Scientists say lung damage caused by vaping can make some young people more vulnerable if they contract Covid-19. Nicky Pellegrino reports.
Jack Barr was 15 when he had his first cigarette. A year on and he was pulling out a pack when partying with friends. Then he got a girlfriend who wasn’t keen on the habit. “I was sick of smoking too but needed something to replace it,” he says.
So he started using e-cigarettes. It was intended as a step towards giving up completely but Barr now has a job in a Wellington vape shop and an accompanying temptation to keep sampling the products.
The 19-year-old knows plenty of other teenaged vapers. “There’s a massive uptake of it everywhere with young people,” he says, noting that younger users tend to go for higher nicotine e-liquids and salts, often asking an adult to make the purchase. His feeling is that such experimentation is inevitable. “If we didn’t have e-cigarettes there would still be kids trying to smoke, because they always have. If the kids want their nicotine, they’re going to get it.”
The concern is that these devices are creating a whole new wave of nicotine addicts in Barr’s generation. The annual ASH Year 10 Snapshot Survey showed that 37.3 percent of students have experimented with e-cigarettes. A relatively low 3.1 percent were daily users but there are reasons why that statistic is no cause for complacency. For a start the survey is limited to 14-15 year olds, and teens tend to be older when they take up smoking. Also, it is based on data collected back in 2018 when pod vapes were first entering the NZ market.
Pod vapes, in particular the Juul, are believed to be behind a surge in popularity among US high school kids – in the last year alone there has been a 78 percent increase in the numbers of them vaping. The Juul is accessible and affordable. As sleek as a flash drive, it can be charged in a laptop, comes in an assortment of fruity and sweet flavours, and creates a discreet amount of vapour. American teens now talk about “Juuling” rather than vaping.
While vaping may deliver fewer harmful chemicals than cigarettes, it affects the lungs in the same way.
Each Juul cartridge has as much nicotine as an entire pack of cigarettes. Still, without doubt vaping is a better option than smoking tobacco, which remains the gold standard of harm that you can legally do to yourself. Whether it is up to 95 percent safer – a statistic that tends to get bandied about – is looking a bit doubtful, particularly in the light of Covid-19.
As medical scientists work on understanding more about the virus still raging beyond our shores, one question they are asking is why some young sufferers have developed severe symptoms, needing hospital care. There is a suspicion that vaping, as well as tobacco smoking, may have played a part. This is new territory and it will take time to find firm evidence, but what we do know is that while vaping may deliver fewer harmful chemicals than cigarettes, it affects the lungs in the same way.
Aaron Scott is an expert in respiratory science at Birmingham University in the UK. His area of interest is alveolar macrophages – cells that play a vital role in clearing the lungs of anything toxic. Scott has looked at the effects of vaped e-liquids on these cells and it isn’t good news.
“We’ve shown that both e-liquids that contain nicotine and those that don’t are toxic to the alveolar macrophages,” he explains. “Even in a smaller dose, where it doesn’t kill them, it’s pro-inflammatory.”
When e-liquids are vaped the humectants, those things that heat up to make the vapour – such as propylene glycol and vegetable glycerine – generate other more harmful components as they break down, including highly toxic formaldehyde. The alveolar macrophages start a clean-up operation straight away, calling in other cells to help. But carry on vaping, filling the lungs with toxic substances and sparking that same immune response over and over, in time it will create chronic inflammation.
Measure the lung function of a vaper after they have used an e-cigarette and it is depressed for an hour afterwards. “Lung capacity, the ability to breathe, is significantly reduced,” says Scott. “If you can see that reduction in capacity after a five-minute vaping session, what happens to someone who vapes for 10 years?”
When lung tissues are already inflamed and compromised and then along comes another threat to the respiratory system such as Covid-19, escalating the problem, a vaper may be in serious trouble.
“Once you go over a certain level of inflammation you start to get acute respiratory distress syndrome which is what happened to those people who ended up in ICU,” says Scott. “They have massive inflammation in their lungs which causes a lot of damage and, even if they survive they’ll have long-term effects.”
Much is made of the fact that the ingredients in e-liquids are food grade, but taking something into your stomach, where it will be safely broken down by gastric juice, is entirely different to heating and inhaling it. “A lot of these chemicals, such as propylene glycol, are used in foods that people eat all the time and it’s fine,” says Scott.
While there is no evidence that vapers are more likely to become sick in the first place, there is some science to show that vaping enables any pathogens that are breathed in to linger in the nose for longer. When another UK researcher, Jonathan Grigg of Queen Mary University put vaped e-liquid on nasal cells he found that more bacteria, especially pneumococcus, stuck to them. The same process happens with exposure to pollution from welding fumes, cigarette smoke and fossil fuel particles.
“These pathogens hijack receptors on the surface of the cells and open up a Trojan horse for bacteria to stick to them,” explains Grigg who has experimented with vapers, brushing their nasal passages for cells before and after a session, and seen this receptor response in action. His advice as a respiratory specialist: “You have to be very cautious with the airway and you shouldn’t inhale anything but clean air.”
The heart as well as the lungs may be affected by vaping, according to UK public health expert Martin McKee. He analysed a number of studies and found that, just like smoking tobacco, using e-cigarettes makes changes in the endothelial system (the cells that line blood vessels) that are associated with a higher risk of stroke. Again there is no proven link with Covid-19 outcomes. But there were reports of young people dying of strokes and there is a growing body of evidence that the virus acts on the endothelial cells, opening up another area for researchers to investigate.
There are arguments in favour of vaping. In fact, when Italy was in lockdown, a respiratory scientist, Riccardo Polosa, persuaded authorities to allow vape stores to continue to operate. He is a harm reduction advocate who believes they present a safer option for cigarette smokers, at least in the short term. And last year a University of Auckland study showed that, used in combination with nicotine patches, e-cigarettes can be an effective quitting option for some smokers.
However with companies like Philip Morris and British American Tobacco claiming a stake in the market and working from much the same playbook as they did last time round, vape products are being targeted at young consumers. Tactics include using social media influencers and sponsorship of events like music festivals – last year Philip Morris tried to sponsor a catwalk show for young designers at NZ Fashion Week and was rebuffed.
“They’re doing lots of youth-oriented promotions,” says Janet Hoek, a public health expert at the University of Otago and co-director of ASPIRE 2025. “When you look at some of the mass-market advertising, it’s not directed at people who have been smoking for 20 to 30 years, it’s positioning the products as cool and glamorous. We think this sort of promotional activity is really concerning.”
Her hope is that proposed legislation changes, currently going through Parliament, will help re-position vaping in New Zealand as a smoking cessation aid by banning advertising and promotion, limiting the availability of flavours available in general shops like dairies and banning sales to under 18s.
In the meantime, Auckland secondary school principals report that vaping is reaching epidemic proportions among students, who mistakenly assume e-liquids are only water and flavourings. Since second-hand aerosol has been shown to contain toxic compounds, they may also be exposing those around them to risk.
It takes 10 years or more to develop a lung condition, thanks to those alveolar macrophages and their amazing cleaning powers. So to understand the long-term effects of inhaling the different compounds in the many thousands of flavours of e-liquids and salts presents a challenge. At this point no one really knows whether vaping is 95 percent safer than cigarette smoking, or 50 percent. Just as with Covid-19, there are large gaps in our knowledge.
And as Aaron Scott says: “If e-cigarettes are a lesser harm but still harmful, then eventually we’re going to get to the same end result.”
This article was supported by the Aotearoa New Zealand Science Journalism Fund