What are the health risks associated with vaping?

Health Risks of Vaping

Vaping poses significant health risks including e-cigarette or vaping product use-associated lung injury (EVALI), cardiovascular damage, respiratory problems, and nicotine addiction, with particular dangers for adolescents, pregnant women, and those with pre-existing conditions. 1

Respiratory System Risks

• EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury):

  • Caused over 2,800 hospitalizations and 68 deaths in 2019-2020 1
  • Primarily linked to vitamin E acetate in THC-containing products 1
  • Presents with respiratory symptoms (cough, shortness of breath), gastrointestinal symptoms, and constitutional symptoms 2
  • Radiographically shows bilateral ground glass opacifications 3

• Common respiratory effects:

  • Coughing, throat irritation, and shortness of breath 1
  • Bronchiolitis obliterans (from diacetyl, a common flavoring agent) 3
  • Increased risk of respiratory infections 2

Cardiovascular System Risks

• Nicotine in e-cigarettes causes:
  • Increased blood pressure and heart rate 1
  • Narrowing of arteries 1
  • Potential contribution to coronary artery disease, atherosclerosis, aortic aneurysms 1
  • Irregular heartbeat 1
  • Particularly dangerous for those with pre-existing cardiovascular conditions 1, 4

Neurological Risks

• Neurotoxic effects of nicotine:
  • Particularly harmful to developing brains 1
  • Affects learning, reasoning, and attention 1
  • Impacts impulse control and personality 1
  • Causes structural and functional alterations in brain areas related to emotion and decision-making 1
  • Increased risk for psychopathology 1

Chemical Exposure Risks

• Harmful chemicals in vaping aerosols:
  • Propylene glycol and glycerin generate pulmonary irritants and carcinogenic compounds (formaldehyde, acetaldehyde, acrolein) when heated 3
  • Metals from heating coils and cartridges (aluminum, chromium, iron, lead, nickel, etc.) 3
  • Flavoring agents lack safety data for inhalation 3
  • Volatile organic compounds (VOCs) and particulates 5

Vulnerable Populations at Higher Risk

• Adolescents and youth:

  • More vulnerable to addiction and nicotine's harmful effects 1
  • Disruption of brain development 1
  • Increased addiction vulnerability 1
  • Usage rates as high as 27.5% in high school students in 2019 4

• Pregnant women:

  • Nicotine crosses the placenta affecting fetal development 1
  • Can lead to impaired fertility, type 2 diabetes, obesity, hypertension in offspring 1
  • Causes neurobehavioral defects and respiratory dysfunction in offspring 1

• Individuals with pre-existing conditions:

  • Increased risk for those with respiratory or cardiovascular conditions 1
  • Compromised immune systems may be more vulnerable to effects 5

Environmental Risks

• Secondhand exposure:

  • Aerosol contains nicotine and other harmful toxicants 1
  • Poses health risks to non-users, especially in enclosed spaces 1, 5

• Thirdhand exposure:

  • Residue remains on surfaces and in dust 1
  • Can react with oxidants to yield secondary pollutants 1

Clinical Management of EVALI

For patients with suspected EVALI, the CDC recommends 2:

1. Initial clinical assessment:

   • Vital signs, pulse oximetry
   • Focused history and physical exam
   • Rule out other possible etiologies (influenza, pneumonia)

2. Determine if hospitalization is needed based on:

   • Oxygen saturation <95% on room air
   • Respiratory distress
   • Comorbidities that could compromise cardiopulmonary reserve
   • Inability to discontinue e-cigarette use

3. For hospitalized patients:

   • Discontinue all e-cigarette and vaping product use
   • Consider corticosteroids (associated with clinical improvement)
   • Ensure follow-up within 48 hours after discharge
   • Schedule pulmonology follow-up within 2-4 weeks

Prevention and Recommendations

• Healthcare providers should routinely screen for all tobacco product use, including e-cigarettes 1
• Advise all patients, especially youth and non-smokers, to avoid initiating vaping 1
• For smoking cessation, recommend FDA-approved nicotine replacement therapy and counseling rather than e-cigarettes 1
• The American Heart Association, American Academy of Pediatrics, and American College of Cardiology recommend against using e-cigarettes for smoking cessation 1, 4

Important Caveats

• Long-term health effects remain incompletely understood due to the relatively recent emergence of these products 1, 6
• Rapidly evolving e-cigarette technology and formulations make standardized research challenging 1
• While e-cigarettes may have lower levels of some toxicants than combustible cigarettes, they are not harmless and introduce their own unique risks 5, 6
• Accidental poisonings in children from e-juice liquids have increased 5