Electronic cigarettes have been marketed as a safe alternative to cigarettes for years, but new findings of lung damage, chemical burns and stiffened blood vessels in e-cigarette users suggest that vaping may be equally as harmful.
As of Oct. 15, lung injury cases associated with using e-cigarette and vaping products has risen to 1,479 across 49 states, the District of Columbia and one U.S. territory, according to the Centers for Disease Control and Prevention.
Thirty-three deaths have been confirmed in 24 states and 79% of patients affected by the use of vaping products are below the age of 35.
“My biggest concern is the fact that we have years of trying to get people off of cigarettes, and we were finally becoming somewhat successful across the nation, and now you’ve got a whole generation of young people who probably never would have picked up a cigarette, who have started using products that do have nicotine in them,” said Susan Morgan, clinical professor in the Department of Periodontics at the WVU School of Dentistry.
Vaping-related lung injury patients reported a gradual start of symptoms, including breathing difficulty, shortness of breath and chest pain before hospitalization, with many of them telling healthcare personnel of their recent use of vaping products containing tetrahydrocannabinol (THC), according to the CDC.
“Current cases seem to be linked to people putting THC or CBD (cannabidiol) oil or Vitamin E in the e-liquid,” said Mark Olfert, WVU researcher and associate professor in the WVU School of Medicine. “These devices are highly modifiable. People can create situations by adding compounds that the manufacturer didn’t put in there that might make it acutely dangerous, which explains the recent cases that we’re seeing for the hospitalization.”
In a report from The New England Journal of Medicine, doctors found that from the 17 patients they examined, with 12 of them having vaped marijuana or cannabis oil, all of them showed a pattern of injury in the lung that resembled chemical burns.
Frankie Tack, clinical assistant professor and addiction studies minor coordinator at WVU, said the metal coil inside the e-cigarette can also contaminate the vapor with more chemicals.
“The other problem we have with vaping is that when chemicals are heated and interact with each other, especially in contact with metal, because the coil inside that turns the liquid into an aerosol is metal, all that is heated comes together and creates other chemicals,” Tack said.
In a John Hopkins Bloomberg School of Public Health study, scientists found that significant numbers of e-cigarette devices generated aerosols with potentially unsafe levels of lead, chromium, manganese and nickel that leaked from the heating coils inside the device.
“If you vape the certain chemicals or certain compounds, you can put the lung in a compromised position and end up in the hospital,” Olfert said.
Two primary ingredients found in e-cigarettes, propylene glycol and vegetable glycerin, are toxic to cells, according to a 2018 study report released by the National Academies of Science, Engineering and Medicine. The more ingredients in an e-liquid, the greater the toxicity.
The report also showed that e-cigarettes produce many dangerous chemicals, including acetaldehyde, acrolein and formaldehyde, which can cause lung disease and cardiovascular disease.
“The big problem is that this is an unregulated product, and there’s lots of chemicals,” Tack said. “Stanford has shown some research that there are dozens of chemicals in the aerosol cloud that’s blown out from a person’s mouth after inhaling from a vape device, including heavy metals and all kinds of chemicals that you normally would completely avoid inhaling.”
Stanford scientists investigated the effect of the e-liquids on endothelial cells that line the interior of blood vessels and found that, when grown in a lab, endothelial cells exposed to the e-liquids, or to blood collected from e-cigarette users after vaping, are less operable and show increased levels of molecules implicated in DNA damage and cell death, according to a Stanford Medicine report.
The cells also struggle to form new vascular tubes and to migrate and help with wound healing.
Olfert conducted similar research at WVU, which suggested that long-term vaping may cause harmful cardiovascular effects and stiffness in the aorta (the body’s largest artery).
Over an eight-month period, Olfert and other researchers exposed three separate animal models to four hours of either an e-cigarette base solution, cigarette smoke or clean air for five days a week, which is the equivalent of 25 years in humans.
