E-Cigarettes and Vaping May Cause Lung Damage and Impaired Immune Responses
By Roberta Attanasio
A few months ago, Oxford Dictionaries announced “vape” as its international Word of the Year 2014 – language research conducted by their editors revealed that its use in 2014 had more than doubled compared to 2013 (and increased by 30-fold since 2012), mostly because of the rapidly growing popularity of electronic cigarettes and the expanding debate over their safety. Although e-cigarettes are portrayed as devices that can help adult smokers quit while providing a safe alternative to tobacco smoking, mounting evidence shows that these devices may cause considerable harm. Indeed, about two weeks ago, California health officials said that e-cigarettes represent a rising public-health risk that threaten to unravel progress made on tobacco by “re-normalizing smoking behavior” and luring a new generation into nicotine addiction.
Electronic cigarettes, or e-cigarettes, are tobacco-free and vaporize liquid (also called e-liquid or e-juice) that contains nicotine, producing “faux” smoke or vapor. Because they don’t burn anything, e-cigarettes don’t release any smoke – therefore, users don’t “smoke”, they “vape.” In addition to nicotine, the e-juice typically contains vegetable glycerin, propylene glycol, and flavorings. There are several types of e-juices, each containing different flavorings – these flavorings make “vaping” especially appealing to young smokers who would not normally try tobacco.
While nicotine addiction caused by vaping in young smokers is clearly a major public health issue, there are also public health concerns associated with toxic substances released by e-cigarette vapors. Indeed, e-cigarettes may likely become a toxic replacement for tobacco products. Results from a recent study (published in the scientific journal PLOSone) show that emissions from e-cigarettes damage lung cells. The damage is mostly caused by inflammatory responses and oxidative stress, which are known to represent key events in the development of chronic airway diseases. Some flavored e-juices – particularly those containing cinnamon – are more toxic than others. Irfan Rahman, lead author of the study, said in a press release: “Several leading medical groups, organizations, and scientists are concerned about the lack of restrictions and regulations for e-cigarettes. Our research affirms that e-cigarettes may pose significant health risks and should be investigated further. It seems that every day a new e-cigarette product is launched without knowing the harmful health effects of these products.”
Results from an additional study recently published in the same journal confirm that vaping may cause potential deleterious health effects. Using a mouse model, the researchers showed that e-cigarettes compromise the immune system in the lungs and generate some of the same potentially dangerous chemicals found in traditional nicotine cigarettes. Thomas Sussan, lead author of this study, said in a press release: “E-cigarette vapor alone produced mild effects on the lungs, including inflammation and protein damage. However, when this exposure was followed by a bacterial or viral infection, the harmful effects of e-cigarette exposure became even more pronounced. The e-cigarette exposure inhibited the ability of mice to clear the bacteria from their lungs, and the viral infection led to increased weight loss and death indicative of an impaired immune response.”
The World Health Organization, the US Food and Drug Administration and regulatory agencies throughout the world are developing new rules extending regulatory authority from cigarettes to e-cigarettes. Will the results from these new studies help in developing these long-awaited new regulations or at least interim safety guidelines?
It would be interesting to compare the magnitude of the immune response affected by vaping e-cigarettes versus smoking traditional cigarettes. On that note, how does it weaken the immune system? Does smoking directly reduce the number of immune cells by killing them or is that because all these immune cells are focused on taking care of the toxic chemicals that this depletes the immune cells? Also, how do you measure the strength of the immune system?
In a public health standpoint, I think it’s a matter of time until more information about e-cigarettes is found and the public is made more aware about it. Just as public health efforts and people’s change in perception (influenced by scientific evidence) of traditional cigarettes led to decreases in the rate of smoking over the years, this may eventually happen for e-cigarettes also. The initial focus should be to protect the non-vaping bystanders from secondhand inhalation, especially in public indoors. Some of the harmful particles (such as heavy metals and organic compounds) that are in aerosolized e-liquids are found at higher levels than in tobacco cigarettes. People who are sensitive to respiratory irritations can be especially affected by them. Regulating the product itself is important, but before we get there let’s protect the nonusers first!
According to E-Cigarettes–Preventions, Pulmonary Health, and Addiction, the effects of “vaping” will cause e-cigarette smokers to have a resistance in the airways, as the amount of nitric oxide is significantly reduced when exhaled. There is an increase in resistance of the airways and an increase in carbon monoxide exhaled. There will be physiological effects with the functions of the lungs and also with the heart.
E-cigarettes have many chemical agents that can be cancerous and volatile, which will cause the toxicity of the “vapors” to significantly increase because of the heat that is generated by the battery. Though e-cigarettes cannot be an effective way to end smoking, humans do not show much response to it. By using e-cigarettes, there is a higher chance that there will be inflammation in the airways, impaired responses towards viruses and bacteria, and a difficulty in balancing the free radicals and antioxidant defenses. The inflammation that is caused in the lungs is due to the increase in macrophages in the airways, which then caused the cytokine, IL-6, to decrease and also MCP-1, which is a chemokine similar to CCL2 that plays a crucial role in the immune responses for migration and infiltration of monocytes, memory T lymphocytes, and NK cells. The scavenger receptors, CD36, are altered due to the regular cigarette smoking, but it is not altered with electronic cigarettes.
