What Are the Dangers of Vaping? Health Risks of E-Cigarettes

According to an analysis of a national survey conducted in 2016, one-third of people who use e-cigarettes or related products reported symptoms of lung or respiratory tract impact or damage. This analysis will be presented at the American Heart Association's 2020 Scientific Sessions.

“Despite many people continuing to believe that vaping or using e-cigarettes and related products is safe or at least safer than smoking combustible cigarettes, the use of these products may carry risks,” said Thanh-Huyen T. Vu, MD, PhD, the senior author of the study and an associate professor of epidemiology in the Department of Preventive Medicine at Northwestern University's Feinberg School of Medicine. The recent outbreak of e-cigarette or vaping-associated lung injury, commonly known as EVALI, has raised serious public concern about the impact of e-cigarettes on lung health. However, information regarding clinical symptoms associated with the use of different types of e-cigarettes and related products is limited, particularly concerning symptoms in other healthy populations.

To fill this knowledge gap, researchers analyzed survey feedback from over 1,400 current users of e-cigarettes and related products, aged between 18 and 64, with an equal representation of males and females, who participated in a national online survey in 2016. Participants reported on the e-cigarette vaping devices and related products they used. Additionally, they selected from 13 specific symptoms those they believed might be caused by vaping and reported other symptoms they thought were due to vaping.

Researchers specifically focused on five symptoms identified by the Centers for Disease Control and Prevention (CDC) as associated with e-cigarette or vaping-related lung injury: cough, shortness of breath, nausea, abdominal pain, and chest pain. They also analyzed whether the choice of specific products affected the occurrence of these symptoms, after adjusting for demographic factors, smoking, and the frequency and duration of e-cigarette and related product use.

Researchers found:

More than half (55%) of respondents reported one or more symptoms.

One-third (33%) reported one or more of the five EVALI-like symptoms; cough and nausea were the most common.

Among respondents reporting EVALI-like symptoms, a higher proportion were under 45 years old, Hispanic, current smokers, or users of other tobacco products such as pipes or smokeless tobacco.

Compared to those using non-rechargeable devices, those using devices that were refilled with more e-liquid were 70% more likely to report these symptoms, and those using rechargeable devices were 95% more likely to report these symptoms.

Those who reported mixing e-liquids had a 40% likelihood of reporting EVALI-like symptoms.

Users of flavored e-cigarettes had a 71% likelihood of reporting EVALI-like symptoms.

After a surge in vaping-related lung injuries and deaths in 2019, investigators at the CDC identified a potential contributor to lung injury: vitamin E acetate, an additive used in some cannabis-containing e-liquids purchased from the internet or legal cannabis dispensaries.
“Our findings suggest that symptoms of vaping- or smoking-associated lung injury are not surprising, given a brief related event or merely the use of tetrahydrocannabinol (THC), the psychoactive component of cannabis, or vitamin E acetate, could potentially contribute to the EVALI outbreak over the past year,” Vu said. “Healthcare professionals need to help patients better understand the full risks and potential harms of using e-cigarettes and related products.”

Although this survey was conducted in 2016, researchers believe these findings remain relevant and significant today. Vu stated that despite the growing public health concerns, the use of e-cigarettes and related products has increased since 2016, and the selection of new devices has also surged—more and more product options are attracting potential users and encouraging existing users to try new products.

While these findings come from a survey of adults, they are also important for young people. From previous studies, we know that youth and adolescents who vape may attempt to change their liquids and devices and choose flavored products,” said study author Rosemary Robertson, MD, FAHA, the associate chief science and medical officer of the American Heart Association and director of the Association's Tobacco Regulatory Science Center. “Public health information should be designed for parents, guardians, or other adults working closely with adolescents (such as teachers and coaches) to enhance understanding of the relationship between e-cigarette use and serious health risks.”

According to the 2020 National Youth Tobacco Survey, there are currently 3.6 million young Americans using e-cigarettes, with reports indicating that over 80% of current users are using flavored e-cigarettes. The American Heart Association supports a proactive, three-pronged initiative that includes research, policy advocacy, and youth engagement to combat the epidemic of e-cigarette use among American youth.

“We know that nearly 90% of smokers become addicted before the age of 20, and nicotine has profound effects on brain development,” said Aruni Bhatnagar, PhD, FAHA, Robertson's colleague at the American Heart Association and a professor of medicine at the University of Louisville School of Medicine in Louisville, Kentucky. “This study provides a clear message that despite the perception that e-cigarettes are less harmful, and some even believe they are completely harmless, they are indeed harmful, and even users of e-cigarettes are noticing this.”

Bhatnagar stated that stricter assessments are needed to better understand subclinical changes in the lungs and circulatory system, whether these changes occur immediately, accumulate over a lifetime, or persist long-term, leading to actual cardiovascular or pulmonary events.

Recently, there has been growing concern about whether vaping-related lung injuries may make individuals more susceptible to COVID-19 infection and more likely to experience severe illness after infection.

Vu stated, “While the relationship between e-cigarettes and EVALI and the relationship between lung injury and COVID-19 require further research, existing evidence suggests that e-cigarettes should be a focus, and avoiding e-cigarettes can mitigate this risk.”