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Electronic cigarettes at risk of lung damage?

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Smoking is bad for you, that’s for sure. Evidence collected over 70 years of studies has now confirmed that tobacco consumption in any form (cigarettes, cigars, pipe, etc.) is extremely harmful to the body on many levels: it increases the risk of cancers of the respiratory tract (lung first and foremost), mouth, vocal cords and other body sites (esophagus, stomach, liver, pancreas, colorectum, kidney, bladder, uterus, etc.); promotes the development of acute and chronic respiratory diseases (bronchitis, emphysema, chronic obstructive pulmonary disease – COPD etc.); promotes the onset of cardio and cerebrovascular diseases; reduces fertility and is harmful to the fetus during pregnancy.

Most damaging to the respiratory system are the byproducts of tobacco combustion, the additives it contains (a total of several hundred toxic compounds) and nicotine, together responsible for more than 90 percent of lung cancer cases and 80 percent of COPD cases. Critical to the cardiovascular system, however, are mainly nicotine and oxidizing compounds (free radicals and reactive oxygen species, ROS), which increase the risk of coronary heart disease, myocardial infarction, and stroke by 2-4 times, even after modest, short-term consumption.

Electronic cigarettes-which have now become a cult object and status symbol for many, especially among younger people-have immediately seemed an ideal means of reducing the impact of smoking on health without imposing a total abandonment of the habit, as well as a “solution-bridge” to facilitate a gradual and less painful cessation for those who have the hardest time quitting. The nicotine in solution contained in their reservoirs is, in fact, released in the form of vapor and in smaller quantities than one would take in by smoking a regular cigarette, greatly reducing the body’s exposure to toxic compounds.

Recent studies and severe adverse events encountered among regular e-cigarette users in the United States have, however, cast doubt on the harmlessness of so-called “vaping” (i.e., “electronic smoking” in vapor form) and its positive value in a cessation perspective, attributing to this mode of consumption also the ability to harm health and, in particular, the respiratory system, albeit in different ways.

The most recent alarm in this regard comes from an investigation conducted in Illinois and Wisconsin (U.S.), following reports of severe lung damage in e-cigarette smokers and preliminarily attributed specifically to vaping. The problem affected 53 people, mostly boys and young adults (the average age was 19), 83% of whom were men. In addition to respiratory symptoms and pulmonary infiltrates verified by CT scan, all had systemic symptoms (i.e., general malaise of various types) and in 8/10 cases gastrointestinal complaints. The clinical pictures were so severe that they required hospitalization for almost all patients and intubation and mechanical ventilation in one third of the cases, with one dying despite these interventions.

When analyzing the vaping devices used by these young people, it was seen that they were of various types, but shared a detail of no small importance: in 84 percent of the cases, in addition to the “common” ingredients of electronic cigarettes, they also contained tetra-hydro-cannabinol (THC), the active ingredient of marijuana responsible-along with cannabidiol (CBD)-for most of its psychotropic effects, but also capable of acting on various peripheral organs where specific receptors are present.

Many experts believe that it is this “addition,” along with the presence of numerous, undefined contaminating compounds, that has made e-cigarettes, which are considered safe in themselves, harmful unless modified. However, in the absence of clear and definitive data, the authors of the survey and several other colleagues suspect that even common e-cigarettes harbor hitherto underestimated risks that are now emerging as a result of increasingly widespread use of these devices, especially among adolescents.

Therefore, as a precautionary principle, pending more information on the health effects of vaping, this mode of smoking should also be avoided as much as classic smoking, giving serious thought to ultimate cessation and opting for other strategies that can help with quitting. Should the decision be made to continue, the advice is to report any unusual respiratory symptoms to the physician immediately to catch potentially serious disorders in the bud.

Sources:

  • Miech R et al. Trends in Adolescent Vaping, 2017-2019. NEJM 2019; doi:10.1056/NEJMc1910739
  • Butt YM et al Pathology of Vaping-Associated Lung In. NEJM 2019; doi:10.1056/NEJMc1913069
  • Christiani DC. Vaping-Induced Lung Injury. NEJM 2019; doi:10.1056/NEJMe1912032
  • Layden JE et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report. NEJM 2019; doi:10.1056/NEJMoa1911614
  • doi: 10.4103/0971-5851.151771
  • Aseem Mishra A et al. Harmful effects of nicotine. Indian J Med Paediatr Oncol 2015;36(1):24-31
  • Center for Disease Control and Prevention (CDC) Health Effects of Cigarette Smoking(www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm). Accessed October 2019

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