Published on November 14, 2022 by Kristina Willis
Vaping is often presented as a safer alternative to smoking—even hyped as a strategy to help people quit using cigarettes altogether. Unfortunately, such benefits are scientifically unfounded, and adverse side effects are pushed under the rug in favor of commercial profit. Yet, approximately nine percent of the U.S. population uses e-cigarettes, with a high concentration of teenage and young adult users.
Though definitive research is still needed, one thing is clear: vaping is far from harmless. The overwhelming consensus is that any form of combustion, including vaping, causes damage to the lungs. In addition to the typical dangers associated with smoking, many of the additives in popular e-liquids are known toxins unsuitable for inhalation. Further exploration will unveil the precise mechanisms of acute, sub-acute, and chronic vape-induced lung damage.
Even though data suggests e-cigarettes are less harmful than traditional smoking, the fact remains that vaping imparts risk. Keep reading to learn about how vaping can cause lung damage.
Electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) heat liquids to create aerosols that users then inhale. Though the exact mechanisms and effects are somewhat speculative, vaping is certainly not akin to inhaling simple water vapor. Both devices disrupt pulmonary operations, causing side effects like dry mouth, throat irritation, and inflammation.
Studies show that many e-liquids contain compounds of questionable safety. For example, a 2016 report found that 92% of e-juice products tested positive for at least one of three compounds implicated in occupational lung problems. For instance, synthetic pulegone was banned by the FDA as a food additive because of its association with cancer in rodent models.
► Nicotine► Diacetyl► Pulegone► Propylene glycol► Diethylene glycol► Acrolein► Benzene► Heavy metals► Pesticides
“Evidence is clear that vaping can cause inflammation of the lung cells and susceptibility to infection.”— Dr. David Christiani, poulmonologist and critical care specialist at Massachusetts General HospitalSource
“Evidence is clear that vaping can cause inflammation of the lung cells and susceptibility to infection.”
As a relatively new phenomenon, the most concerning aspect of vaping is the lack of product regulation. Currently, there are over 1000 flavors of e-liquids on the market—all with different chemical make-ups. On top of that, e-cigarette devices have varying components and consequent delivery rates. As a result, it is impossible for researchers to comprehensively investigate every product and evaluate how damaging vaping truly is.
In addition to standard smoking concerns, e-liquids contain many additives and aerosolized flavorants that may be safe to ingest but are toxic when inhaled. For example, saccharides, typically used as sweetening agents, thermally degrade to furans and aldehydes, known carcinogens. Other contaminants include volatile organic compounds and heavy metals. One case study involved a patient who suffered from interstitial pneumonia caused by high levels of cobalt in her vape fluid.
In 2019, an outbreak of e-cigarette or vaping-associated lung injury (EVALI) resulted in several thousand hospitalizations and more than 60 deaths. FDA investigations revealed that the additive Vitamin E Acetate (VEA) was the likely cause. A systematic review of EVALI found more than ten patterns of lung injury among patients, indicating that differences in causal factors led to significant symptom variance. Moreover, e-cigarette use has been linked to chronic lung diseases, and some studies suggest that second-hand exposure to vapor may cause an acute inflammatory response.
E-liquid composition: flavorants, nicotine concentration, toxins
Device specifications: materials influence wicking efficiency, voltage, and temperature
User: age, gender, and pre-existing conditions such as pediatric asthma have been linked to EVALI
Exposure: Frequency and duration of e-cigarette use
There is also evidence that vaping causes damage to cardiovascular systems and increases the risk of viral infections. Most recently, vaping has been implicated as a risk factor for contracting COVID-19 and experiencing increased symptom severity.
Vaping is considered a risk factor for bronchiectasis, ground glass opacities, and nodule formation.
Symptoms often present as a result of acute or chronic inflammation and may include:
► Coughing► Sore throat► Dry mouth► Difficulty breathing► Chest pain► Fever or chills► Nausea► Vomiting► Stomach pain► Diarrhea
Additional human studies and clinical trials are critical for building our understanding of the link between vaping and lung cancer. Current data and reasoning lead most researchers to assume that vaping increases lung cancer risk as e-liquid substances often contain known carcinogens. Unfortunately, conclusive evidence is severely lacking.
“E-cigarette devices and vaping fluids demonstrably contain a series of both definite and probable oncogenes including nicotine derivatives (e.g. nitrosnornicotine, nitrosamine ketone), polycyclic aromatic hydrocarbons, heavy metals (including organometal compounds) and aldehydes/other complex organic compounds.”— DaraBracken-Clarke et al. (Source)
“E-cigarette devices and vaping fluids demonstrably contain a series of both definite and probable oncogenes including nicotine derivatives (e.g. nitrosnornicotine, nitrosamine ketone), polycyclic aromatic hydrocarbons, heavy metals (including organometal compounds) and aldehydes/other complex organic compounds.”
One study linked e-cigarette vapor to an increased risk of developing lung cancer in mice. However, there is some question as to whether rodent models accurately mimic human e-cigarette use.
Research remains inconsistent regarding the onset of vape-induced lung damage. In some cases, effects are apparent shortly after exposure and continue until use ceases. One study found that acute exposure to nicotine-free vapers for as short as three minutes was enough to alter the systemic inflammatory state.
Fortunately, the lungs are a notably resilient organ capable of impressive healing. Even in the case of EVALI, most patients were able to recover normal or near-normal lung function once they stopped vaping.
According to evidence, the lungs heal relatively rapidly once smoking ceases. Patients noted reduced lung inflammation as soon as 5 days and improved lung health within a few months.