- December 20, 2019
- Posted by: admin
- Category: Blogs
The use of tobacco in all its forms is a fairly old habit, at least in the Americas where the plant originated from. Originally, its use was restricted to doctors-sorcerers and priests, but over the centuries it became popular. There have been many people defending the use of tobacco as well as a significant number as opposed to the inconvenience caused by smoke or the risks that its use implies.
Tobacco was introduced into the European market intensively from 1500-1600 and was even used as currency for commercial transactions. A century later (1700s) the tobacco industry was born and was prosperous, despite health observations that were noticed and increasing from 1602, “when an English doctor compared the lesions observed in chimney sweeps with the effects produced by tobacco ”[1, 2, 3].
“The main reason for the tobacco boom in Europe was due to its supposed healing properties. Europeans believed that tobacco cured almost everything from bad breath to cancer! ”As can be read on the Boston University website
In 1795 Von Soemmering, in Germany, noted the increase in the incidence of lip cancer in pipe smokers. Three years later, in 1798 in the USA, Benjamin Rush wrote for the first time about the risks of tobacco. In 1920 the first reports on the possible relationship of smoking and the development of lung cancer began to emerge, a correlation that was confirmed through a series of studies conducted in the 1950s and 1960s [1].
Reports that not only circumscribed Europe or America, but also began to increase in 17th Century China when the philosopher Fang Yizhi pointed out that the use of tobacco caused “burned lungs” [4].
However, the industry continued to grow, and its growth looked unstoppable until a decline in consumption from the second half of the twentieth century came about due to apparent changes in consumer preferences from increased awareness about the direct and indirect effects of tobacco´s use [1].
Moreover, greater controls on the use of tobacco forced the industry to use warning labels on its products, indicating the health risks involved [4].
And this has forced the tobacco companies to redirect their efforts towards new markets (the Asian market, for example, which represents 63% of the industry) or the development of new products such as e-cigarettes, e-pipes among others [1, 5].
And it is precisely the vaping and its risks that we will be talking about in this article, particularly the growing adverse effects in increasingly younger populations.
Boom and fall
Vaping is on the rise due to the desire to maintain the pleasure of experiencing the effects of tobacco but without its risks. “Joseph Robinson, in 1927, dreamed of what would be the first electric vaporizer, as a device for medicinal uses” [6].
In 1963, Herbert Gilbert, proposed another model of a vaporizer without capturing the attention of the market. Neither did other proposals that came along later, such as Jed Rose’s (inventor of the nicotine patch). Interest in this type of device began with the flourishing cannabis industry in 2000, but it will be the Chinese pharmacist Hon Lik who will definitely be recognized as the inventor of the e-cigarette (a fact that happens in 2003) [6].
Lik himself said that he developed the idea as an attempt to reduce his addiction to tobacco (after his father, a chronic smoker, died of lung cancer). However, both he and many others did what they became “dual users”, as they smoke both conventional cigarettes and e-cigs (acronyms with which they have been known for a long time) [6].
In 2008 the WHO warned that such devices “constituted a safe and effective form of nicotine replacement therapy” [6]. Although the growth was slow initially, from 2016 onwards these have been considered explosive and controversial, as some of the companies producing this type of devices direct their campaigns towards the adolescent population [6].
Moreover, according to the aforementioned source,
“A quarter of the adolescent population in the USA today has tried vaping, while 6% of high school students regularly vape”
Thus, the e-cigs, e-pipes (electronic pipes) and, the e-liquids (for some, the most important part of “the experience” represented by the liquids that generate the steam) became popular and began to be adopted as part of common jargon and socially accepted habits.
With the passing of the years, complaints began to emerge against some of these companies, arguing the appearance of nicotine addiction in people who had never used tobacco directly, but had only used e-cigs. The most serious effects came later, with a series of deaths in young vapers occurring in the US, due to a “mysterious” form of lung disease.
In fact, on December 10, 2019, the CDC counted a total of 2,409 cases of EVALI (Pulmonary Disease Associated with Vaping) in 50 States of the US, with a total of 52 deaths in 22 of the States [7].
In 2012, Australia discussed a ban on the importation of e-cigs, arguing that these types of devices had “toxic chemical compounds that could cause greater problems than the nicotine itself present in cigarettes” [8]. These measures have been complemented with other schemes around the world through to the present, including increasing warnings from health authorities.
E-cigs: its components and risks
Every electronic cigarette is basically composed of four elements; the cartridge (where the liquid that will be inhaled is deposited once it is transformed into steam), the heater (or vaporizer itself), the battery (energy source that heats the liquid) and, the mouthpiece through which it is inhaled [9, 10].
Interest has been focused on the “toxic substances” to which many refer and also the health authorities in charge of what they already classify as an epidemic .
It should be noted that for regulatory bodies in the USA, this type of device is added to a group of products known as “Non-combustible Systems for Nicotine Supply” (ENDS), and as such is under the control of the FDA, among other agencies [11].
In the “vaping juice”, the basic components include water, vegetable glycerin, propylene glycol, flavorings and, nicotine [12, 13]. But the list of additives does not stop there, there are additional contaminants that are generated during heating such as formaldehyde or acrolein [14].