There has been research done in mice, which shows that electronic cigarettes affect the responses in the pulmonary system. According to the article, there are about 7.0×1011 free radicals in e-cigarettes. Since there is a lot of bacteria and viruses present in the body, just by inhaling e-cigarettes vapors impairs the destruction of bacteria in pulmonary system. The bacterium that was cleared was due to the reduction of phagocytosis via the macrophages in the alveolar. There were studies that showed that mice were exposed to the bacteria, S. pneumoniae, and e-cigarette vapors, which then led to apoptosis of the macrophages in the alveoli. If there is a viral infection, then immune response to defend the antimicrobial agents in the pulmonary were impaired. E-cigarettes were susceptible to the flu strain as the T cell responses from the lungs were halted. The airways had a significant increase in neutrophils, and a decrease in cytokines. According to PLOS, “Nicotine has…impaired antibacterial defense…[which has] altered macrophage activation to suppress adherence, chemotaxis, phagocytosis and intracellular killing of bacteria…It [has also] impaired antibacterial and antiviral responses observed in E-cig exposed mice are partially mediated by nicotine.”
A question of concern is how immunologically compromising it is for someone who is in close proximity to someone who is “vaping”. Yes there are research-based arguments affirming that e-cigarettes do pose critical health implications with regards to lung cells for the one who “vapes.” However, how are the by-standers affected and are they threatened by any known health risks? To answer such questions, one must understand why there is need for laws preventing vaping habits. The Center for Disease Control and Prevention (CDC) issued an article in Morbidity and Mortality Weekly Report (MMWR) which explains that states have made efforts to prohibit the indoor use and sale of what the review calls “Electronic Nicotine Delivery Systems (ENDS)” to minors. The review went on to explain that 40 states were on board for making sale of “ENDS” illegal to minors as of November30, 2014; however, only 3 of the 40 states supported its use in private restaurants and worksites. Moreover, the report also stated that the Surgeon General did make it known that “ENDS” does pose health risks to others in the nearby vicinity of those who “vape”.
A study that was carried out to review published articles that evaluated the posed human health risk of vaping found that many of the articles had a conflict of interest on the topic of e-cigarettes. On the other hand, there were other articles that illustrate findings that show that e-cigarettes have some health-related risks. One study found that e-cigarettes can change gene expression in a similar way that tobacco can. Sad to say that not much research emphasis had been thoroughly placed on finding out the second-hand effects of e-cigarettes. Most of the literature research on the potential health effects of e-cigarettes states that the lungs are the prime target affected of such vapors. Other studies illustrate adverse effects such as the minimal cytotoxic effects on the fibroblast of the skin, being irritating to the upper-respiratory tract because of cell changes in that area based upon ingested concentrations of the vapor. I can only hope that more in depth research can be done to understand what the health risks of “vaping” are, thus alleviating health concerns of non-vapers and whether the “vape” of others can affect bystanders!
Research into the effects of e-cigarettes seems to be in progress. The current and growing generations presents a specific health risk to everyone including children and elders by using this new devices known as flavored e-cigarettes. I have heard from many individuals about flavors of e-cigarettes, but surprised to see the actual perception behind this electronic cigarettes which contains nicotine. This growing of trend “vape” among individuals impose troubles to new generations and their health. An increased in use of this e-device tells us that many individuals lack knowledge on how it gives rise to health problems. However, new research in progress inform many individuals associated with e-cigarettes effects. It is surprising to see that this new device was introduce for the heavy smokers to quit, but in both case it alters physiological mechanism to body’s defense. Despite the fact that research is providing the awareness and disadvantages behind e-cigarettes to cause damage to lungs due to flavored e-juices and other toxic substances, this can draw attention that it will lead to compromised immune system and result can be resistance to antibiotics due to inhalation of carcinogenic products. I have had come across the information on how nicotine in place of acetylcholine helps decline several disease; such as, Alzheimer’s disease. Nevertheless, nicotine addiction in smokers issues other major health problems. To sum up, the debate can be running in present or in future, the regulation of this e-device must be achieved from government agencies to stop the present and new trend to becoming addict to its flavors and other health problems by having strict rules and restrictions. Despite this growing knowledge on effects of e-cigarettes and its research, will it be worth increasing in price of these devices that can change habits of inhalers? It is only the knowledge among individuals that can change the outcome to this era of e-cigarettes.
Within the past year, I was always amazed at the audacity individuals had for smoking within restaurants, libraries, or inside public transportation. However, I was shocked when I realized it was not actual tobacco smoking but a concept unbeknownst to me, “vape”. Undoubtedly, the growing trend of e-cigarettes and their use are important in assessing the physiological implications, physiologically, socially, economically, etc. The pros/cons are worthwhile to debate from the initial consequence that vaporizers can lead users to a dependency of nicotine, which interferes with regular interactions of acetylcholine acting on adrenergic receptors in the body; cause for associated cardiovascular, respiratory, and nervous system drawbacks.
