The news about vaping just keeps getting worse.
Originally marketed as a safer alternative to smoking traditional cigarettes, the practice and products have now been shown by multiple studies to endanger users’ health. The dangers and damage of vaping go beyond nicotine addiction to include respiratory and cardiovascular complications, exposure to harmful chemicals and the risk of unknown long-term health consequences.
“Back in the [’60s and] ’70s when cigarette smoking was thought to be cool, we didn’t know much about the long-term effects,” said Dr. Indley Johnson, pulmonologist with Cleveland Clinic Indian River Hospital. “We are at the point now where we don’t know much about vaping.
“What we do know is that it’s not better [and may be worse, especially for young people]. There’s definitely a risk that it is more harmful than actually smoking cigarettes.”
Vaping works by heating liquid in a small device so you can breathe it into your lungs. The E-cigarette, vape pen or other vaping device heats liquid to create an aerosol. Despite the name, vaping doesn’t make water vapor. The aerosol mist contains small particles of nicotine, metal and other harmful substances that can cause inflammation to your lungs.
Vaping devices use e-liquid, also called e-juice or vape juice, to make the vapor. These juices usually contain nicotine, the highly addictive chemical in cigarettes, along with propylene glycol and glycerin to create the vapor and flavoring. They also often contain chemicals that can cause cancer like acetaldehyde, formaldehyde, THC, and heavy metals like nickel, lead and cadmium.
According to a 2024 study by Johns Hopkins Bloomberg School of Health, “popular e-cigarette devices expose users to at least a dozen toxic metals in dangerous concentrations.”
The research team “compared the concentrations of 12 metals in aerosol samples collected from three types of devices: modifiable devices, or MODs, pod systems or PODs, and disposable devices, or d-Pods. They also compared the metal concentrations by device brand and flavors – tobacco, mint and fruit – and toxic metals were detected in every sample analyzed,” according to the study.
“With vaping, every single batch contains something different,” Dr. Johnson warned. “There is no regulation around it. The manufacturers of these e-liquids change the chemicals in these products so often that even the regulators can’t keep up with it. Much of it is manufactured in labs in foreign countries and by the time the FDA or DEA or any of the regulators find out about it, they’ve already changed it. They simply go around the FDA and change the compound very quickly.”
Some e-flavorings like vanilla, maple and coconut contain diacetyl, a chemical that when inhaled causes bronchiolitis obliterans, a serious and irreversible lung disease commonly known as ‘popcorn lung.’
“Chemicals like diacetyl, THC and a vitamin E derivative found in vaping liquid are usually oil-based and the body doesn’t know how to break it down, so it causes an immune response to the lung,” explained Dr. Johnson. “The lung is made up of millions of small air sacs. Once they become inflamed these air sacs cannot exchange oxygen. Popcorn lung is the street name of the immune response and it’s a very acute process that can happen very rapidly – sometimes within 24 hours. It prevents the oxygen from getting to into the blood and it can turn fatal quickly.”
“Researchers at Harvard found that 39 of 51 e-cigarettes brands contained diacetyl,” according to the American Cancer Society. The research “also found two similarly harmful chemicals – 2,3-pentanedione and acetoin – present in 23 and 46 of the 51 flavors tested. An alarming 92 percent of the e-cigarettes tests had one of the three chemicals present.”
Vaping also has an immediate harmful effect on vascular health and oxygen levels, according to resent research presented at the annual meeting of the Radiological Society of North American in Chicago. The study explored what happens to the bodies of cigarette smokers, e-cigarette vapers and vapers who used products without nicotine.
In the small study, 31 vapers and smokers were compared to 10 people who did not smoke or vape.
Each participant got an MRI before and after vaping or smoking or at each visit for nonsmokers. Researchers put a cuff on each person’s upper thigh to restrict the blood flow and once the cuff was deflated, they evaluated the speed of blood flow in the femoral artery and measured the amount oxygen in the blood returning to the heart after it supplied the body’s tissue.
Each time someone vaped or smoked, researchers saw a significant decrease in resting blood flow velocity in the femoral artery.
People who used vapes with nicotine had the most reduction in vascular function, followed by those who used vapes without nicotine. Vapers also took in less oxygen to their lungs. Poor vascular health can lead to blood clots, high blood pressure and stroke.
Vaping is becoming an urgent issue for public health, especially considering the popularity of e-cigarette smoking among teens. The FDA estimates that over 1.6 million youths are vaping in middle and high school.
“Vaping is very popular among teenagers, and I understand they are starting it in middle school,” Dr. Johnson said.
“It’s easy to hide from teachers and parents, so they have it in their pockets, take it out, take a hit and put back in. They don’t have to light anything; they just press a button. And there is no smell.
“Because vaping hasn’t been around very long, we won’t really know the long-term effects for another 20 to 30 years. Right now, teens’ bodies are resilient, but as they age they’ll be more prone to developing diseases. Parents need to start the conversations with their children as early as middle school and educate them on the long-term damage vaping can cause.”
Even as evidence against vaping continues to mount, the sleek design and general acceptance of e-cigarettes has attracted a new generation of users who might not have otherwise engaged with nicotine or other drugs.
Current trends appear to be setting the stage for a potentially catastrophic public health crisis in coming decades unless parents, schools and government agencies do a better job of regulating/restricting vaping and making children more aware of the harm vaping causes to their bodies and futures.
Dr. Indley Johnson completed his medical education at Ross University in Miramar, and his residency at New York Presbyterian Brooklyn Methodist Hospital. He completed his fellowship in pulmonary and critical care at SUNY Downstate Medical Center in Brooklyn, New York. His office is located in Indian River Hospital’s Rosner Family Health and Wellness Center, 3450 11th Court, Vero Beach. Call 877-463-2010 for an appointment.
