When vaping became mainstream a little over a decade ago, it was initially marketed as a healthier alternative to smoking cigarettes, or a way to help wean yourself off nicotine gradually. But in reality, it’s a lot more complicated than that.
On Friday, August 23rd, the Centers for Disease Control and Prevention confirmed the first death following an outbreak of severe lung disease in those who use e-cigarette or vaping devices. According to CDC Director Dr. Robert R. Redfield, this reinforces the serious health risks associated with e-cigarette products — as well as how much is still unknown.
“Vaping exposes users to many different substances for which we have little information about related harms – including flavorings, nicotine, cannabinoids, and solvents,” Redfield said in a statement. The CDC is currently working with state and local health departments and FDA to investigate the cause of this ongoing outbreak.
Giving that vaping is relatively new — especially given America’s long history with cigarettes and other tobacco products — there is a lot we are still learning about its impact on the body, both in the long- and short-term. Here’s what we know so far:
The first electronic cigarette was patented in 1965, and consisted of a battery-powered element would heat tobacco flavor without combustion. A similar smokeless non-tobacco product, called the Flavor Cigarette was introduced in 1986, but never took off. The modern e-cigarette as we know it was developed in China in 2003, and made it over to the United States a few years later.
According to the National Institute on Drug Abuse, “e-cigarettes” or “vape pens” describe battery-operated nicotine delivery systems which are activated when a person puffs, vaporizing the liquid in the cartridge. The person then inhales the resulting aerosol or vapor — known as “vaping.” In addition to nicotine, it’s also possible to vape other substancese liek tetrahydrocannabinol (THC), the chemical in marijuana that produces the feeling of being high.
In 2008, the World Health Organization came out against vaping, noting that contrary to what some marketers of e-cigarette imply in their advertisements, it is not a legitimate therapy for smokers trying to quit. At that point, the WHO pointed to the dearth of research on the effects of vaping, and called on those selling the products to conduct clinical studies and toxicity analyses.
The following year, the Food and Drug Administration tested two popular brands of e-cigarettes — NJOY and Smoking Everywhere — and found that they expose users to harmful chemical ingredients, including diethylene glycol, a toxic chemical used in antifreeze, and carcinogens, including nitrosamines. As a result, the FDA issued a warning in July 2009 on the health risks posed by vaping and, like the WHO, called for clinical studies to help determine whether e-cigarettes are safe for their intended use.
An alternative to smoking
The first wave of studies linking smoking to lung cancer were published in the 1940s and 1950s, but it took several decades before the large-scale national public health campaigns communicating the message that “smoking is bad” were really taken seriously. Going hand-in-hand with telling people not to smoke was also informing them that if they did currently smoke, they should quit — and there were plenty of products to help them do it. The FDA approved nicotine gum as a cessation aid in 1984, followed by the transdermal nicotine patch in 1991, but neither of these mimicked the physical sensation of holding and smoking a cigarette. So when e-cigarettes hit the market in the mid-2000s, they were immediately marketed as a healthier alternative to smoking and something that could help people quit.
But, as a 2018 article published in the journal Current Drug Safety points out, vaping was put forward as a viable alternative — and solution — to smoking without any clinical trials on their long-term health impact. There are, however, some shorter-term data demonstrating the effects of vaping on our lung health — and it’s not good news. In January 2018, the National Academies of Science, Engineering and Medicine released a consensus report that reviewed over 800 different studies and found that the inhalation of harmful chemicals from e-cigarettes can cause irreversible lung damage and disease. Specifically, that the two primary ingredients found in e-cigarettes — propylene glycol and vegetable glycerin — are toxic, and that vaping produces several dangerous chemicals including acetaldehyde, acrolein and formaldehyde, which can cause lung and cardiovascular disease. And vaping isn’t exactly a solution to the harmful effects of secondhand smoke, either: A 2016 Surgeon General report found that secondhand emissions from vaping contains volatile organic compounds like benzene — which is found in car exhaust — and heavy metals, such as nickel, tin and lead, among other things. The bottom line is that even if vaping isn’t as harmful as smoking traditional cigarettes, it’s still bad for your health.
Recent cases of pulmonary illness
Though there is no long-term research on the impact of vaping, a string of related respiratory illnesses this summer has provided insight into some of the effects of e-cigarettes on our health. As of last week, there were 193 cases of severe lung illness associated with e-cigarette product use reported by 22 states between June 28 and August 20, according to the CDC.
At this point, the CDC hasn’t identified a singular cause for these illnesses, though those affected have reported use of e-cigarettes, as well as vaping products containing THC. So far, there is no evidence to suggest that an infectious disease is involved, or that there is any specific product linked to the condition. In many cases, people with the illness reported the gradual onset of symptoms including breathing difficulty, shortness of breath, gastro-intestinal issues and fatigue. The most seriously ill individuals have reported extensive lung damage — some of which is expected to be permanent — and have required treatment with a ventilator, the New York Times reports.
“Even though cases appear similar, it isn’t clear if these cases have a common cause or if they are different diseases with similar presentations,” Dr. Ileana Arias, senior scientific advisor and acting deputy director for non-infectious diseases at the CDC said in a phone briefing on Friday. “The state departments of health are investigating the possible cause of the illness by testing patient specimens and e-cigarette products as well.”
During the CDC briefing, Dr. Jennifer Layden of the Illinois Department of Public Health explained there has been one confirmed death of an adult with unexplained illness after vaping or e-cigarette use — one of 22 reported cases of people hospitalized in the state for the same condition, a majority of whom are men. And though there has not been a specific product identified across all cases, Layden noted that the one consistent is that all patients have vaped in recent months.
And though it appears as if this condition has emerged all of a sudden, Dr. Brian King of the CDC’s Office on Smoking and Health noted that “it’s possible that the reported cases could have been occurring before this investigation was even initiated” but health officials across various states did not necessarily connect the dots between the cases. Now, states where the illness has been reported will lead the investigations, sharing information with federal health officials. Specifically, the CDC is actively working to develop a way to collect, aggregate and analyze that data at the national level to help identify the illness and its potential causes, Dr. Josh Schier of the CDC’s division of unintentional injury prevention explained during the telebriefing.
As part of the ongoing investigation, the FDA will analyze samples of various e-cigarette and vaping products containing nicotine and THC to help identify any chemicals or substances that may have contributed to the widespread pulmonary illnesses. According to Mitch Zeller of the FDA, the testing “won’t necessarily answer any questions about causality, but it’s a starting point and an important piece of the puzzle.”