Introduction

Herbert Gilbert, a Pennsylvanian scrap metal merchant and cigarette smoker, is credited with the invention of vaping. Gilbert's apparatus worked similarly to contemporary electronic cigarettes. They both use batteries to vaporize a liquid for inhalation. He acknowledged to the Smithsonian magazine that, because it lacked nicotine, he thought it was a revolutionary substitute for smoking cigarettes. He believed that vaping would protect people from the negative effects of tobacco. Gilbert’s device was never mass-produced despite numerous attempts to do so. However, several businesses have since referenced Gilbert’s patent.¹

The Surgeon General Luther Terry published his study "Smoking and Health" on the possible health effects of cigarette smoking in 1963. This was one year after the patent was filed. It was the first study linking cigarettes to any of the following conditions: laryngeal cancer, chronic bronchitis, heart disease, and lung cancer.¹

The original idea behind vaping tobacco was to replace smoking with a healthy alternative. However, it quickly gained popularity and its own industry. In 2019, vaping tobacco became a new approach to consuming nicotine. Vaping often avoids the first stage of cigarette addiction. It is thought to be more discrete, efficient, and safe. It is also believed to taste better. Compared to their first cigarette smoke, vapers have a generally better first experience with the product. Cigarette smoking was socially acceptable and even seen as “cool” eighty years ago.¹ 

These days, vaping has a distinct culture that is frequently distinct from that of cigarette smoking. But what are the unseen risks of vaping? There is a need to learn more about the hidden health dangers that come with vaping. Possibilities include exposure to certain chemicals, threats to the heart and lungs, and long-term consequences on mental and physical health. These potential dangers cannot be overstated, even in light of its growing popularity.

Vaping

Vaping is the process of inhaling a mist ("vapour") into your lungs. This is done by using a portable electronic device. Via a mouthpiece, you inhale an aerosol. This aerosol is made of heated nicotine, flavouring, propylene glycol, and other ingredients. These aerosols are inhaled while using an e-cigarette, vape pen, or a different electronic nicotine delivery system (ENDS). In addition to other ailments, vaping can harm organs and cause breathing difficulties and addiction.²

E-cigarettes (vape pens)

A device called an electronic cigarette, or "e-cigarette," heats up the liquid nicotine and flavours it. This allows you to inhale it. Vapes, vape pens or sticks, e-hookahs, hookah sticks, mods, and personal vaporizers (PVs) are just a few of the many names for e-cigarettes. Alternatively, they may be referred to as electronic nicotine delivery systems (ENDS).²

Components of e-cigarettes

These devices are available in various forms, dimensions, and kinds. They also go by numerous names. The earliest vape devices looked like cigarettes. Newer models look like a USB flash drive or small pod.

Most e-cigarettes have:²

• A cartridge, tank or pod that holds liquid (refillable)
• An atomizer (a coil that is the heating element which changes the e-liquid in vapour)
• A battery to power the heating element
• A power or control button
• A mouthpiece to breathe in the vapour
• An e-liquid (a mixture of chemicals such as nicotine, flavouring, etc.)

Health risks of vaping

The risks associated with vaping are:² 

• Asthma
• Lung scarring
• Organ damage
• Addiction to nicotine
• Cancer

Dangerous substances in e-liquid

Unlike nebulizers, which coat lung tissue with therapeutic spray, vaping exposes the lungs to potentially toxic substances. These toxic substances can include fine particles, volatile organic compounds, toxicants and heavy metals. Additionally, e-liquid mixtures often contain flavourings, aromatic compounds, and either nicotine or THC (the psychoactive ingredient in marijuana). All of these ingredients are mixed with an oily liquid base. Some of the vaporized elements of this oil are believed to reach the deeper parts of the lungs and trigger an inflammatory response.³

Vitamin E is another e-liquid ingredient under examination. It is frequently added to e-liquids as a thickening and delivery agent. vitamin E is believed to irritate the respiratory system when inhaled. In contrast, vitamin E is harmless when applied topically or taken orally as a supplement. Vitamin E has been found in the lungs of individuals with significant vaping-related lung damage known as EVALI.³

The lungs may also be at risk from other compounds. These compounds are either already present in the e-liquid or created when the e-liquid is heated. Some of these compounds are:³

1. Diacetyl is a food additive. It is used to enhance the flavours of e-cigarettes. Diacetyl has been shown to harm the lungs' smaller airways
2. Formaldehyde is another hazardous substance. It can aggravate heart and lung conditions
3. Acrolein is a chemical that is most frequently employed as a weed killer. When inhaled, it can damage the lungs 

Unseen Risks Beyond Vapor Clouds

Potential effects on respiratory health: EVALI

An inflammatory reaction in the lungs due to inhaled substances is known as EVALI. EVALI stands for e-cigarette or vaping product use associated lung injury. It is not unexpected that the extent of EVALI can vary. This is due to the wide variety of products (many of which are illegal or counterfeit) and ingredients. It might manifest as fibrinous pneumonitis, pneumonia, or injury to the alveoli. Alveoli are small air sacs in the lungs.⁴

What are the causes of EVALI?

