What is vaping?

Vaping is an umbrella term describing multiple ways of aerosolised nicotine consumption. Vape pens are alternatively called e-cigarettes, electronic nicotine delivery systems (END), e-cigars, and e-hookahs. Additional vernacular terms have emerged to describe both the various vape pen devices (e.g., tank, mod, dab pen), vape solutions (e.g., e-liquid, vape juice), as well, as the act of vaping (e.g., ripping, juuling, puffing, hitting). A conventional vape pen is a battery-operated handheld device that contains a storage chamber for the vape solution and an internal element for generating the characteristic vape aerosol. (1)

What is the impact of vaping on the lungs?

E-cigarette, or vaping, product use-associated lung injury (EVALI; originally called vaping-associated pulmonary injury), initially described in 2019, is an acute or subacute respiratory illness that can be severe and life-threatening. (2)

More than 2800 hospitalised cases of EVALI were reported to the Centers for Disease Control and Prevention (CDC) in the United States as of 18 February 2020. Among those, there have been 68 deaths. Approximately 66 % of reported cases were male, and nearly 80 % were younger than 35 (range 13 to 85 years). (2)

The pathogenesis of EVALI is not known. EVALI appears to be a form of acute lung injury and may reflect a spectrum of disease processes rather than a single process. (2)

What ingredients might be instrumental in causing lung injury?

Examination of products used by affected patients and bronchoalveolar lavage fluid (BAL) samples has found tetrahydrocannabinol (THC) and/or vitamin E acetate in the majority. However, other additives might include nicotine, cannabinoid (CBD) oils, and other substances such as coconut oil and limonene. (2)

What are some of the other health problems associated with vaping?

The problems vaping causes include (3):

• Asthma: Vaping can make a person more likely to get asthma and other lung conditions. It can worsen existing asthma.
• Lung scarring: Diacetyl, a chemical used in some flavourings, can cause bronchiolitis obliterans (“popcorn lung”). Bronchiolitis obliterans causes permanent scarring in the lungs.
• Organ damage: In addition to the lungs, nicotine and other substances in e-liquid can damage the heart and brain. Nicotine affects brain development, raises blood pressure and narrows arteries.
• Addiction: Nicotine is highly addictive. It causes changes in the brain so that the person craves nicotine and may be unable to stop vaping voluntarily unless it starts causing health problems. Even e-liquids that claim they’re nicotine-free have small amounts of nicotine.
• Cigarette smoking: Many people start vaping and end up smoking cigarettes, which contain higher amounts of harmful chemicals.
• Second-hand exposure: Vaping doesn’t make people smoke, but people in the vicinity are exposed to nicotine and other chemicals.
• Explosions: There have been incidents of batteries in vaping devices exploding and causing severe injuries and burns.
• Cancer: Some ingredients in e-liquids are known to cause cancer.

What are the signs of use?

Vaping is easy to hide, and the signs can be easy to miss. Unlike traditional cigarettes, e-cigarettes don’t leave the telltale scent of tobacco. The following are clinical and behavioural signs of vaping (4):

• Presence of unfamiliar technology, online purchases, or packaging
• Faint, sweet or fruity scents
• Behavioural and mood changes
• Increased irritability or restlessness
• Cutting back on caffeine
• Desire for flavour due to tastebud degradation
• Pneumonia
• Increased thirst
• Nosebleeds

Are e-cigarettes less harmful than cigarettes?

There is no FDA oversight of e-cigarettes, meaning there is no oversight regarding potentially harmful ingredients. (5)

• E-cigarettes are highly effective at delivering nicotine through a liquid that produces a chemical-filled aerosol.
• Acrolein, a known ingredient of many e-cigarettes, causes irreversible lung damage. Nicotine exposure during adolescence can harm the developing brain.
• No e-cigarette has been found to be safe and effective by FDA in helping smokers quit.

Are e-cigarettes regulated?

The South African Bureau of Standards (SABS) has established a National Technical Committee (TC) to develop South African National Standards to guide the use of e-cigarettes and vaping products. Currently, there are no guidelines or regulations for vaping production in South Africa, and the SABS will be responsible for setting guidelines and promoting standardisation in the field, covering electronic vaping products and their components, including cartridges and reservoirs. (6)

Currently, the Department of Health has a draft bill on the control of Tobacco Products and Electronic Delivery Systems that is undergoing public enquiry. The SABS said it will focus on vaping products and consider the inclusions of the draft bill, with the knowledge that standards are voluntary. (6)

Sources:

1. Jonas A. Impact of vaping on respiratory health. BJM. 2022.
2. Uptodate: Kathuria H et al. E-cigarette or vaping product use-associated lung injury (EVALI). Jan 2023. Accessed on 07/07/2023
3. Cleveland Clinic. Vaping (E-cigarettes). 2023. Accessed on 07/07/2023. https://my.clevelandclinic.org/health/articles/21162-vaping
4. American Lung Association. What you need to know about vaping. 2023. Accessed on 06/07/2023. https://www.lung.org
5. American Lung Association. E-cigarettes & Vaping: What Parents should know. 2023. Accessed on 06/07/2023. https://www.lung.org.
6. Businesstech. New e-cigarette and vaping rules planned for South Africa. May 2022. Access on 07/07/2023. https://businesstech.co.za/news/business/588004/new-e-cigarette-and-vaping-rules-planned-for-south-africa/.

DISCLAIMER: The information on this website is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional.