MountainStar Health - February 19, 2019

Vape pen rests on gray surface

Vaping refers to the use of e-cigarettes and similar electronic handheld devices, which heat and vaporize liquids for users to inhale. Vaping liquids typically contain nicotine, flavor enhancers, color dyes and chemicals like propylene glycol. However, the exact combination of ingredients varies according to brand and flavor, plus package labels aren’t always accurate.

“Until we actually have FDA-approved studies, there really is no consistent way for consumers to know exactly what they’re getting,” says Susan Garwood MD, an HCA Healthcare pulmonary critical care physician. That lack of transparency and concern over the safety of chemical ingredients has sparked demand for FDA regulation of vaping products.

In response, federal courts ruled that vaping companies must submit for FDA approval beginning in August 2016. However, existing products will remain on the market during the application and review process.

What’s in your e-cigarette?

You might not know what you’re inhaling with each puff. Here are some common ingredients found in e-cigarettes and vaping products.

Nicotine. The majority of vaping liquids contain nicotine. Some offer less per puff than cigarettes, which is one reason why vaping has been marketed as the “safe” alternative to smoking—exposure to potentially fewer chemicals is also often cited. But the nicotine content of vaping liquids still poses numerous health risks.

Vaping among pregnant women is particularly concerning, says Dr. Garwood. “Somehow I think that society sees e-cigarettes as more acceptable for pregnant women to use. That is not the case. Nicotine is still going to lead to low birth weight, preterm delivery and other complications in pregnancy,” says Garwood.

Parents must also take great care to keep vaping devices out of the reach of children, says Garwood. A law was only recently put in place to require childproof packaging. Many cartridges can still be opened by curious children and vaping liquids may hold ten times the lethal pediatric dose of nicotine.

Using e-cigarettes or other vaping products is risky for teenagers as well. Nicotine elevates the heart rate, is highly addictive and is associated with impaired cognitive development among adolescents.

Flavor enhancers. Some of the most appealing flavors on the market, including cinnamon, cherry and butter, often contain chemicals like diacetyl, which may cause lung irritation and lasting asthma-like diseases. More research is needed to confirm whether the amount in most e-cigarettes is enough to cause lasting effects. But with those flavors, says Garwood, “not only do you have an uncertain carcinogen risk, but now you also have more of an inhalation damage risk… and those flavors tend to be the popular ones.”

Chemicals. E-cigarettes often contain an array of chemicals that become toxic when heated. For example, propylene glycol turns into formaldehyde at high temperatures. Formaldehyde can trigger asthma, affect lung function and is a known cancer-causing agent. The amount that users inhale varies according to brand, flavor, frequency and size of puffs, but some research suggests that it’s possible to get more formaldehyde from e-cigarettes than traditional smoking.

“It depends on how long it takes you to ingest the three milliliters of liquid, but if you're puffing through a whole cartridge in a day, you're going to get substantially more formaldehyde than with a pack of cigarettes,” explains Garwood.

Can vaping help you quit smoking?

Vaping is neither approved by the FDA, nor supported by the American Lung Association as a safe way to taper off cigarettes. More studies are needed to learn if any brands or devices might be a feasible part of a healthy quit plan.

Currently, the amount of nicotine that users inhale isn’t controlled, monitored by a doctor or carefully decreased over time as with other tapering strategies. Instead, it varies according to the size and frequency of puffs. In fact, says Garwood, “people may actually be getting more nicotine because of the way they use the devices.”

Is it safe to vape?

“The jury’s out,” says Dr. Garwood, as more studies are needed to learn the contents of vaping liquids and to measure their health risks. But she warns that “consumers need to be aware that they’re not taking away all of the cancer risk. There are carcinogens in the liquids.”

Preliminary studies have shown that some brands contain cancer-causing chemicals like nitrosamines and carbonyl compounds in addition to formaldehyde. In general, there are fewer harmful chemicals in e-cigarettes compared to traditional cigarettes, although the amount of exposure varies with brand and user habits.