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Your Questions About Vaping, Answered by a Lung Transplant Expert

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Vaping, or inhaling and exhaling an aerosol produced by an e-cigarette or vape pen, has garnered national attention recently as reports surfaced of at least 450 cases of vaping-related lung illnesses in 33 states and six vaping-related deaths occurring nationwide.

To understand what vaping is and how vaping affects the lungs, we talked with Cynthia Gries, MD, MSc, the medical director of the lung transplant program at the AdventHealth Transplant Institute.

What Is Vaping?

Vaping was initially introduced to deliver nicotine or other drugs. The drug is heated up to a very high temperature and it is turned into vapor. When you vape, you inhale vapor, not smoke. Many people believed that it would be safer than smoking.

“I tell my patients that vaping is something new that we really don’t know anything about,” Dr. Gries says. “Vaping has been around for about a decade and we are only now recognizing how harmful vaping really is.”

Is Vaping Safer Than Smoking Cigarettes?

It took researchers years to figure out that smoking caused diseases like cancer and emphysema. “From my perspective as a pulmonologist, the only thing that you should be putting into your lungs is air,” Dr. Gries notes.

Medical professionals are now starting to see that vaping can result in life-threatening lung failure and may be more dangerous than tobacco use acutely. Only time will tell what bad long-term effects have on people, Dr. Gries explains.

“I worry that people think that because they are not inhaling smoke when they vape that it is better for them. But actually, we know that the chemicals that you need to vaporize substances are also serious toxins, like formaldehyde, for example, which is known to cause cancers,” Dr. Gries says.

Other chemicals break down, too, causing severe inflammation of the lungs. For example, early on with the vaping trend, there were some reports that patients could get popcorn lung, which is a similar reaction to being exposed to a specific chemical in a popcorn plant, Dr. Gries points out. Essentially, the lungs become inflamed from being exposed to irritants that are in the vapor liquid.

What Happens in Your Lungs When You Vape?

Vaping essentially differs from cigarette smoke in that vaporizers have to dissolve the nicotineinto a liquid so that it can be heated into a vapor. To do this, propylene glycol is added, and the elements in the vapor heat up propylene glycol to 350 degrees, which makes the aerosol particles move quickly enough to vaporize.

“Your body has natural defenses to stop cigarette smoke such as tiny hairs and cough reflexes that prevent bigger particles from ever getting into your lungs. But when you vape, you breathe in tiny particles of toxic chemicals that can get further down into your lungs than cigarette smoke can,” Dr. Gries says. In your lungs, these particles of broken-down chemicals can cause severe inflammation, acute respiratory distress and even cancer.

Is It Safer to Use Non-Flavored Vaping Products?

“It doesn’t matter if a vape product is flavored or not flavored, we’re still seeing people having bad reactions from vaping. So, I do not want the population to think they are safe if they vape with no flavors or vape with other harmful substances,” Dr. Gries explains. All vaping is bad for the lungs.

How Do People End Up in the Hospital After Vaping?

“I’ve seen a couple of cases of young people needing immediate and intensive medical care after vaping. A young person was using a Juul vape and came in with nausea and vomiting, tiredness and felt like they were coming on with a cold,” Dr. Gries explains.

“Their lungs became so inflamed that oxygen couldn’t get into the bloodstream, and even though the patient was on a breathing machine, their oxygen levels were quite low, and the lungs became very stiff.”

“We used an extracorporeal membrane oxygenation (ECMO) machine, which operates like dialysis for the lungs. It takes blood out of the body, takes off carbon dioxide (a waste gas) and then it puts oxygen back in the lungs. We had to keep them on that machine to help their lungs recover.”

During this treatment, patients are really sick. They have a feeding tube because they’re unable to eat and they get to a point where they can’t even stand because their legs get so weak from being so sick in bed for so long.

“We watched this young patient have to relearn how to walk with all these different machines going just to try to keep them alive,” Dr. Gries recalls.

“It’s important to point out that this case was years ago, meaning that these reactions have been occurring ever since the vaping trend started, but we’re just now realizing that vaping is what’s causing cases like this.”

Does Vaping Affect Teens Differently Than Adults?

“The data is limited in terms of the number of deaths and the amount of people who’ve been affected, and I think that this is something that has been misdiagnosed frequently. If someone who is 50 to 60 years old develops respiratory distress syndrome and requires ECMO, they are less likely to survive it,” Dr. Gries says.

Lung specialists are more likely to support someone with these advanced technologies when they’re younger. “When you’re younger, you have a greater resilience to surviving ECMO or surviving being on the ventilator,” she says.

Young people might survive the illness, but their lungs — and their body — won’t be normal. They’ll still need years and years of recovery and physical therapy to have to relearn how to walk, talk and swallow, Dr. Gries explains.

Also, many of the people who are on a breathing machine or ECMO have severe post-traumatic stress from this experience. “While we’re seeing deaths in older people more so than young people, young people need to be aware that honestly, their outcome might be worse because they may survive it but be debilitated, facing an extremely difficult recovery,” Dr. Gries says.

Over Time, Does Vaping Lead to Lung Disease or Other Conditions?

Vaping most likely raises your risk of lung disease. “I suspect that in 20 years, once we see a long-term exposure to vaping, we’re going to see similar effects that we see with tobacco. It will likely cause some form of lung damage and it will most likely predispose to cancer, but we just don’t have the data to know, yet,” she explains.

The one fact that medical professionals don’t see from smoking, but are seeing from vaping, is that it only takes one vaping session to put yourself at risk of lung failure.

“With smoking, when we make a diagnosis of emphysema, commonly known as chronic obstructive pulmonary disease (COPD), usually we don’t make that diagnosis in people until they’re older than the age of 45,” Dr. Gries explains.

“It takes about 20 years of smoking to start seeing that damage of the emphysema. We know that long-term smoking causes damage eventually, but we don’t have enough follow-up time to really know if vaping will lead to that. We don’t know what years of vaping will look like in the lungs,” Dr. Gries says.

Tips to Keep Your Lungs Healthy and Strong

Steering clear of vaping and smoking are key preventative measures to avoid developing lung disease, Dr. Gries affirms. Additionally, to keep your lungs healthy and prevent lung disease, you can:

  • Avoid secondhand smoke and people who smoke or vape
  • Be mindful of your environment’s air quality
  • Get regular cardiovascular exercise to boost lung fitness and overall health
  • Get regular check-ups from your primary care physician and discuss any concerns about your lung health
  • Get the pneumonia vaccine
  • Get your annual flu shot and encourage others in your household to do so
  • Practice deep breathing, or diaphragmatic breathing, exercises
  • Stay home if you are sick to avoid spreading colds and respiratory illnesses to others
  • Wash your hands frequently with soap and water, especially during flu season

Comprehensive Lung Treatment From Experts Who Care

The AdventHealth Transplant Institute’s lung transplant program is a designated Center of Excellence, meaning you can rest assured knowing you’re receiving state-of-the-art treatment from skilled and compassionate specialists like Dr. Gries.

If you or a loved one needs a lung transplant, our program offers benefits like:

  • A higher-than-average survival rate
  • A shorter wait time, with offers often within weeks, instead of months or years
  • Education for you and your support team on using and interpreting oxygen levels
  • On-site support groups with others in the lung transplant program
  • Pulmonary rehab for lung disease
  • Tools and resources to handle breathing-related anxiety
  • A dedicated team available 24 hours a day, seven days a week, before, during and after surgery

To learn more about lung transplant or protecting your lung health, we’re here to help. Our team is here to guide you with expert, whole-person care so that you can breathe easier.

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