refers to a rare condition of the respiratory tract that affects the smallest airways in the lungs. As a result of infection or inhalation of toxic chemicals, these airways become damaged, inflamed, and even scarred. Many of the above-mentioned chemical additives in e-liquid have been associated with popcorn lung.³

Initially, symptoms may not develop; However, skin rash, night sweats, fatigue, fever, wheezing, cough or shortness of breath before or after exercise are signs that someone may be affected by this condition.

There is currently no treatment available for popcorn lung. Affected individuals will require lifelong care to manage their symptoms and treatment responses may vary. Moreover, this condition does not heal on its own and can be fatal if left untreated.

It is important to begin treatment as soon as possible and quit e-cigarettes once diagnosed.⁴ Prednisone and other corticosteroids can help manage symptoms by relieving inflammation. Patients may also benefit from inhalers or inhaled forms of medication, such as albuterol, to dilate the bronchial tubes to reduce shortness of breath or wheezing. In more serious or extreme cases, steroids, oxygen, and even a lung transplant will be recommended.

Collapsed Lung

A collapsed lung, also known as primary spontaneous pneumothorax, is caused by a hole in the lung that allows oxygen to escape. This can also occur when someone suffers a knife or gun-related injury and also when air bubbles burst in the lungs. Air bubbles are not a concern Johns Hopkins MedicineIt may occur naturally in tall, thin individuals who experience a period of rapid growth during adolescence. Rapid growth can cause weak spots in the lungs to bulge, but the affected person will probably not be aware of them until rupture occurs. The process of smoking and using e-cigarettes puts individuals at risk of bursting blisters and suffering lung collapse.⁵

Shortness of breath, difficulty breathing, and/or sharper chest or shoulder pain may be indicative of this event. A collapsed lung may heal on its own with rest and oxygen therapy; however, in severe cases, a chest tube must be inserted to remove leaked oxygen from the body, and surgery may be required to directly repair the hole.

“At Johns Hopkins, we see collapsed lungs in young people… We always ask if they smoke, and they often say, ‘No, I don’t smoke.’ But I use electronic cigarettes.’ We now tell patients not to smoke or vape if they want to avoid another lung collapse and surgery in the future,” said Stephen Broderick, MD, a lung cancer surgeon at Johns Hopkins. In an online post from Johns Hopkins Medicine.

Lung Cancer

Although the components of e-liquid have known associations, there is still not enough data to draw conclusions about the relationship between vaping and lung cancer. A report published in Journal of Cancer Biology has made some progress in this regard.⁶ Their research found that nicotine and other carcinogenic ingredients in e-cigarettes alter the self-repair capacity of human DNA, thus making human cells more likely to undergo mutation or tumor formation. They also observed that more than 20% of mice exposed to e-liquid aerosol for 54 weeks (which translates to at least 3 years of vaping for humans) developed lung adenocarcinoma, while more than 50% developed a precancerous form of bladder urothelial hyperplasia. Although the authors acknowledge that animal studies do not mean that e-liquid aerosols have the same effect on human cells, they write: “It takes more than two decades for a lifelong tobacco smoker to develop cancer. E-cigarettes take just over eight years to develop cancer.” If tobacco smoke carcinogenesis is the paradigm for E-cig carcinogenesis in humans, then we may not see the emergence of E-cig aerosol-related human cancers in the next decade… There is therefore no reasonable basis for E-cigarette users to assume that E-cig aerosol does not cause cancer, which is a possibly dangerous step for various types of cancer.

Other research suggests that individuals who use e-cigarettes go on to develop similar cancer-related molecular changes often seen in smokers, observable mostly in oral tissue.⁷

Although there is not enough data to show that e-cigarettes cause lung cancer, it is important to note that e-cigarettes are not without risk. Similar to traditional cigarettes, the surest way to avoid potential consequences is to limit exposure to e-cigarette vapor whenever possible or quit vaping altogether.

References

1. Fadus MC, Smith TT, Squeglia LM. The rise of e-cigarettes, pod mod devices, and JUUL among youth: factors influencing use, health outcomes, and downstream effects. Drug Alcohol Addict. 2019;201:85-93. doi:10.1016/j.drugalcdep

2. What’s in an e-cigarette? American Lung Association. 9 September 2024. Access date: 5 November 2024. https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette#:~:text=E%2Dcigarettes%2C%20aka%20JUULs%20and,glycol%2C 20%sweeteners%20and%20other%20chemicals

3. Popcorn lung (bronchiolitis obliterans). Cleveland Clinic. 16 March 2022. Access date: 5 November 2024. https://my.clevelandclinic.org/health/diseases/22590-popcorn-lung-bronchiolitis-obliterans

4. Bronchiolitis obliterans symptoms, diagnosis and treatment. American Lung Association. Updated October 29, 2024. Access date: 5 November 2024. https://www.lung.org/lung-health-diseases/lung-disease-lookup/popcorn-lung/symptoms-diagnosis-treatment#:~:text=Bronchiolitis%20obliterans%20is%20an%20irreversible,%20answers does not give%20to%20other%20drugs

5. What does e-cigarette do to your lungs? Johns Hopkins Medicine. Access date: 5 November 2024. https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-does-vaping-do-to-your-lungs#:~:text=Vaping%20and%20Popcorn%20Lung&text=Diacetyl%20is%20frequently %20added%20,lung%20yes%20no%20permanent%20treatment

6. Tang MS, Tang YL. Can electronic cigarette use cause cancer? J Cancer Biol. 2021;2(3):68-70. doi:10.46439/cancerbiology

7. E-cigarette users show cancer-related genetic changes. Tobacco-Related Disease Research Program. Access date: 5 November 2024.