Tuesday, August 20, 2019

To vape or not to vape...

What is an e-cigarette and why should you care? Electronic cigarettes are battery-operated devices that heat a liquid solution to generate an aerosol that users inhale. The liquid contains nicotine and a liquefier, either glycerin or propylene glycol, and flavoring. While the device itself can be as large as the pipe smoked by Sherlock Holmes or a cigar, most are closer to the size of a cigarette. The most popular delivery device is smaller than a standard disk-on-key and sold by Juul.
Juul is heavily marketing their product as a healthier alternative to cigarettes and claims to be marketing only to adult smokers. For those of us with long memories, this recalls filtered cigarettes being marketed as a healthier choice, or the “doctors prefer Camels” ads of even longer ago. The fact is that use of e-cigarettes by U.S. youth surpassed their use of traditional cigarettes in 2014, and by 2017, 20% of high school students reported having used them. Studies have shown that among teens and young adults who have not previously smoked, the odds of starting are three to six times greater among those who have tried e-cigarettes. A study published on-line this week on JAMA NETWORK found that the odds of marijuana use in adolescents and young adults was 3.5 times higher among those who used e-cigarettes.
Are there any health benefits? Switching from cigarettes to e-cigarettes does reduce the amount of tars and other carcinogens inhaled. Among smokers with chronic lung disease who switched, there were fewer reported lung symptoms (cough and shortness of breath), and measured lung function improved slightly in those who switched.
The harms are led by the fact that e-cigarettes deliver nicotine, a highly addictive substance and one which damages brain development in youth, and that they appear to act as a “gateway” to use of traditional cigarettes and marijuana. The delivery of nicotine is highly variable, and nicotine poisoning can occur. There are many unknowns about the effects of the liquids inhaled.
More dramatic ill effects have led headlines. There have been at least two cases reported in which the lithium batteries led the device to explode, in one case killing the user by severing his carotid artery (the main artery in the neck bringing blood to the brain), and in another shattering his jaw and requiring multiple surgeries to correct the damage. These may have been flukes, but there is a reason that airlines do not let you pack lithium batteries in checked baggage. Between 2009 and 2016, the US Fire Administration recorded 195 documented incidents of fire and explosions involving e-cigarettes, resulting in 133 injuries, 38 severe enough to require hospitalization.
The FDA announced on August 20 that it had received 127 reports of seizures or other neurological symptoms suspected to be related to e-cigarettes over the period 2010-2019. In addition to seizures, some people suffered fainting or tremors.
Also very worrisome are the reports from several states this summer about a mysterious severe lung disease among previously well adolescents and young adults who vaped. First reported in Wisconsin, multiple cases have now been reported from Illinois, California, Indiana and Minnesota. The CDC has at least 94 cases from 14 states reported between June 28 and August 15, 2019 under investigation. These previously healthy young people developed cough and shortness of breath, and some required respirator support. No infectious cause could be found. While a cause-and-effect with vaping cannot be proven, it was the common thread.
A recently published study in Radiology reported that inhaling even nicotine-free e-cigarette vapor in healthy young non-smokers caused constriction of blood vessels.
The bottom line? If you are not now a smoker, do not try these thinking they are “safe.” If you are a smoker who has been unable to quit, switching to e-cigarettes MAY be slightly less unhealthy, with a lot of unknowns. All of us should work hard in our communities to keep e-cigarettes out of the hands of youth and make education about their harmful effects part of the school curriculum.

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