Vaping, also known as electronic cigarette or e-cigarette use, has gained substantial popularity in recent years.

It involves the inhalation of aerosolised substances, typically referred to as vapour, produced by an electronic device. It has gained popularity among individuals seeking an alternative to traditional smoking, especially among young adults and current or former smokers.

A vaping device consists of a battery, a heating element, and a cartridge or tank containing an e-liquid solution. Users inhale the vapour produced when the heating element vaporises the e-liquid.

What are the different types of vaping devices?

Cig-a-likes

Resembling traditional cigarettes, these devices are often disposable and have limited customisation options.

Vape pens

They are larger and more powerful than cig-a-likes, often refillable, and offer more customisation options for e-liquids and heating elements.

Mods and advanced personal vaporisers

APVs are more complex devices, allowing users to customise various settings such as wattage and temperature. They often have removable batteries and larger e-liquid tanks.

What is in the e-liquid?

E-liquids are the substances vaporised and inhaled during vaping. They typically consist of a mixture of propylene glycol (PG), vegetable glycerin (VG), flavourings, and often nicotine or marijuana, or both. PG and VG serve as the base for e-liquids and help produce vapour, while flavourings provide the desired taste.

In addition, vaping aerosols contain a variety of other chemicals, often harmful, including volatile organic compounds (VOCs), such as formaldehyde and acetaldehyde, which can be generated when the e-liquid is heated, heavy metals (eg lead, nickel, tin), and ultrafine particles. The presence and levels of these chemicals can vary depending on the specific device, e-liquid ingredients, and usage patterns.

What is the role of vaping in smoking cessation?

It appears that e-cigarettes may be effective aids for smoking cessation. One advantage of e-cigarettes is their resemblance to conventional cigarettes in terms of appearance, taste, and handling, which may make them more appealing to users.

E-cigarette users experience a reduction in cravings for traditional cigarettes. It is important to note though, that there is a concern that the availability of e-cigarettes as an alternative may discourage individuals from utilising other proven smoking cessation medications that have established safety and efficacy records.

In that regard, the American Thoracic Society recommends the use of established pharmacotherapy, such as Varenicline, for smoking cessation rather than e-cigarettes. Similarly, the US Preventive Services Task Force acknowledges that the current evidence is insufficient to fully evaluate the benefits and potential harms of e-cigarettes for smoking cessation, especially after the 2019 Evali outbreak (see below).

What are the potential effects of vaping on health?

Short-term effects

Vaping can lead to acute effects such as throat and mouth irritation, coughing, and increased heart rate. These effects are generally milder compared with traditional smoking.

Respiratory effects

Several studies have shown that vaping can cause lung inflammation, indicated by increased levels of inflammatory markers in the lungs. This inflammation can potentially contribute to respiratory symptoms and lung damage. In 2019, a widespread outbreak of lung injuries associated with vaping occurred, known as Evali. Clinical studies have linked Evali to certain chemicals or contaminants present in some types of e-cigarettes or illicit vaping products. Evali can cause severe lung damage and even be life-threatening.

In addition, research suggests that vaping may impair the immune response in the respiratory tract, making individuals more susceptible to respiratory infections such as pneumonia and bronchitis.

Cardiovascular health

Vaping has been shown to cause a temporary increase in heart rate and blood pressure, which can put strain on the cardiovascular system. Prolonged and repeated exposure to these effects may have long-term implications for heart health. Also, some studies have found an association between vaping and arterial stiffness, a risk factor for cardiovascular disease, including chronic hypertension, heart attacks and strokes.

Cancer risk

Many e-cigarette components are carcinogens. While these chemicals are generally present at lower levels than in traditional cigarettes, their inhalation still poses cancer risk through DNA damage, similar to the effects observed with traditional smoking. DNA damage is a potential precursor to the development of many forms of cancer.

Gateway to smoking

Vaping can also “normalise” smoking behaviour, especially in children and young adults. Several studies have also indicated that it can act as a gateway to traditional cigarette smoking, due to the addictive nature of nicotine in e-cigarettes, which can lead to a transition from vaping to smoking.

Finally, and in the interest of brevity, it is worth mentioning that there are currently some discrepancies in e-cigarettes and vaping recommendations between different nations, including between the USA and the UK, and further and clearer regulations are expected to come out in the next years from the WHO and various countries.

• Joe Yammine, MD is a consultant cardiologist at the Bermuda Hospitals Board. The information here is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician.