The science of vaping

Adequate nicotine replacement therapy or the gateway to a worldwide health epidemic?

Vaping is viewed globally as a viable and safe alternative to traditional smoking, but this idea is beginning to come under fire with connected cases of respiratory diseases on the rise. 1604 cases of lung injury associated with e-cigarette usage and 34 related deaths have been recorded by the US Center for Disease Control and Prevention (CDC). The root cause of increasing alarm among the general public is the fact that the specific chemical exposure that causes these issues associated with vaping remains unknown. Moreover, there is increasing confusion as to why scientific investigations into the effects have not yet been fully conducted. Consumer trust and confidence in e-cigarettes is at risk. The question remains: why have the exact origins behind these odd respiratory illnesses not yet been identified? A vast amount of the scientific information available regarding the harm associated with vaping is mere speculation. 

So far, what is known is that when the element in an e-cigarette is heated, the e-liquid is vaporised, creating an aerosol. When the cells in the epithelium of the lungs are exposed to this aerosol during inhalation, oxidants and reactive oxygen species aggravate the lungs, causing an inflammatory response and oxidative stress. Generally, these events are key in the progression and course of chronic airway disease.

Two independent studies have shown that when e-liquid without the nicotine component was added to lung cells, it was clear that this was still toxic to them – cells were prevented from replicating and growing. This stands to prove that the mix of chemicals in the e-liquid is definitely harmful to the respiratory system, but to what extent is still unknown. Also, the vapourisation of e-liquid leads to the production of carbonyls, a functional group consisting of chemicals such as formaldehyde, acetaldehyde and acrolein. These reactive compounds tend to disrupt protein function in lung tissue, altering the biochemistry of the respiratory defensive system, potentially causing disease.

However, the levels of potentially harmful carbonyls produced as a result of vaping is only a fraction of the amount produced due to conventional cigarette smoke. Experimental results on varying carbonyl production between vaping and cigarette smoking changes depending on brand and amount of inhalation. There are between nine to 807 times more carbonyls produced by conventional smoking than that produced using a vaping device.

So can we say that vaping is the lesser of two evils when it comes to conventional cigarette smoking and e-cigarette use? There is clear evidence that the use of e-cigarettes has been of tremendous aid to those needing to quit traditional smoking. It has also led to a reduction in the general population’s susceptibility to neurological, pulmonary and cardiovascular diseases. Lung cancer is the most common cancer globally, and led to 1.1 million deaths in 2018. The most important risk factor for the development of lung cancer is tobacco use, especially cigarette smoking. After decades of cigarettes being branded as safe and considered fashionable, it’s no shock that people are sceptical about information shared about anything that may cause harm to the respiration system. So until we know otherwise, vaping devices are adequate and remain government-approved nicotine replacement devices, but restrictions must be adhered to. What if regulations were put in place so that the e-cigarette was treated and sold like a medical device, where professional medical consultation was needed to approve their sale?

Dr. Tanusree Jain, the assistant professor of Ethical Business in Trinity has conducted extensive research on the sale of vapes on a global scale, and urges there be more research done into the risks associated. She comments: “what is very important is to allow the use of e-cigs for those you want to quit traditional smoking … it (the use of e-cigarettes) should not be advertised as “safe” because they aren’t, especially given recent news on deaths due to vaping and ongoing research that suggests that it could be less harmful but not harmless.”

Is vaping being sufficiently portrayed as a gateway to giving up smoking, or is it indirectly being marketed as a pathway to starting? Over the last year, Dr. Jain has spoken publicly on numerous occasions on her research into the sale of e-cigarettes. She expressed how regulations on the marketing of e-cigarettes to younger consumers urgently need to be put in place. She added that restrictions on the age limit for the purchase of vapes are desperately needed, and that companies should be stopped from producing flavours directed in enticing the younger generation to start vaping. In speaking to her on her research she explains: “brand distancing was being created so that an e-cig brand that was manufactured by a tobacco company was sold under a different brand so that no connection could be made … thereafter, these independent brands would open Instagram accounts and popularise their products targeting teenagers by showcasing them as cool, and hip and trendy. This was clearly to create an image appeal.” 

“The mix of chemicals in e-liquid is definitely harmful to the respiratory system, but to what extent is still unknown.”

It seems that not only were e-cigarette companies marketing their product towards young people, but they were successful in their attempts to alter their products to suit the preferences of the adolescents they were exploiting, along with making them easily accessible. These efforts led to an 80% spike in e-cigarette use among teens between the years of 2017 and 2018Dr. Jain believes: “the flavours such as mango and peach and strawberry were to cater to young folks. The older consumers would (it is my assumption) prefer more mint, coffee and such mature flavors. Online sales in many countries also meant that any one could buy these products.”

It is incredible to see a domino effect of political leaders speaking publicly on the issue, having come to the realisation that action is needed to be taken with regards to controlling and monitoring the actions of e-cigarette companies. The Trump administration announced in September that it would push for a new rule banning flavoured e-cigarettes, which are of particular appeal to children. On October 22, Simon Harris spoke of how he believes tobacco companies are working around the clock to try and get another generation addicted to smoking, and hopes that by early next year there will be a ban on the sale of e-cigarettes to under 18s. Following on from this, Dr. Jain commented on how a lot of her predictions with regards to e-cigarettes are beginning to become realities: “many of these things have gradually been restricted – again laws are different in different geographies. For instance, India has completely banned e-cigs with a heavy penalty for users. This happened just a couple months back. Interestingly, tobacco is still being sold.” 

Dr Samuel Chamberlain from the Department of Psychiatry at the University of Cambridge has produced some very interesting finds on the link between mental health disorders and vaping. On speaking to him with regards to his take on the harms associated with vaping, he noted: “In our study, we found that e-cigarette use (vaping) was associated with various mental health difficulties, such as substance use problems, anxiety, and lower self-esteem, in young people.” His studies indicate the need for longitudinal research into the effects of chronic nicotine consumption on brain function and mental health. “Research by other groups has found that e-cigarette use can lead to higher risk of later cigarette smoking in young people. Given how common vaping is becoming, we urgently need more research into long-term associations between vaping and both physical and mental health.”

I think it’s fair to conclude that two things are in vital need of consideration. Firstly, regulations urgently need to put in place on the sale and marketing of vape devices to those under 18. Additionally, it is crucial that more research is done into the harmful effects of vaping, before this “hip cool” trend among the younger generation starts to cause a worldwide epidemic of newly emerging respiratory disease.