Experts know that e-cigarette aerosol can contain harmful and potentially harmful ingredients.
Some evidence of the health risks showed up in 2019, when more than 2,500 people got sick after using vaping products. The illness is called EVALI. That stands for e-cigarette or vaping product use associated lung injury.
EVALI describes severe lung problems that resemble pneumonia in some cases, and chemical burns in others. Some people with EVALI suffer total lung failure. More than 60 people have died.
What causes EVALI?
It’s still not clear which e-cigarette ingredients cause these bad reactions, but most experts agree that vitamin E played a part in the recent incidences.
Vitamin E is approved for use in vitamin supplements and cosmetics, but has not been tested for inhalation. It was used in vaping fluids to reduce production costs.
Most of those who became ill also had vaped tetrahydrocannabinol or THC. THC is the active ingredient in marijuana.
But staying away from these two ingredients may not protect you from vaping related lung injuries. Health problems could be caused by other ingredients.
“Vape companies make new products and new flavors all the time,” says Jason Robinson, Ph.D., associate professor in MD Anderson’s department of Behavioral Science. “Until there is comprehensive regulation, yes, it’s likely something like this will happen again with other untested ingredients.”
What does EVALI do to the lungs?
In the most serious cases, EVALI causes extensive damage to vapers’ lungs. Doctors call it acute lung injury because of the massive destruction to the lung tissue.
“On a microscopic level, the lungs get so inflamed that the small sacs that collect air get clogged with blood, pus and other fluids,” says Chad Strange, M.D., assistant professor in MD Anderson’s department of Thoracic Imaging.
When that happens, your lungs cannot send oxygen around your body. You suffer the same fate as someone who dies from smoke inhalation.
“You literally starve of oxygen,” says Strange. “You can’t breathe because your lungs are so full of this debris and inflammation.”
Symptoms of EVALI
The signs of vaping related lung injury can be vague. Some people do not start with symptoms relating to their lungs.
“They may not have a cough or shortness of breath,” says Yuqi Wang an MD Anderson resident physician who studies EVALI cases. “They often come in with nausea or vomiting or abdominal pain and a fever.”
EVALI's symptoms can extend beyond the lungs, because the lungs transmit toxins throughout your system.
“Diagnosis relies on the doctor eliminating other illnesses and then asking questions about your lifestyle, like whether you vape,” says Wang.
What can you do to avoid EVALI?
The most important thing you can do to avoid all health problems related to vaping is to not use e-cigarettes or other vaping products.
People who have never smoked should not use e-cigarettes. This is especially true for young people. E-cigarettes have nicotine, which is harmful to people under age 26 because it damages developing brains. It affects the part of the brain that controls mood and attention.
And the long term safety of e-cigarettes is unknown.
“It’s certainly the case that e-cigarettes could be causing permanent damage to the lungs of users, especially those who start young,” says Robinson.
But what about people who smoke or vape?
If your smoking or vaping has not led to a chronic disease yet, there’s not enough data to make a confident assertion about your risk for COVID-19. But you should still be extremely careful, and do all you can to quit now.
“We know that smokers are at higher risk for respiratory infections,” says George Eapen, M.D., Professor in MD Anderson’s department of Pulmonary Medicine. “Vaping could be even worse.”
That’s because smoking damages your lungs’ defense system and impairs your immune system. And vaping can lead to immediate inflammation and lung injury.
Why do smokers get more respiratory infections?
Your lungs rely on a complex mucous transportation system to stay clean and clear of debris.
Tiny structures called cilia continuously transport mucous up and out of the lungs. It is then swallowed or expelled by coughing. This process is key to keeping your lungs healthy.
“When you smoke a cigarette, it temporarily stuns these structures and they cannot clear your lungs as well,” says Eapen. “We think this is one reason why smokers get sick more often.”
Another reason is that hot smoke from cigarettes or cigars disrupts the cells of your sinuses, nasal passage and throat. This disruption of the cell barrier may make you vulnerable to infections, including respiratory viruses.
Each infection you get causes a little more damage to your lungs.
“It’s like Russian roulette. We don’t know exactly which infection will lead to serious problems,” says Eapen. “But the one thing you can do is stop adding additional burden to your lungs.”
Those with smoking-related illnesses like COPD or heart disease may face more complications if they contract a COVID-19 infection.
What about vaping?
During a vape session, you take an aerosol of chemicals and nicotine into your lungs. The long term risks are unknown but many short term problems have been identified.
E-cigarettes can make asthma worse, and cause coughing and wheezing. The most serious risk is for vaping associated lung injury or EVALI.
Experts think this is caused by a bad reaction to untested ingredients. An outbreak in 2019 was linked to vitamin E and tetrahydrocannabinol or TCH.
“The lung scans of people who have vaping associated lung injury look identical to people with COVID-19,” says Eapen. “So if people are vaping, I would say absolutely stop it now.”
Until vaping products are properly regulated, we don’t know for sure what they contain or what harm they cause. The important thing to remember is that any existing lung damage is likely to increase your risk for COVID-19 complications.
The less damage you do to your lungs through either smoking or vaping, the better your chances of surviving a COVID-19 infection.
You can quit vaping and smoking
The best way to quit smoking is to use a combination of medications and counseling.
You can get free phone and text support through the Quitline in your state by calling 800-784-8669 or text QUIT to 47848. Visit www.SmokeFree.gov for more information.
Programs designed for young people and teenagers also are available:
“There’s not much we can do about COVID-19 right now except practice hand hygiene, social distancing and reduce our known risk factors,” says Eapen. “Smoking and vaping are risk factors you can change.”
Learn more about COVID-19 and precautions MD Anderson is taking.