They found that chronic exposure to e-cigarette vapor stiffened the aorta 2.5 times more than the regular aging process did in a vape- or smoke-free environment. Cigarette smoke caused a 2.8 times increase.
“It is not unreasonable for people to think that the damage to the lung will be less severe compared to a cigarette, but the work that my lab has been doing has been looking at not just the lung, but at other organ systems; in particular, blood vessels,” Olfert said. “When we look at animals that have been exposed to cigarettes or e-cigarettes, we find in most cases that the blood vessels don’t behave normally, and we can’t distinguish whether an animal was exposed to cigarettes or e-cigarettes.”
Olfert said aortic stiffness is an early warning sign of cardiac and vascular-related diseases, which can include atherosclerosis, heart attacks, hypertension, stroke and aneurysm.
“The fact that vaping and smoking leads to a two to three full increase in stiffness of blood vessels, compared to someone who ages normally, there’s a huge red flag, and it tells us that vaping is likely going to lead to an increase in cardiovascular events in people that are using these products,” he said.
The body is able to control the size of blood vessels by opening them up (dilating) or narrowing them down to restrict blood flow to certain organs. The system will automatically send blood flow to where the body needs it, Olfert said.
In someone that vapes or smokes, their blood vessels’ ability to dilate is impaired by about 50%, Olfert said. As a result, the area needing blood flow doesn’t receive the correct amount.
Olfert also said animal models exposed to the e-cigarette vapor and cigarette smoke showed dysfunction in the brain as well.
According to the U.S. Surgeon General report on e-cigarette use among youth and young adults, nicotine exposure during adolescence can cause addiction and can harm a developing adolescent brain.
“One of our big concerns with college-age students is that we now know that the brain doesn’t fully develop until the mid-20s, and so still in this period of college age, 18-22, the brain is still in an important formative stage, which makes it much more vulnerable to the effects of nicotine,” Tack said.
Tack said that because the brain is still in the developing stage, the young adult brain can form addiction much quicker and that the effects of nicotine in young adults can be more detrimental to their brains.
“Nicotine can impair cognition, attention processes and learning and things like impulse control and can make someone more susceptible to mood disorders like depression [or] bipolar disorder,” Tack said. “If a person uses nicotine at a young age, they have a greater risk of priming for other addiction because the brain gets wired. It’s developing its hardwiring from experience.”
“If the brain is receiving addictive chemicals, it’s wiring for that experience and making it more likely,” Tack said. “Then, people could develop addictions to other chemicals.”
Some e-cigarette products can deliver doses of nicotine that exceed a traditional tobacco cigarettes’ dose, said Melissa Blank, assistant professor of behavioral neuroscience at WVU.
“Use of those products would then expose the brain to nicotine at levels that can produce drug dependence,” Blank said. “Thus, users who are nicotine-naïve, or not regular users of products that contain nicotine, may then develop dependence as a result of e-cig use, and those who are already nicotine-dependent may stay dependent.”
Morgan said her primary concern is that the young adults already addicted to the nicotine will have a difficult time quitting and will be more susceptible to other drugs.
Olfert said there’s evidence of e-cigarettes helping people quit smoking, but there’s a lot more evidence that says people don’t actually quit vaping after they quit smoking.
“The studies that I’ve been doing from long-term exposures tell us that humans are going to start experiencing cardiovascular diseases and complications and that vaping should not be done in the long term,” Olfert said.
WVU offers a variety of different smoking cessation programs on campus for WVU students and faculty including:
• Breathe Well: Live Well
– WVU Medicine’s six-week smoking cessation program led by a team consisting of a certified tobacco cessation counselor and a doctor of pharmacy.
• Cessation services through WVU insurance plans. PEIA will cover an initial and follow-up visit to a physician or nurse practitioner and tobacco-cessation products (both prescription and non-prescription) are available at no cost.
• The West Virginia Tobacco Quitline available at 877-966-8784.