Vaping: Safe Alternative to Smoking or Hazardous to Your Health?

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Not so long ago, vaping – or inhaling vapor from an electronic cigarette – was seen as a healthier alternative to smoking tobacco cigarettes. After all, solid research showed that smoking tobacco causes lung disease and cancer. But recent reports have linked serious lung injury – and even deaths – to vaping. UH emergency room physician Benjamin Boswell, DO, explains how e-cigarettes cause illness and why people are coming to the ER after vaping.

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Podcast Transcript

Macie Jepson

Well, we've all seen the headlines. Something is killing people who use vaping products. And something is leaving thousands of others with permanent lung damage.

Pete Kenworthy

Yeah. What was initially marketed as the safe alternative to smoking cigarettes has now catapulted into this industry that's leaving some people, at the very least, baffled. Right? What's in this stuff?

Macie Jepson

Hi, everybody. I'm Macie Jepson.

Pete Kenworthy

And I’m Pete Kenworthy and this is Healthy@UH. Today, we'll break down what is happening in emergency rooms across the country as people are succumbing to damaged lungs after vaping. And we're going to discuss whether vaping is or whether it can be this healthy option for smokers the way that it was initially marketed.

Macie Jepson

So, Pete, you and I've talked about this. You don't have a lot of backstory. I do. We always told our kids, listen, vaping will put moisture in your lungs. That can't be a good thing. We don't know. This is new. Sat them down, scared them to death. They didn't try it in high school. Then one of our college daughters comes home this summer, and about two months into the summer she starts coughing this wet, deep cough. I'm like, what is going on? Antibiotics didn't fix it. I'm worried. Gary's worried. We walk into her room. He finds this thing that looks like a thumb drive into her computer. He pulls it out, and it's a vaping product. We have a long talk. We sit down. We have a family discussion. He found her pods, by the way. No, it wasn't THC. But she had gotten it as a gift at the beginning of summer and started using it. And guess what? About two weeks after she stopped, the cough went away. It was scary for us. At the end of the day though, we still don't know exactly what happened and what went wrong.

Pete Kenworthy

Yeah, the good news is she's OK today.

Macie Jepson

Yes, she is.

Pete Kenworthy

As we like to say, we're not the experts here, right? But Dr. Benjamin Boswell is. He's an emergency room physician from University Hospitals. He's on the front lines in our ER, and he has firsthand knowledge of what these illnesses look like. Doctor, first of all, thank you for being with us.

Dr. Benjamin Boswell

Thank you for having me.

Pete Kenworthy

We have all seen enough headlines to know that something isn't right here. Right? But the question is, well, this is what keeps going through my head. Cigarettes aren't going to send you to the emergency room, but vaping can. So what's going on? You're actually seeing people in the emergency room as a result of vaping.

Dr. Benjamin Boswell

Yeah, we are. So, what we're really referring to is previously known as vaping associated lung disease, which has become well-known to the medical population. It's becoming aggressively worse. And we actually have a new definition as of October 11th, 2019, and it's called E-cigarette or Vaping product use Associated Lung Injury or EVALI, E-V-A-L-I. And what this is is, simply put, it's causing lung damage or acute lung injury. So, you know, there's a lot of discussions about what could be the cause, and the CDC has been very aggressive with trying to find out what is causing these issues. So, you know, and it can go any, it can be anything from mild, like an acute asthma attack in an asthmatic or something that mimics an asthma attack in a young, healthy individual to something more severe as in causing them to actually be, have mild hypoxia or difficulty with oxygenation because of acute lung injury. Or even the most severest form, we've seen patients that have had to actually have cardiopulmonary bypass because of this severe lung injury.

Macie Jepson

And so, we're hearing that there isn't one common denominator across the board with these illnesses, but a majority, some people are saying as high as, you know, 70 percent, it's related to THC. So, take that out and is the problem solved?

Dr. Benjamin Boswell

Not necessarily. So, what we have found is that the majority of patients that have been diagnosed with EVALI are approximately, depending on which study you read, is anywhere from 70 to 85 percent of patients that have EVALI did admit to use of THC pods or vaping pods. But also there is a significant portion of patients that have been diagnosed with EVALI that have not used THC. The most common culprits we have, that we feel are, are nicotine and THC. So, approximately, depending, again, depending on the paper you read, approximately 58 percent of patients said they've used nicotine pods. And like I said before, you know, anywhere from seventy to 85 percent of these THC pods.

Pete Kenworthy

Is it possible that number is, and maybe I shouldn't go down this road, but is it possible that number is even closer to 100 percent because people aren't admitting to THC being in there? I guess there's no way to know that.

Dr. Benjamin Boswell

Yes, absolutely. And I'm glad you said that because I was thinking the same thing, and that's what we've all thought is a lot of times patients will not admit to using THC because it is a component of marijuana. So, absolutely.

Macie Jepson

Hmm. OK. So, Doctor, let's talk about what is in these pods that is so concerning?

