Vaping, eCigarettes and COPD

Recent reports of severe and even fatal lung injury after using electronic cigarettes (e-cigarettes) is of concern. It is important for the COPD community to better understand the dangers of e-cigarettes, vaping pens, and similar devices. The COPD Foundation's Medical and Scientific Advisory Committee (MASAC) looked at the available data to write this report for the COPD Foundation community. New information is arriving daily and may change our current suggestions.

E-cigarettes are sometimes called "e-cigs", "vapes", "e-hookahs", "vape pens", and "electronic nicotine delivery systems" (ENDS). The use of these devices is called "vaping", “juuling", or "dabbing". Each of these devices works differently and may have different risks for each person with COPD.

These devices use a small container or pod filled with liquid or "juice." Nicotine, THC and CBD (the active parts of marijuana), flavors, glycerol or ethylene glycol (also used in antifreeze), and other things are added to the liquid or juice. The pods and the juice may be:

• made at home
• made by local dealers
• purchased online, at vaping shops, or in convenience stores.

All e-cigarettes and vaping devices include a heating element which heats the juice or liquid to form a vapor or mist that is inhaled into the lungs. The nicotine and other things added into the liquid are quickly absorbed by the lungs and may also go into the blood stream and the whole body. The vapor or mist from e-cigarettes or vaping contains chemicals called volatile organic compounds (VOCs) which can irritate, inflame, and harm the lungs and other organs, such as the liver or heart. The added flavors, like bubble gum, can contain diacetyl, which has been linked to a condition known as “popcorn” lung (bronchiolitis obliterans). E-cigarettes and other devices may contain heavy metals and formaldehyde, which can cause cancer.¹ Users may not even know exactly what is in the vapor or mist that is going into their lungs.

The Food and Drug Administration (FDA) regulates the creation and sale of e-cigarettes, vaping devices, and liquids.² It is illegal to sell e-cigarettes to minors under age 18, and the FDA monitors the marketing of e-cigarettes. While the FDA regulates and monitors these factors, this does not mean that vaping and e-cigarette use is safe, especially for those with lung conditions.

E-cigarette and Vaping Associated Lung Injury (EVALI) Epidemic

An outbreak of lung injury, called “E-cigarette and Vaping Associated Lung Injury” (EVALI), has been linked to e-cigarette use. By October 2019, the CDC reported nearly 1,300 cases of EVALI in over 49 states, including 34 deaths. . Those dying from EVALI ranged in age from teenagers to individuals in their 70's.³ More people with EVALI and deaths are being reported every day.

Most of the people with EVALI used e-cigarettes or vaping with THC, coming from illicit dealers or friends and family. But EVALI is not limited to this group. Many people with EVALI used only nicotine products. The people who did the worst with EVALI were 50 and older³ or had heart or lung disease like COPD. We do not know exactly what causes EVALI, who is most likely to suffer from EVALI, and if this is new or has been around and just not noticed before.

Are e-cigarettes safer than tobacco cigarettes?

Stopping all tobacco cigarettes and replacing them with e-cigarettes or vaping may give people less exposure to some toxic chemicals.¹ However, in one study, mice who vaped had changes in their lungs much like changes caused by tobacco smoking. This included emphysema-like changes.⁴ The harms of using e-cigarettes for a long time are not known. The recent epidemic of EVALI suggests a risk of some people having severe, and sometimes fatal events after vaping. People with COPD are likely to be at high risk for lung injury, respiratory failure, and death from EVALI.

Recommendations

Adapted from the CDC guidance,⁵ MASAC agrees with the following:

• Everyone and especially people with COPD should not vape or use any of the device liquids that may contain THC or CBD or liquids that you get off the street or from family and friends. It may be hard to know what they really contain.
• People using oxygen should not use e-cigarettes or vape due to risk of fire from the device's heating element.
• Contact your doctor, nurse, clinic, or a hospital if you use e-cigarettes or other devices and develop cough, shortness of breath, chest pain, nausea, vomiting, stomach pain, diarrhea, new tiredness, fever, or weight loss. These may become EVALI over days or weeks. EVALI has happened in people who vaped as long as 90 days ago.
• If you are trying to quit smoking cigarettes, ask for help and use proven treatments like counselling and FDA-approved nicotine replacements and medicines.⁶ Talk to your health care provider!
• If you have quit smoking cigarettes by using e-cigarettes or vaping, don't go back to smoking. Instead use FDA approved nicotine gums, patches, lozenges, nasal sprays, or inhalers. You can also ask your doctor or nurse about other FDA-approved medicines to lower your urge to smoke, such as Varenicline or Bupropion.⁶
• If you see or know about a vaping or e-cigarette problem, report it to your health department or the FDA at https://www.safetyreporting.hhs.gov/SRP2/en/Home.aspx?sid=acd5f36d-6a68-48f4-ad8c-ccf75f495d60