What to Know About Vaping

A pulmonologist explains how vaping works, the difference between e-cigarettes and regular cigarettes, and how vaping impacts lung health.

E-cigarettes, also known as vapes, are battery-operated devices that contain several components: a cartridge, which holds a liquid that usually contains nicotine, flavoring, and other chemicals; and a battery that heats up the liquid until it becomes a vapor, which is then inhaled. Vape sales increased by 46.6% from 2020 to 2022 — surging from 15.5 million units to 22.7 million — and it’s especially popular among youth. From 2022 to 2023, the Food and Drug Administration (FDA) reported that more than 2.1 million American middle school and high school students used e-cigarettes, with more than 1 in 4 of those using them daily.

To limit the appeal, in 2020 the FDA officially banned most flavors of cartridge-based reusable vapes, allowing just menthol and tobacco. But this issue has proved hard to regulate; illegal, disposable e-cigarettes with flavors like watermelon, cotton candy, and pina colada are still readily available in stores across the U.S.

“These products boast delicious-sounding flavors, which taste good and make them sound harmless,” says Dr. Joshua Davis, a pulmonologist at NewYork-Presbyterian/Weill Cornell Medical Center.  “They may not look like cigarettes, but they’re just as addictive and can cause a lot of harm.”

Health Matters spoke with Dr. Davis to find out more about the effects of vaping on overall well-being, particularly in young people.

Dr. Joshua Davis

How does vaping work, and what are people breathing in?
Dr. Davis: Vapes contain nicotine, typically concentrated from tobacco, but there’s a common misconception that when you vape, you’re inhaling pure nicotine. There are many other chemicals in the e-liquid.

Propylene glycol, a common additive in a lot of foods, is used in vape pens to turn the nicotine into a smoke. Other ingredients include heavy metals, chemicals that have been found in weed killers and are known pulmonary toxins, and ultrafine particles that can go very deep down into the lungs.

Is vaping better for you than cigarettes?
Many people think that vaping is healthier or safer than traditional tobacco cigarettes, but that’s not true. They’re both dangerous, though we don’t know exactly how harmful e-cigarettes are yet, especially in the long run. Doctors in the 1930s and ’40s used to claim cigarettes were healthy for you. Now, we laugh at this sort of rhetoric because we know how dangerous they are. In the future, I think that we’re going to be looking back on vaping in the same way.

How do e-cigarettes impact our lungs and overall health?
Because vapes have only been around for the past two decades or so, there is limited data on their long-term effects. Vaping is not only harmful to the lungs, but also to the cardiovascular system. We know that nicotine increases blood pressure and stress on the heart by tightening the blood vessels. Over time, this can lead to atherosclerosis (hardening of the blood vessels) and risk for strokes and heart attacks. It also puts users at a higher risk for blood clots and increases inflammation in the body in general, increases triglycerides, and lowers good cholesterol.

There is some data that shows high school students and young adults who vape experience higher rates of bronchitis and asthma, though it’s likely too early to know about vaping and lung cancer. It also was observed to cause an increased susceptibility to COVID-19 in the population between ages 13 and 24.

As with cigarettes, the chemicals in vapes impair the lungs’ protective enzymes and cleaning mechanisms. They weaken the lungs’ ability to filter other toxins in the air as well. As a result, vape users may be at an increased risk of developing emphysema.

The chemicals from e-cigarette smoke have been found to cause damage to DNA, as well as to the body’s ability to repair DNA. Electronic smoke also seems to increase the risk of bladder and lung cancer in animal models.

Another concern is secondhand exposure to e-cigarette smoke. A lot of work has been done to remove tobacco smoke from indoor spaces over the last 25 years, and the rise of vaping (which many people engage in indoors) is cause for concern. There is some data that suggests secondhand smoke exposure can lead to chronic bronchitis and asthma. And for children and patients who already have recognized lung diseases, the exposure to this type of smoke is certainly a risk for them.

What is popcorn lung and how does it to relate vaping?
Popcorn lung is a rare type of lung injury related to exposure to a chemical called diacetyl. It was initially found after workers in a plant making flavored popcorn were exposed to this chemical and developed severe lung problems. Diacetyl is a flavoring chemical which has been found in many different flavored vapes — not just popcorn flavored ones! Inhaling this chemical can lead to permanent scarring on the airways, which causes shortness of breath.

Can vapes actually help people quit smoking cigarettes?
It’s not clear. There is a decent amount of observational data that shows e-cigarette usage helps some patients quit smoking cigarettes, but there’s not a lot of high-quality data that compares its effectiveness to other well-studied techniques, like nicotine replacement and pharmacotherapy. The problem is, it may help patients to stop smoking cigarettes, but the majority of patients have just replaced cigarettes with vapes.

What are some strategies and tips for patients who want to quit vaping?
Normally, we treat a vaping addiction similarly to the way we’d treat a cigarette addiction, with a combination of nicotine replacement and behavioral support. Individuals have different needs and should consult with their doctor to create a plan that fits.

Nicotine patches are very helpful for a low amount of nicotine around the clock, and nicotine gum is also extremely helpful for cravings, when used properly. A lot of people think it works like regular chewing gum, but it doesn’t; once it’s chewed, you have to park it in between your teeth and your cheek so that the nicotine can enter into your bloodstream through the gums. Nicotine lozenges are another alternative.

It can also help to have a “quitting buddy” if you have another friend or family member who is trying to stop vaping. There are a lot of free resources available throughout the country, including the hotline 1-800-QUIT and nysmokefree.com, which can provide counseling and even free nicotine replacement for patients.

If you’ve never smoked before, my biggest advice is don’t start vaping. If you already use e-cigarettes, it can be incredibly hard to stop smoking cigarettes and vaping, but I want people to know that if they don’t successfully quit on their first try, it definitely shouldn’t dissuade them from continuing to try.

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