Clearing the Air: The Truth About Vaping and Lung Health

Vaping, initially intended as a smoking cessation tool, has evolved into a harmful trend, especially among young people. Tushi Singh, M.D., and Ricardo Franco, M.D., pulmonologists at Texas Tech Physicians, talk to us about the history of vaping and why it's harmful to our health, and stress seeking professional help for smoking cessation. 

Dr. Singh's previous episode: "When Breathing Gets Hard: Understanding COPD"

Sara Tello, APRN, on smoking cessation: "The Great Escape: Breaking Free from Nicotine Addiction"

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. Vaping might seem harmless, but it can cause significant harm, especially among young people. According to the 2023 Texas Youth Tobacco survey, 13.8% of middle and high school students reported having used or trying e cigarettes in 2023. Among adults 18 to 29 49.5% reported having tried or using an e cigarette product. What makes them so unsafe and how do they affect our lungs is this episode's topic. Previous guests, Dr Tushi Singh and Dr Ricardo Franco, both pulmonologists with Texas Tech physicians, tell us about the history of vaping or E cigarettes and how they started as a way to help smokers quit, but how chemicals, aerosols and carcinogens make vaping harmful and as addictive as cigarettes.

Melissa Whitfield  1:28 
Dr Singh, Dr Franco, welcome to our podcast.

Dr. Ricardo Franco  1:30 
Thank you for having us.

Melissa Whitfield  1:31 
Dr Singh, welcome back.

Dr. Tushi Singh  1:33 
Thank you.

Melissa Whitfield  1:34 
How are y'all doing today?

Dr. Ricardo Franco  1:36 
I'm doing great. Thank you for asking.

Dr. Tushi Singh  1:38 
I'm doing well too. I'm really excited to be back.

Melissa Whitfield  1:38 
Can y'all tell us a little bit about yourself, what you do here at the Health Sciences Center and your expertise?

Dr. Tushi Singh  1:46 
Okay, well, my name is Dr Tushi Singh. I am an assistant professor in pulmonary and critical care medicine, and I've been here for about four years now. I'm really excited to be back on this podcast talking about pulmonary health.

Dr. Ricardo Franco  2:02 
And I'm Ricardo Franco. I am an assistant professor of pulmonology and critical care, specializes in interventional pulmonology. And same, I'm excited to be here and talk about E cigarettes.

Melissa Whitfield  2:15 
Well, welcome to our podcast. And as you mentioned, we're going to be talking about vaping, and then E cigarettes. How did vaping start and what was it originally intended for? Are they the same as E cigarettes?

Dr. Tushi Singh  2:28 
So vaping are indeed the same as E cigarettes? So this was patented back in 2003 the term vaping comes from use of vapors and E cigarettes to vaporize the nicotine or the THC, and that's how vape became popular. But essentially they are both the same things. The initial intention was to help people quit smoking, but back in 2008 WHO proclaim that this is not to be used as a smoking cessation tool. And through the course of our podcast, we'll talk about why this came about.

Dr. Ricardo Franco  3:11 
Yes, so initially, as Dr Singh mentioned, the trend was to try to use them as a as a help for people who are smoking. And initially the mechanisms that were used were very similar. They looked like cigarettes.

Melissa Whitfield  3:25 
How did it change from a smoking cessation tool to a trend?

Dr. Tushi Singh  3:30 
Very interesting. So when it was initially launched as a smoking cessation tool, the liquid that was presented e cigarettes was mostly nicotine, and obviously people raise skepticism about how this would help with quitting smoking, especially because nicotine is the most addictive component of cigarettes. So the companies that launched e cigarettes now found a segue into different flavors of E cigarettes, because they saw that this had become really popular among teenagers and youngsters, and that is what led to this trend of increasing use in E cigarettes, the availability of flavors and them being marketed as a quote, unquote, safe alternative to smoking.

Dr. Ricardo Franco  4:18 
Yeah, and I believe currently, there are over 7000 different variants of flavors that you can be used so.

Melissa Whitfield  4:25 
So what types of vaping products are there and are any of them safe?

Dr. Tushi Singh  4:29 
So the most common ones are nicotine ones. You know, these are the ones which were first launched in the market. But with time, you know, they started adding other components to it. Then came along Tetra Hydro Cannabinol, which is the active component of cannabis that became really popular. And if you will recall, back in 2010 there was an epidemic of hospital admissions and some unfortunate deaths with this use. And then the so called flavored ones, you know. Which they say do not really use any addictive substances, but most of the research shows that in the vapes there are a lot of heavy metals like nickel, lead and other hydrocarbons, all of which are known to be very toxic to humans. Is it as bad as, as carcinogenic as cigarettes, maybe not. Studies have shown that they are not. But is it completely safe to allow its unbridled use? Also no.

Melissa Whitfield  4:29 
Why isn't vaping uh quote, unquote safe alternative to smoking, even the nicotine free juice?

Dr. Ricardo Franco  5:35 
So in regard to safety, as Dr Singh mentioned, there are a lot of other products in the solutions themselves. Heavy metals, volatile carbon compounds that you are inhaling. And even though they may not have nicotine in them, you are still inhaling all of these, these contaminants, and many of those have been linked to lung injuries.

Melissa Whitfield  6:06 
Well, that leads us to the next question, what are some of the short term and long term health problems from vaping?

