Diseases & Conditions
Can vaping damage your lungs? What we do (and don't) know
The rising popularity of vaping has been dramatic, especially among teenagers. According to a 2019 study, about 37% of high school seniors reported vaping in 2018, up from 28% the year before. An estimated 2.1 million middle school and high school students reported using e-cigarettes in 2017; that number jumped to 3.6 million in 2018. A more recent survey found that among high school seniors, more than 40% had tried e-cigarettes. Certainly, age restrictions — it's illegal to sell e-cigarettes to anyone under 21 (18 or 19 in some states) — aren't preventing use among teens and young adults. And more than nine million adults 18 or older use e-cigarettes, according to a 2020 survey by the CDC.
E-cigarettes use a battery-powered device that heats a liquid to form vapors — or, more accurately, aerosol — that the user can inhale (thus "vaping"). These devices heat up various flavorings, nicotine, marijuana, or other potentially harmful substances. Nicotine is addictive, of course. And while that fact is prominently displayed in advertising, we know from experience with regular cigarettes that warnings don't always work!
Reports link vaping to severe lung disease
You may have seen news reports of sudden and severe lung problems, including deaths, linked to vaping. This condition is called e-cigarette, or vaping, product use-associated lung injury, or EVALI.
- More than 2,800 e-cigarette users have required hospital admission due to EVALI through February 2020; 68 of these people died. Most cases were among teens and young adults.
- Typically, symptoms have started gradually, with shortness of breath and/or chest pain before more severe breathing difficulty led to hospital admission.
- Experts now suspect contamination with a form of vitamin E (called vitamin E acetate) in some tetrahydrocannabinol (THC)-containing e-cigarettes as the cause of EVALI. Other contaminants and other factors (such as pre-existing lung disease) may also play a role.
- The number of new EVALI cases have declined dramatically since September 2019, probably due to public health messaging about a link between THC in e-cigarettes and EVALI and removal of vitamin E acetate from e-cigarettes.
What we don't know about vaping and severe lung disease
It's not entirely clear how often vaping might lead to lung trouble or who is at highest risk. For example, are lung problems more common among vapers who already have breathing problems (such as asthma) or who smoke other substances, such as regular cigarettes or marijuana? Is it more common among younger individuals?
Other health risks of vaping
The tragic and alarming cases of severe lung disease are clearly cause for concern. A number of other health effects are also worrisome:
- Nicotine is highly addictive and can affect the developing brain, potentially harming teens and young adults. Even some "nicotine-free" e-cigarettes have been found to contain nicotine.
- Some substances found in e-cigarette vapor have been linked to an increased risk of cancer.
- Teens who vape are more likely to begin smoking cigarettes.
- Explosions and burns have been reported with e-cigarettes while recharging the devices, due to defective batteries.
- Accidental exposure to liquid from e-cigarettes has caused acute nicotine poisoning in children and adults.
- Vaping during pregnancy could harm a developing fetus.
How vaping affects our overall health is uncertain. However, there appears to be ample evidence that vaping is not "95% less harmful than smoking" as some have claimed.
But what about the benefits?
In addition to whatever enjoyment vaping brings, some evidence suggests vaping helps some people stop smoking (though other evidence suggests otherwise). How it compares to a nicotine patch or other methods of smoking cessation is not clear. So far, the FDA has not approved vaping as a method of smoking cessation. And many smokers who vape continue to use both cigarettes and e-cigarettes.
The true balance between the benefits and risks of vaping remains impossible to assess. We don't always know what's in e-cigarettes. The FDA, which is responsible for authorizing or approving tobacco products, authorized marketing of a few e-cigarette products in 2021 and has denied many others; but, as noted by the agency, these actions "do not mean these products are safe or FDA approved." And, there is no information available about their long-term health impact.
The bottom line
Perhaps vaping should be viewed as a "lesser of evils" for current cigarette smokers. Still, it's clear that there is a lot about vaping we don't know. One way we'll learn more is by people reporting possible vaping-related health problems to the FDA — you can let them know if you've had such problems.
Until we know more, think twice about vaping. Federal and state authorities recommend avoiding all vaping until more is known. If you do decide to vape, avoid e-cigarettes bought "off the street" and stick with brand name e-cigarette products without modification (such as adding marijuana or other drugs).
These cases of severe lung disease among people who vape raise important questions about the safety of vaping. Perhaps we shouldn't be surprised that lung problems might develop in people who vape: our lungs were meant to inhale clean air and nothing else. It took many years to recognize the damage cigarettes can cause. We could be on a similar path with vaping.
About the Author
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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