Recent reports of serious vaping-related illnesses have stirred concern among healthcare providers in Connecticut and across the United States. As of November 20, the Centers for Disease Control had reported more than 2290 cases of e-cigarette or vaping related lung injury, 47 of which resulted in death. Cases have been scattered across 49 states, including Connecticut, and state health officials here have urged residents to refrain from using e-cigarettes or vaping products containing THC.
“I ask all my patients ‘Do you vape?’” says Middlesex Health pulmonologist Ricardo J. Perez, MD. “I talk to them about my concerns – and about what we can do to get them not to vape.” But much is yet unclear about these illnesses, he says.
Most of the affected people reported having vaped products containing THC, the psychoactive ingredient in marijuana, he explains, or both THC and nicotine, but others have only used nicotine. “So it is assumed that it is the mechanism of taking in these products more than the ingredients themselves that are leading to acute lung injury and/or death,” he says.
Seasons recently talked with Dr. Perez, who joined the Middlesex staff in July, about the dangers of vaping and the recent spate of vaping-related lung injuries.
Smoking vs. vaping: What’s the difference?
Electronic cigarettes – also known as e-cigarettes, e-hookahs, JUULs and vape pens – operate by heating a liquid to produce an aerosol that users inhale instead of smoke. While smokers inhale the smoke created from burning tobacco into their lungs, with vaping (or JUULing) there is no tobacco (or marijuana) being burned.
Though health experts have not yet pinpointed the exact cause of the recent lung injuries, they suspect that people are inhaling a toxic component – or a mixture of components – in the vaping fluid that in some people leads to a severe inflammatory response in the lungs, Dr. Perez explains. “These vaping products are not regulated through the FDA,” he adds. “One of the major vaping producers had a product containing over 150 known toxins.”
We know that smoking cigarettes causes scarring and chronic inflammation in the lung’s airways, he says, gradually leading to chronic bronchitis or asthma-like symptoms. “With the vaping cases being reported,” he explains, “you hear about people having more of an acute respiratory distress syndrome – they have severely low oxygen levels and are severely ill.”
Whereas smoking-related respiratory illnesses like emphysema and COPD (Chronic Obstructive Pulmonary Disease) develop over the course of decades, patients with the vaping-related lung illness grow sick within a couple of days or weeks, he says. “There is quite the gamut of how severe it can be – the ones getting the attention are the ones that are getting intubated in the ICU.” Still, he says, anyone experiencing symptoms like significant shortness of breath, as well as fever, chills, nausea and/or vomiting, should seek immediate care.
To understand the nature of the vaping-related lung injuries, it is necessary to understand the anatomy of the lungs and how they work: Healthy lungs draw in air, which travels down the trachea, down the main-stem bronchi, and into thousands of smaller airways known as bronchioles, eventually reaching the alveoli. “This,” Dr. Perez says, “is where the magic happens.”
These air sacs are rife with blood vessels, and it is here where carbon dioxide is removed from the blood, and oxygen from the air we breathe enters the bloodstream and is carried to the rest of the body and all its cells. “A lung is almost like a honeycomb, and usually there are empty spaces in the honeycomb,” he explains, “but after an insult like vaping – and subsequent inflammation – the alveoli become filled with a protein-like fluid, and oxygen is not able to get in.”
Although the dangers of smoking – it leads to respiratory illness, heart disease and cancer – have been well documented, there are few long-term studies on the health consequences of vaping. “We have decades of information on smoking cigarettes,” notes Dr. Perez, “but vaping is still very new – and unregulated – and we’re just starting to see some of the information now.”
The vaping trend: Trading one danger for another?
Though many people have used vaping as a means to cut down on smoking, says Dr. Perez, the use of vaping for smoking cessation has had mixed reviews. One major study in Europe, he notes, found that people who vaped in addition to smoking only smoked one cigarette less per day. “People might just be trading in one danger for another,” Dr. Perez says. “The answer is not to smoke or vape.”
Not only have e-cigarette manufacturers marketed their product as a healthier alternative to smoking, despite the fact they were never cleared by the FDA as a safe and effective smoking cessation tool, Dr. Perez points out, but some people feel that e-cigs have also been marketed more toward children and young adolescents.
Indeed, the CDC reports that 15 percent of the vaping-related lung disease cases have occurred in children under 18; 38 percent have occurred in otherwise healthy 18- to 24-year-olds. “It’s easier for kids to get a hold of e-cigs than regular cigarettes,” Dr. Perez adds. While some e-cigarettes look like regular cigarettes, others look like USB flash drives, pens and other everyday items, making them easier for kids to hide from adults.
CDC experts stress that the use of e-cigarettes is unsafe for kids, teens and young adults, and not only because of the threat of vaping-related lung injury. Most of these products contain nicotine, which is highly addictive and can impair adolescent brain development, which continues through the early to mid 20s. In addition, children who use e-cigarettes may be more likely to smoke cigarettes in the future.
Just as more research is needed about the health consequences of vaping, notes Dr. Perez, there is still much that is unknown about the health effects of marijuana. Yet vaping cannabis has also become an increasingly popular alternative to smoking the dried plant. “We don’t know what is the safest way to ingest marijuana,” says Dr. Perez. “It’s probably safer to get medical marijuana through the right, regulated channels – buying at a reputable dispensary versus buying it on the street. But at the end of the day, you are inhaling something that is not supposed to be in your lungs.”
Kicking the smoking – and vaping – habit
According to Dr. Perez, those who are trying to kick the e-cigarette habit can benefit from some of the same smoking cessation strategies as those trying to quit smoking cigarettes. Antidepressants like Chantix and Wellbutrin, he says, have been shown to also decrease smoking cravings, and when combined with nicotine replacement in the form of patches, gum or lozenges, can be very effective.
Studies on smoking cessation have found that combining counseling with nicotine replacement therapy or medication doubles the chances that someone will quit tobacco. Specialists at Middlesex Health’s Center for Chronic Care Management, which offers smoking cessation classes, take this approach. “Behaviorally, one size does not fit all,” according to Beth Roberts, a tobacco intervention specialist at the center.
For some, setting a specific end date, having a plan, and then putting it into practice is best. For others, a harm reduction approach works better. This might involve mini-quits, or the elimination of one trigger at a time. “The behavioral changes one must make to stop tobacco,” she says, “may transfer easily to vaping.”
Though Dr. Perez says he hasn’t yet encountered any cases of vaping-related lung disease in his practice, he is sure to talk to his patients who vape about the health concerns. “It’s best to stop using these products, to not be addicted,” he says. “You don’t want to be that case of the young, healthy person who passes away from these terrible lung diseases that are preventable.”
Lori Miller Kase is a freelance writer living in Simsbury.
Photography by Stan Godlewski. Stan Godlewski is an editorial, corporate and healthcare photographer based in CT and NYC.