Vaping refers to the use of noncombustible Electronic nicotine delivery systems (ENDS). Since first introduced in 2006, the estimated number of tobacco smokers has decreased from 45.1 million in 2005, to 36.5 million in 2017. Although use of combustible tobacco products has decreased, Vaping has increased. Despite the ENDS product popularity, little substantial evidence is known about the long-term exposure health risks.
Vaping is known to expose the lungs to numerous potential toxins and carcinogens. As of Jan 21, 2020, the Centers for Disease Control and Prevention (CDC) confirmed 60 deaths related to vaping associated lung injuries. Individual reports of e-cigarette, or vaping, product use-associated lung injury (EVALI) have described acute eosinophilic pneumonia, diffuse alveolar hemorrhage, lipoid pneumonia, and respiratory-bronchiolitis interstitial lung disease.
Substantial evidence exists that vaping can induce acute endothelial cell dysfunction and asthma exacerbation. Moderate evidence exists on vaping links in elevations of heart rate and blood pressure shortly after nicotine inhalation. Many long-term health unknowns still remain in the domains of dependence, cardiovascular, cancer, respiratory, and oral diseases, along with maternal-fetal outcomes.
According to the CDC, nearly 7 million adults 18 or older used e-cigarettes in 2018. An estimated 3.6 million middle and high school students reported vaping in 2018, up from 2.1 million in 2017. Nicotine in adolescence is known to harm parts of the brain controlling attention, learning, mood and impulse control.
Guidance intended to support healthcare providers;
- Nicotine stimulates the adrenal glands to release the hormone epinephrine (adrenaline) and increases the levels of dopamine, a chemical messenger in the brain.
- Pleasure caused by nicotine’s interaction with the brain’s reward system motivates some people to use nicotine, despite possible risks to health and well-being.
- Research suggests vaping is less harmful than combustible cigarettes when people who regularly smoke switch as a complete replacement, but still damages a person’s health.
- E-cigarettes have not received Food and Drug Administration approval as smoking cessation devices.
- Approved Nicotine Replacement Therapy (NRT) is one of the most helpful tools to use to quit smoking.
- The American Lung Association recommends that questions be added to Electronic Health Records (EHR) to ensure the use of e-cigarettes are incorporated into all patient tracking so that the health impacts can be followed.
- Additional questions should be asked regarding e-cigarette use when the patient is being examined by a healthcare professional.
Further research is needed to help understand the long-term health effects of vaping and whether e-cigarettes are effective in quitting smoking. There is evolving evidence about the health risks on the lungs—including irreversible lung damage and lung disease. E-cigarettes are not safe for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products.
Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems. National Academies Press, May 18, 2018, pages 2-26.
National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems. National Academies Press, May 18, 2018, pages 2-26.