Dr. Benjamin Boswell

So, what we believe is it’s actually the burning of the oils in the pods. So, whether it's flavoring oils or, which has been the most commonly believed causative agent, what we've recently found is something called vitamin E acetate. As of a recent paper released by the CDC, which is what we believe it to be, but also in the burning of these oils, there's something called hydrocarbons, which we know can be very damaging to tissue. There was a recent study put out a few months ago showing the different substances that have been released from burning vaping pods anywhere from, again, these damaging hydrocarbons, but specifically, we found things such as formaldehyde as we know is a preservative agent we use for tissues in cadavers. There's also been things discovered like toluene or benzene, which are common chemicals in solvents, which these are just three examples of approximately 80 different volatile compounds that they’ve found in these substances.

Macie Jepson

And we need to, I guess, underscore the fact, and people probably know this, but it's not FDA regulated, is it? Or not to a great extent?

Dr. Benjamin Boswell

Correct. So, a lot of these pods are actually retrieved from or bought in headshops or shops selling smoking products, which are not FDA regulated. So, there's a lot of substances in these pods that we don't even know about yet.

Pete Kenworthy

I want to go back to when we talked about cigarettes aren't putting you in the ER, but vaping is. How quickly is that happening? Is this something where you could vape a couple of times, and these chemicals get in your system and you're in the ER? You're at least having to see a doctor that quickly?

Dr. Benjamin Boswell

Yeah. So, that's what we’ve found is that there are these episodes of acute lung injury, and the question is how much or how little does it take? We don't really know. We have had episodes where we've had, I've seen a patient who says they've only been using it for a couple of weeks and had a very significant lung injury. And then there's also patients who've been vaping for years and years and never had a problem once. So, it’s, and this is also part of the uncertainty of what is causing this. Is this new because of something we're just now recognizing? Or is this new because now it's become more popular so more and more people are using it and more and more companies are producing pods that are perhaps not even regulated, especially with these headshops?

Macie Jepson

So, what would you say to a former smoker who says, wait a minute, this is a better alternative for me? I've got a friend who’s been doing it for a few years now. No issue. Is there ever a safe way to do this?

Dr. Benjamin Boswell

It's a very good question. You know, traditionally, we thought that this was a safer alternative to smoking. And in fact, in some cases it is because there are, at least initially, considered to be less carcinogenic materials in vape pods as there are in traditional cigarettes. However, we're finding that there are plenty of, there are lots of carcinogenic components as well as these hydrocarbons and vitamin E acetate, which are causing an acute lung injury.

Pete Kenworthy

So, one of the things that cigarette smokers were thinking that would be better for them is they're eliminating the tobacco. Right? They're just now getting their nicotine fix, I guess, with something like this. But the dangers are still there even though they're different dangers. Is that what you're saying? And then there's these other things even beyond nicotine.

Dr. Benjamin Boswell

Yeah. Correct. And so, what's interesting is that the amount of nicotine in the vaping pods is not regulated, so they're still being exposed to nicotine. But then we're not even certain how much nicotine there are in these pods. So, it'd be very, very easy for users to actually get more nicotine from the vaping pods and they would from cigarettes.

Pete Kenworthy

There are many people who are using this product who would probably still contend this is still safer for me than smoking cigarettes. True or false.

Dr. Benjamin Boswell

Initially thought true. However, recently we're finding out that that's actually false.

Pete Kenworthy

Worse for you than cigarettes.

Dr. Benjamin Boswell

Correct. In, at least, in this setting. Overall, it's really hard to say, I guess, but I would say for me personally, from what has been, what we've been seeing is that vaping is causing a very serious acute lung injury and, in some cases, leading to death.

Macie Jepson

And so, Doctor, as we wrap this up, what would you say to a person who is thinking about using this as an alternative or just for fun?

Dr. Benjamin Boswell

For me, just because of these episodes of the acute lung injuries or EVALI, I would say you should strongly avoid vaping. Now, when you compare vaping to cigarette use, you know, we know, that, like you said, we know the long-term effects of cigarette use, but we don't know the long-term effects of vaping yet. And that will change because it's become something that's become very popular over the past several years. So, we don't really have any good long-term data on the outcomes of vaping in the long-term. However, I am, from what we've seen recently, I would strongly suggest avoiding vaping simply because of these new findings of the acute lung injuries that are becoming very harmful.

Macie Jepson

And that's after just short-term data.

Dr. Benjamin Boswell

Yes, absolutely.

Pete Kenworthy

All right, Dr. Ben Boswell, ER physician at University Hospitals. Thanks again for being with us.

Dr. Benjamin Boswell

Thank you so much for having me.

Pete Kenworthy

You can find our podcasts on iTunes, Google Play Music, Stitcher or wherever you get your podcasts.

Macie Jepson

And, as always, for more health news, advice from our medical experts and Healthy@UH podcasts, go to UHHospitals.org/blog.