Dr. Tushi Singh  6:13 
So the short term health problems, if among our listeners, we have students of microbiology and pathology, maybe it will interest them when I explain how inhalation of these aerosols will affect the local lung immune system. It affects how the mucoceli action works. It affects how the local macrophages work, and in the short term, it makes the person that's using vapes more prone and more vulnerable to viral infections and bacterial infections, which means, if you were to take an otherwise healthy college student and if they were exposed to a common cold virus, the ones that don't smoke will get over it in less than 48 hours, like most of us who do not smoke do, but the ones who do use vapes or any other kind of smoking devices are likely to succumb to complications like pneumonia, and very recently, I had a young patient that presented with a pneumo mediastinum and then developed a pneumothorax, which is basically leaking of air from the lungs into the rib cage. As I'm sure, Dr Franco has seen people with such complications.

Dr. Ricardo Franco  7:24 
Yes, recently we had a patient who had tried to come off of cigarettes, and she was using vaping products. Otherwise than her smoking she had no other health issues at the time, and she ended up in the medical ICU, intubated. And was unable to come off the ventilator because of the extensive damage that had occurred secondary to the vaping. Long term damage, in her case, was consistent with ARDS, which then started leading to lung fibrosis, which is permanent.

Melissa Whitfield  8:00 
Is quitting vaping as difficult as quitting cigarettes, and how long does it take for our lungs to start recovering?

Dr. Ricardo Franco  8:07 
Just to kind of give you an idea, regular brand cigarettes like your Marlboro Reds, for example, have about 10 to 12 milligrams of nicotine per each and the lighter cigarettes usually have about half of that. So the nicotine that is delivered in these products is, you know, mostly within the range of 6, 14 milligrams, 21 but some can even go up to 35 or even higher. So in reality, you know, while many will try to use these as a, you know, as a step to quit smoking cessation and be not reliant on or dependent on nicotine products. They are sometimes receiving more nicotine from these products than they would from cigarettes. So they were still addicted to the nicotine itself. So it's definitely very difficult to quit as well.

Dr. Tushi Singh  8:55 
As far as recovery is concerned, I think I have come across some studies that say that the longer you've been smoking cigarettes, or likewise, e cigarettes, the longer your period to recovery becomes. On an average, once you quit smoking completely, we find that immune cells inside your lungs, they start to recover their function in the six to eight week period. But for the lungs to recover completely will depend upon the extent of damage that has been caused from the prior smoking and use of E cigarettes.

Melissa Whitfield  9:32 
What should parents tell their children about vaping?

Dr. Ricardo Franco  9:37 
Well, that it's definitely not safe. You know, one thing that I guess, behind the scenes the concern is that these help emulate a culture of smoking, because they look like cigarettes and so with that, you know, they can be influenced in their behavior at a later date about smoking. Also, you know, smoking at a young age you are prone to a lot of lung injuries, as Dr Singh mentioned of her young patient who had a pneumothorax, several young patients will come in with pneumothoraces, just in and of themselves, for no reason or cause. So the vaping will actually put them at a higher risk of these processes or diseases, you know, and still, the long term effects of vaping are not fully known at this time, and the FDA is still actively researching this to see how, you know what are the long term effects from vaping?

Dr. Tushi Singh  10:31 
At this point, I would tell all parents to warn their children about the side effects of E cigarettes, because even though they are being marketed as being safe, and you know, in our minds, we think, if something is strawberry flavored, how could it potentially be harmful? And this is why we like to reiterate to all of our patients that, yes, it might sound quite mundane and not dangerous, but the presence of all these toxic substances in the oils that they use can cause extensive lung damage. Once again, I'd like to take you all back to the epidemic in 2010. At that time, we had discovered that it was Vitamin E acetate, that was a liquid that was used to thicken the solvent in THC, is what was causing extensive damage to the lungs, and that led to multiple ICU admissions among the users. So FDA has currently banned that. How well that ban is being enforced, we don't know with you know the unrestricted sale of these products online as well as at stores, so it's better to be safe than sorry and stay away from these kind of products.

Melissa Whitfield  11:46 
What can we say or do for loved ones to help them quit or not take up vaping?

Dr. Ricardo Franco  11:51 
You can slap the vape out of their hand. Well, you know, touching on what we've discussed here, it's definitely not a safe alternative. And while it is not the traditional inhaling of smoke, it is not in it of itself, without its inherent dangers and harmful effects. And as things progress and as more research research comes out, we will then start to find out the long term effects of this, but you don't want to be a guinea pig for it.

Dr. Tushi Singh  12:26 
Yeah, that's exactly right. Do not become a statistic. Instead, what I would recommend strongly is to simply Google quit smoking, and that will take you to several resources which are available for free on these websites that will help you quit this habit. If you're interested Texas Tech also runs a smoking cessation clinic, and we will be more than happy to see our patients and help them with quitting smoking, quitting e cigarettes. And we also offer electronic visits. Our nurse practitioner, Miss Sara Tello, who is extremely dedicated to this practice always goes out of her way to help patients out. So if you're struggling with the addiction to E cigarettes and you don't have anybody you can turn to. If you don't trust your friends and family you don't think they will give you support, please reach out to us. We're here for you. We will help you.

Melissa Whitfield  13:21 
Is there anything else you'd like to add?

Dr. Tushi Singh  13:24 
Yeah, stay healthy. We like healthy lungs.

Melissa Whitfield  13:27 
Well, thank you so much for coming on our podcast. Dr Singh, thank you so much for coming back, and we hope to have you all come back soon.

Dr. Ricardo Franco  13:34 
Thank you.

Dr. Tushi Singh  13:34 
We look forward to it. Thank you so much.

Melissa Whitfield  13:38 
Thank you for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Krystal Meazell, Kay Williams and me, Melissa Whitfield.