There is a significant connection between vitamin E acetate and EVALI. It is mostly present in fake brands (and more lately, in South Korean JUUL products). Vitamin E is a supplement. It can be regarded as harmless when ingested or applied to the skin. The oil derivative is known as vitamin E acetate. It is utilized as a thickening agent in vaping products. Roughly half of the EVALI-related items contain it. Vitamin E deposits were discovered in the lung tissue of EVALI patients in a small study.⁴

Additional chemical components were discovered in the lungs of EVALI patients. The components found include triglycerides, plant oils, petroleum distillates, and diluent terpenes. However, not every patient shows traces of these components.⁴

Impact on brain development and cognitive function

Adolescent brain development can be harmed by nicotine, which is addictive. The mid-20s is the period when the brain continues to develop. Teenagers who use nicotine may experience damage to the areas of the brain. These areas are responsible for mood, impulse control, learning, attention, and learning. Teens who use nicotine also have a higher likelihood of trying other substances. Nicotine addiction is hard to overcome. To quit vaping permanently, you'll need time, patience, and support.⁵ 

Public health initiatives and education

Public awareness campaigns about vaping risks

A survey by George Institutes for Global Health in the UK uncovered some interesting results. People between the ages of 15 and 30 who thought e-cigarettes were dangerous were 40% less likely to use them than people who did not think them dangerous. However, just 53% of individuals who use e-cigarettes on a monthly basis reported having seen warning labels on the product's packaging.⁶

E-cigarettes that are thrown away do not only pose health concerns to others. They also harm the environment by producing a significant amount of plastic and technological trash. Out of four vapers aged 15 to 19, three used disposable e-cigarettes. These disposable e-cigarettes are often less expensive than refillable ones. This is in line with a well-documented and growing trend of teens using throwaway electronics.⁶

School-based education programs targeting the youth

The FDA has an ongoing campaign called ‘The Real Cost’. ‘The Real Cost’ is a successful juvenile tobacco prevention campaign. In 2018, it has reached more than 10 million people between the ages of 12 and 17 who have either used or are willing to try e-cigarettes. The campaign informs young people about the possible dangers of e-cigarette use.⁷

Teens are reached by ‘The Real Cost’ where they spend the majority of their time: online and in school. Additionally, the campaign is distributing e-cigarette prevention materials to high schools around the country. Students can access these materials during the school day via educational digital platforms as well as in school bathrooms.⁷

Addressing common misconceptions and myths

1. Vaping is safer than smoking

Every puff of a cigarette exposes the user to toxins, carcinogens, and hazardous metals. Vapers also inhale harmful substances like acetone. Acetone is a solvent that can cause your skin and eyes to become irritated. With ongoing exposure, additional chemicals included in vapes may lead to cancer. ⁸

2. It's simple to give up vaping

The addictive nicotine content of one vape pod is equal to that of twenty cigarettes. The impulse to vape more is created by training the brain to expect more nicotine through vaping. Nicotine has a particularly strong impact on the adolescent brain. It also raises the likelihood that kids may start smoking cigarettes later on. This makes it more difficult to quit vaping.⁸ 

Summary

The popular trend of vaping marijuana and nicotine was promoted as a healthy substitute for smoking. Occasionally, it was even suggested as a way to help people to stop smoking. Given the available data and the 2019 EVALI outbreak, all medical professionals have a duty to inform their patients that vaping poses new and serious risks. These risks will need to be investigated further. Additionally, it is imperative to know that vaping is not safer than smoking. Healthcare professionals need to become more knowledgeable about the risks associated with vaping. This will allow them to recognise the negative effects vaping causes in patients. Based on verified data and established patterns, an evidence-based strategy to allow people to quit smoking is required.¹ 

Originally thought to be a less dangerous option than smoking, vaping has become very popular. Unfortunately, the apparent vapour clouds conceal undiscovered health risks. These hazards, fueled by nicotine addiction, include organ damage, lung scarring, and asthma. Campaigns for public awareness and educational initiatives seek to debunk myths. These campaigns and initiatives aim to address the concerning increase in diseases linked to vaping. This highlights the critical need for evidence-based strategies to permit people to quit smoking.