The ongoing research that correlates e-cigarettes and E-juice to toxicity, oxidative stress and an inflammatory response are foundations for how these vapors may be acting to debilitate a healthy body and community. The inhalation of carcinogenic byproducts or negative effects done to the mucociliary escalator is of primary concern since it diminishes any debilitating significant difference between tobacco smoking and vaping. Undoubtedly, more research is essential for outlining key details for the harm in e-cigarettes vapors, especially if it hinders the body’s line of defense rendering susceptibility to infections. Lastly, the focus on the matter is one that revolves around a commercial gain whereby a gain in consumerism for a product leads to greater profit. The lack of restrictions for these products furthers bypassing any commercial threat, while individuals succumb to addictive social practices. As new discoveries and regulations on vaping are made, will it be worth it despite health risk warnings? The result will be a personal choice comparable to tobacco smoking advisory warnings being dismissed.
Investigations into the harmful effects of cigarettes have been carried out for decades, and the majority of these studies have proven the hazards of smoking beyond all doubt. Despite the overwhelming evidence of the dangers cigarettes pose to smokers and non-smokers alike, people continue to use cigarettes. It is astounding that this practice is still commonplace even after decades of undeniable proof that cigarettes cause cancer and a myriad of other health problems. The case of cigarettes proves that studies of harmful products may cause some consumers to take notice of the associated health risks, but that a surprising percentage of people seem to disregard such information or simply not care. While studies proving the dangers of e-cigarettes will draw some attention to the issue, more must be done if this new, harmful fad is to be controlled. Stricter regulations need to be placed on labelling and advertising in order to dismiss the notion that these devices are associated with better health. Harsher punishments should also be implemented for companies that use this sort of false advertising. Federal agencies are putting the public at risk by not taking the appropriate action in regulating these devices and many other products. Investigative studies proving the dangers of e-cigarettes can be carried out for years, but, as with the case of cigarettes, e-cigarette usage will continue to flourish unless the government steps in and does its job.
The tobacco industry seems to try and “reinvent the wheel” on a regular basis in an attempt to convince the consumer that their products are not harmful, or at least healthier than they used to be. In doing this, they entice new smokers to start and current smokers not to quit, despite the cancer risk. In the beginning in an attempt to decrease the cancer risk, filters were added to the cigarette. While this may have reduced some of the carcinogens infiltrating the body, it didn’t make smoking healthier. Now e-cigarettes and vaping are actually being advertised as a healthier alternative to smoking. Unfortunately, the consumer is unaware of the hidden risks to vaping. While they may understand that they are still subjecting themselves to nicotine addition, they do not realize that their risk to developing cancer is still high. This is because of the hidden ingredients in the juice used in e-cigarettes. Propylene glycol and glycerol are both additives in the liquid juice. When these two substances interact under heat, they produce formaldehyde. Formaldehyde is listed as a known carcinogenic by the the International Agency for Research on Cancer (IARC). It is suspected in causing the following cancers: myloid, nasopharygeal, sinonasal, and brain cancer. It is also associated with health issues in the lymphatic and hematopoietic systems. The consumer is trading one form of cancer causing agent for another with the use of e-cigarettes.
Would the consumer be so quick to jump on the e-cigarette band wagon if they knew they were inhaling formaldehyde and the inherent health risks associated with it? When will the FDA get involved and stop this false advertising of the products from the tobacco industry?
In trying to solve the problem of smoking another problem was introduced to replace the previous problem, in essence no solution was proffered. Rules and regulations will only curb the use of e-cigarettes it will not provide the ultimate intention for which e-cigarette was introduced; which was to quit smoking. Instead of regulations, more attention should be focused on the role of the brain in addiction to smoking. To effectively resolve the issue of smoking, there should be comprehensive knowledge on how smoking affects the brain function. Experiments have been carried out to compare the brain of a non-smoker with an addicted smoker. The article “The addicted human brain: insights from imaging studies” explains that there is a connection between smoking addiction and the reward pathway of the brain. In addiction, the prefrontal cortex of the brain responsible for cognitive control is made almost silent while the motivation and reward pathways are reinforced. Dopamine is a monoamine hormone that is secreted when a person ingest something they enjoy. It gives a feeling of euphoria and the memory of that feeling remain. In an addicted smoker, it will take more cigarettes to attain the level of secretion of dopamine that gives the feeling of euphoria. Since e-cigarettes are doing more harm than good, the reward pathway of the brain can be regulated and therapeutic treatments can be made to activate the prefrontal cortex of the brain. Therapeutic activation of the prefrontal cortex for cognitive control will be more effective because it will strengthen their will power helping them to have more control. This will provide a lasting solution to smoking. This way, there will be no “vaping”, the environment will be safe, the individuals will be healthy, and basically this will be a solution for everyone.