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Tip/Thought of the Day

New Studies Show Vaping Disrupts Lung Function

Over the course of several years, we have followed as studies attempted to dissect the cause of increasing cases of lung injuries (called EVALI) related to ENDS (electronic nicotine delivery systems) products. Including vape pens, e-cigarettes, hookah pens, etc- ENDS products come in many forms. Some issues with ENDS products include undeclared ingredients, ingredients that are harmful if ingested, and now new evidence shows that vaping impacts a specific element of lung function, raising the potential for lung injury.

As the prevalence of ENDS products has increased, the U.S. Food and Drug Administration has shifted its response, particularly in light of the dramatic levels of use amongst youth. In some cases, products have been denied market approval, as with the Fontem product line “myblu”. The FDA released the statement, “Based on the information provided in the applications . . . [they] lacked sufficient evidence regarding design features, manufacturing, and stability. Additionally, the applications did not demonstrate that the potential benefit to smokers who switch completely or significantly reduce their cigarette use would outweigh the risk to youth.”

The focus on youth usage of ENDS products is crucial, as it continues to rise. A study released August 2021 in Jama Pediatrics shared the alarming findings that young, healthy adults that use vaping products even once can trigger immediate damage to cells that lays the groundwork for future illness. It was found that even half an hour of vaping leads to oxidative stress within the body, where there is an imbalance of free radicals (molecules which damage cells) and the antioxidants that can fight them.

This is especially concerning as the popularity of vaping continues to grow among teens and young adults. Nearly 30% of high school students in a 2020 study said they had used an e-cigarette during the previous month. That even one-time use of vaping products can wreak havoc on young bodies raises serious alarm as the long-term effects are still not known.

Newest study reveals vaping damages critical element of lungs

Inhaling vape products may damage a critical layer of the lungs called surfactant. Made of lipids and proteins, surfactant makes it possible to breathe with minimal effort by reducing surface tension. Researchers say breathing would require more effort and possibly mechanical help without this layer.

“Vaping continues to be popular, but not much is known about what happens with the aerosol when it enters the lungs,” said researcher Ruud Veldhuizen, a scientist at the Lawson Health Research Institute in Ontario, Canada. The researchers shared that when vapor enters the lungs, the first element of the lungs it comes into contact with is the surfactant, “After vaping, we saw high surface tension, which suggests the surfactant would not be as effective at supporting proper lung functioning”.

The FDA exerts authority as concerns persist

In previous years, the FDA was heavily criticized as it was deemed too lenient on ENDS manufacturers, particularly during the review process. The FDA allowed a two-year window for manufacturers to continue selling their products while submitting them for review- and an additional year to allow for the review to be complete. During these time frames, no adjustments to the products are required, essentially leaving consumers vulnerable to any ill effects they may cause. But since then, and as lung injuries persisted, the FDA has exerted its authority.

Previously, some flavored tobacco products were removed from the market (July 2020), as they did not have adequate pre-market approval and were deemed as highly youth-appealing. Most recently in July 2022, the FDA issued marketing denial orders (also referred to as MDOs) to JUUL Labs Inc., one of the largest manufacturers, for all of their products currently marketed in the United States. As a result, the company must stop selling and distributing these products. In addition, those currently on the U.S. market must be removed, or risk enforcement action. The FDA release shared:

“FDA determined that the applications lacked sufficient evidence regarding the toxicological profile of the products to demonstrate that marketing of the products would be appropriate for the protection of the public health. In particular, some of the company’s study findings raised concerns due to insufficient and conflicting data – including regarding genotoxicity and potentially harmful chemicals leaching from the company’s proprietary e-liquid pods – that have not been adequately addressed and precluded the FDA from completing a full toxicological risk assessment of the products named in the company’s applications.”

State laws result in wide availability of cannabis ENDS products

ENDS products had previously been solely an alternative to traditional nicotine smoking products (e.g. cigarettes and cigars). As state have legalized cannabis products for medial and recreational use, cannabis ENDS products have become the focus of new studies.

Often called a “gateway drug”, cannabis has been legalized by 39 states (in addition to Washington D.C.) for medical and recreational use. Cannabis is recognized as having a variety of medicinal properties that can help manage a range of health conditions, from anxiety and cancer to chronic pain and more. Still classified as illegal by the Federal government, state laws have opened up the market to cannabis ENDS products that may contribute to increased cases of lung injuries.

Sources share that vaping THC (a cannabinoid in marijuana) oil just once can significantly impact your lungs. A study in the Journal of the American Medical Association found that first-time and infrequent users of marijuana were more likely to experience adverse reactions from vaping THC oil. This study’s authors suggest that the negative impacts of this THC ingestion method are largely due to the enhanced delivery of the oil. This was evidenced by participants having more pronounced effects and experiencing significant impacts on their motor skills and cognitive abilities.

Studies have found:

  • Smoking marijuana harms your lungs, but vaping marijuana appears to be even worse.
  • While additional research is needed, vaping marijuana appears to be more dangerous than vaping or even smoking nicotine products due to the method of delivery of the THC oil.

After conducting a study published in 2021, researchers said they were surprised to find that vaping marijuana was even worse than using e-cigarettes. Among adolescents, marijuana vaping was significantly more likely to cause symptoms of lung injury.

As researchers continue to explore the consequences of vaping any product, what is already clear is that using ENDS products can result in lung injuries. “Just like there is no safe level of tobacco cigarette smoking, there is no safe level of electronic cigarette vaping — vapes are not harmless, and nonsmokers should not use them,” said lead researcher of the study exploring the damage from oxidative stress related to vaping, Dr. Holly Middlekauff, a professor of cardiology and physiology at the University of California, Los Angeles David Geffen School of Medicine.

If you are looking to quit smoking, the CDC shares these resources as a starting point, or call 1-800-QUIT-NOW.










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