Because of growing safety concerns, the U.S. Food and Drug Administration (FDA) issued a ban this month on specific types of vaping products. Recent research from investigators at Johns Hopkins Medicine in Baltimore further fuels the argument that e-cigarettes are not good for you. Their analysis found that inhaling heated tobacco vapor through e-cigarettes increased the odds of chronic obstructive pulmonary disease (COPD) and asthma — two conditions long associated with smoking traditional combustible cigarettes. In one of the reports published this month in the American Journal of Preventive Medicine, the Johns Hopkins team reviewed data from more than 700,000 individuals and calculated that about 11 percent of e-cigarette users said they had chronic bronchitis, emphysema, or COPD — twice as many as reported having those chronic health problems among those who said they had never used e-cigarettes. In a separate, related analysis of the same data published in October 2019 in BMC Pulmonary Medicine, the scientists found that almost 11 percent of the e-cigarette users reported having asthma, compared with 8 percent of those who had never used e-cigarettes. “The e-cigarette aerosols contain nicotine, ultra-fine particles, heavy metals, and cancer-causing chemicals,” says Albert Osei, MD, the lead author on both investigations and a postdoctoral research fellow in the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins Medicine. “Studies suggest that exposure to e-cigarette liquids or aerosol extracts could lead to impaired antimicrobial defenses and destruction of lung tissue.” The bottom line, according to Dr. Osei, is that e-cigarettes contain ingredients that can do real damage to our health. RELATED: 8 Steps That Helped Me Finally Quit Vaping
A Breath of Not-So-Fresh Air: 2 Studies Identify Vaping Risks
For the study on asthma, Osei and his collaborators examined information from 402,822 “never smokers” — they reported smoking fewer than 100 combustible cigarettes in their lifetime. Less than 1 percent (3,103) identified themselves as e-cigarette users. A total of 34,074 reported having asthma. The scientists calculated that the current e-cigarette users were 39 percent more likely overall to indicate having asthma compared with those who never used e-cigarettes. That likelihood rose according to the frequency of vaping. The risk of having asthma was 31 percent greater among those who used e-cigarettes only some days but jumped to 73 percent among daily users compared with the never users. The research highlights how e-cigarette use is a problem much more common among young adults than older adults — the average age of users was 18 to 24 years old. About two-thirds were men and more than half (57 percent) were white. In the report regarding COPD, the analysis included 705,159 adults. Approximately 9 percent identified themselves as current tobacco smokers, more than 3 percent said they currently enjoyed e-cigarettes, 30 percent were former smokers, 61 percent had never smoked, and 2 percent reported using both e-cigarettes and traditional cigarettes. Those currently vaping but not smoking cigarettes were 75 percent more likely to report having COPD compared with those who never used e-cigarettes. The e-cigarette users in this analysis were slightly older (30 to 34 on average). A total of 60 percent were men and 72 percent identified as white.
The Double Whammy of Both Vaping and Smoking
Osei expressed special concern for individuals who partake in both e-cigarettes and regular combustible tobacco. Among the 2 percent of participants in the study who reported using both combustible and e-cigarettes, the dual users were almost six times more likely to report having COPD compared with those who had never used either. Those who smoked only regular cigarettes, however, were only three times as likely to indicate they had COPD compared with individuals who had used neither e-cigarettes nor combustible cigarettes. “Our analysis shows that dual users of e-cigarettes and combustible cigarettes had the highest odds of COPD,” says Osei. “The use of e-cigarettes may actually act additively with smoking combustible cigarettes to promote the pathophysiology [functional changes from a particular disease] of COPD.”
Reconsidering Vaping as a Cessation Tool
As reported in Everyday Health in November, many people have turned to e-cigarettes as a way to quit smoking. In that article, Enid Neptune, MD, an associate professor of medicine at Johns Hopkins Medicine, warned that, ironically, some individuals may be viewing traditional smoking as the healthier option as concerns over vaping rise. “As a pulmonologist, I was originally pushing e-cigarettes on patients who smoked to get them to stop smoking,” says Mangala Narasimham, DO, a pulmonary disease physician and regional director of critical care medicine at Northwell Health in New Hyde Park, New York, who was not involved with the study. “But now I’ve seen 40 or so patients who vape with asthma or COPD — many of whom are very sick and [who have] needed to go to an ICU. So there is more to the story with vaping than we first thought.” Osei adds that, unfortunately, many who try vaping as a route to quitting smoking wind up doing both. It’s worth noting that e-cigarettes are not approved by the FDA as a smoking cessation method.
Questions Still to Be Answered
Because these scientific reports from Johns Hopkins relied on self-reported responses gathered through a large federal government telephone survey of adults, Dr. Narasimham suggests that the results may not accurately reflect the extent of the problem. “The study gives a sense of how many times people have been sick, but it wasn’t based on actual pulmonary function testing or any actual diagnosis by CAT scan of COPD or asthma,” she says. RELATED: Pulmonary Function Tests and the Other Ways Doctors Diagnose Asthma Osei emphasizes it’s important to recognize that the findings do not prove a causal relationship either — they only identify an association between vaping and respiratory problems (meaning it’s impossible to know from this data if it’s the vaping alone that’s causing the respiratory problems). He also notes that details on e-cigarette device types and flavorings used were not available in the study. “Still, the findings provide a robust rationale and a strong scientific premise for conducting longitudinal studies to explore the pulmonary risk associated with using e-cigarettes, particularly in those individuals who have never smoked combustible tobacco products,” he says. Narasimham believes future research needs to focus more on determining the ingredients that actually go in to e-cigarette products and how heating affects these ingredients. “Our young people are doing a lot of vaping, so we very quickly have to figure out what is safe or not safe,” she says.
