Vaping, the inhalation of aerosolised substances (including nicotine) produced by electronic delivery systems (ENDS), has gained widespread popularity in recent years. In the United Kingdom, the prevalence of vaping has increased significantly; teens and young adults have seen the biggest uptake in use of vape pens, which have superseded conventional cigarettes as the preferred modality of nicotine consumption.
Relatively little is known, however, about the potential effects of chronic vaping on the respiratory system. Further, the role of vaping as a tool of smoking cessation and tobacco harm reduction remains controversial and continuously debated.
Here, we provide an examination of vaping’s impact on respiratory health, encompassing clinical aspects, vaping-related lung injuries, and its role in smoking cessation, ultimately concluding with an evaluation of health outcomes among vape pen users.
Clinical Aspects of Vaping
Vaping involves the inhalation of a mixture of propylene glycol, vegetable glycerin, nicotine, and various flavourings. While vaping is considered less harmful than traditional combustible tobacco, it is not without risks. Studies have shown that exposure to vaping aerosols can lead to irritation of the respiratory tract, potentially resulting in symptoms such as cough, wheezing, and shortness of breath.
Additionally, vaping may contribute to the development of chronic respiratory conditions, such as bronchitis and asthma, due to the inhalation of harmful substances present in the aerosols. Although long-term effects are still being researched, it is crucial to acknowledge the potential for vaping to exert adverse effects on respiratory health.
Vaping-Related Lung Injuries
In recent years, there has been an emergence of vaping-related lung injuries (VALI), characterised by a spectrum of respiratory symptoms ranging from mild cough to severe respiratory distress. VALI cases have been attributed to the inhalation of harmful substances, including vitamin E acetate, found in some black-market vaping products.
Healthcare providers must remain vigilant in identifying and managing VALI cases, as prompt recognition and treatment are essential in preventing long-term respiratory complications. Comprehensive patient histories and diagnostic imaging, including chest radiographs and computed tomography scans, play a pivotal role in evaluating suspected cases of VALI.
The 2019 EVALI Outbreak
The 2019 EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury) outbreak marked a significant public health crisis, shedding light on the potential dangers of vaping. Beginning in the United States, this outbreak saw a surge in severe respiratory illnesses linked to e-cigarette or vaping product use.
Patients presented with a range of symptoms, including cough, chest pain, shortness of breath, and fever, often progressing to acute respiratory distress syndrome (ARDS). The outbreak prompted intensive investigations by healthcare authorities and researchers, ultimately revealing a commonality among cases: the use of e-cigarette products containing tetrahydrocannabinol (THC) and vitamin E acetate, primarily obtained from unregulated sources.
The response to EVALI led to heightened awareness of vaping-related risks, strengthened regulation, and reinforced the importance of education on safe vaping practices. The outbreak serves as a stark reminder of the urgent need for continued research and vigilance regarding the health effects of vaping.
Role of Vape Pen Use in Smoking Cessation
One of the primary motivations for vaping is its potential as a smoking cessation aid. Vape pens, particularly those containing nicotine, have been advocated as a less harmful alternative to traditional cigarettes. Studies suggest that vape pen use can assist individuals in reducing or quitting smoking, with some reporting increased success rates compared to conventional nicotine replacement therapies.
However, it is imperative to acknowledge that vaping is not entirely risk-free, and long-term effects remain uncertain. Healthcare providers should engage in open and honest discussions with patients considering vaping as an aid to stop smoking, providing balanced information on potential benefits and risks. One particular risk is associated with the self-certification of vaping devices which allows poor quality devices to be sold cheaply, and often with higher risks of heavy metal inhalation through the heating coil.
Health Outcomes Among Vape Pen Users
While vaping offers a potential avenue for smoking cessation, its long-term impact on respiratory health remains a subject of ongoing research. Preliminary studies have shown a reduction in respiratory symptoms among individuals who transition from combustible tobacco to vaping. However, the potential for other adverse health effects, such as cardiovascular complications, requires further investigation.
Vaping has become a prevalent practice in the UK, warranting a comprehensive examination of its impact on respiratory health. While vaping is considered less harmful than traditional smoking, it is not without risks. Clinicians must remain vigilant in recognising and managing vaping-related respiratory conditions, and be informed about the potential benefits and risks associated with vape pen use for smoking cessation. Continued research is essential to elucidate the long-term health outcomes among vape pen users and to guide evidence-based clinical practice.
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