Moreover, one consideration is the ingredients that are listed in the product, but other considerations should be the chemicals that are inhaled with steam. In this sense, Becker [14] pointed out just over a year ago that,
“Scientists have found that regular vanilla, cinnamon and cherry flavors react with propylene glycol, a basic component in vaping juice, to create new chemicals… that can act as lung irritants after prolonged use. And people don’t know they are inhaling them”
It should be added that the authorities themselves are not convinced of the safety of the inhalation of propylene glycol or vegetable glycerin, which although they appear to be safe after ingestion do not appear to be so if they are inhaled. The CDC has paid a lot of attention to cases of EVALI deaths from vitamin E acetate, which is used in some of the liquids to vape [15, 16, 17].
So far, we know that acute exposure to propylene glycol can cause eye or airway irritation. The concern is not the direct effects of this chemical, but the effects that arise after combination with the different flavorings used. Apparently, the secondary substances that arise from the reaction of propylene glycol with the flavorings may develop over time to cause some type of cancer.
It has been known for some time that the group of aldehydes and diacetyl react to generate formaldehyde. As well as being an irritating substance, formaldehyde is also known as carcinogen. Moreover, a study was conducted where the presence of toxic substances in users of e-cigs, duals and smokers was compared. This found that those who only use electronic cigarettes demonstrated the presence of high amounts of toxic chemicals in urine [18].
These chemicals include acrylonitrile, acrolein, propylene oxide, acrylamide and crotonaldehyde. It is suspected that these may act as airway irritants.
In relation to the nicotine present in these types of devices, studies suggest that although the effects are less than exposure to tobacco, the concentrations are variable, as the concentration of nicotine in blood will be diverse.
In reality everyone should be concerned about the addictive effect of nicotine and its role as a possible agent. This has been found to alter neurodevelopment, increases the risk of cancer (associated with some of the secondary substances that are formed during vaping), and increases the probability that the adolescents accustomed to vaping will become smokers of cigarettes [19].
As well as the risk of explosions or burns associated with the batteries used for heating, or acute nicotine poisoning after accidental direct contact with the vaping liquid, the negative effects of substances inhaled on the fetus should also be considered ( in the case of pregnant women who vape) [19].
A final comment about the lung lesions that are being observed in vapers is known as “lung popcorn” or obliterating bronchiolitis. You should think about it, obviously, if you regularly use e-cigs, also if you have any of the following symptoms: difficulty breathing, wheezing or wheezing with breathing, dry cough and tiredness [20].
Can we prevent the risks?
Without a doubt, avoid the use of vapers and follow suggestions made by the health authorities. In particular, avoid the use of THC with vapers, as well as the use of liquids of doubtful origin that may incorporate substances or products not declared by the supplier, into the mixtures [21].
In the same way, if it is decided to use vapers, if any of the symptoms described above or repeated respiratory infections, without apparent cause, specialists should be consulted. While using them, both e-cigs and e-liquids should be kept out of the reach of children. If you are an adult you should protect your skin when refilling the cartridges, as well as proceed to discard e-cigs as indicated on the label [22].
References:
[1] Cancer Council. (Without date). A brief history of smoking in Cancer Council NSW. Recovered from https://www.cancercouncil.com.au/31899/uncategorized/a-brief-history-of-smoking/. Access on December 13, 2019.
[2] Boston University Medical Center. (August 31, 1999). History of tobacco at Boston University Medical Center. Recovered from https://academic.udayton.edu/health/syllabi/tobacco/history.htm. Access on December 13, 2019.
[3] World Health Organization. (Without date). The history of tobacco in WHO Atlas. Recovered from https://www.who.int/tobacco/en/atlas2.pdf. Access on December 13, 2019.
[4] Tobacco free life. (2016). History of tobacco in Tobacco free life blog. Recovered from https://tobaccofreelife.org/tobacco/tobacco-history/. Access on December 14, 2019.
[5] Marco Trade News. (April 4, 2018). Asia turns on the tobacco industry worldwide in Marco Trade News. Recovered from http://www.marcotradenews.com/noticias/asia-enciende-la-industria-del-tabaco-a-nivel-mundial-60957. Access on December 14, 2019.
[6] Brueck, H. (November 12, 2019). The wild history of vaping, from a 1927 ‘electric vaporizer’ to today’s mysterious lung injury crisis in Insider. Recovered from https://www.insider.com/history-of-vaping-who-invented-e-cigs-2019-10. Access on December 14, 2015.
[7] CDC. (December 12, 2019). Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products at CDC Smoking & Tobacco Use. Recovered from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#. Access on December 14, 2019.
[8] Consumer Advocates for Smoke Free Alternatives Association. (2019). A Historical Timeline of Electronic Cigarettes at CASAA website. Recovered from http://www.casaa.org/historical-timeline-of-electronic-cigarettes/. Access on December 14, 2019.
[9] National Institute on Drug Abuse. (November, 2019). Electronic cigarettes (e-cigs) in NIH. Recovered from https://www.drugabuse.gov/es/publicaciones/drugfacts/cigarrillos-electronicos-e-cigs. Access on December 15, 2019.
[10] Matthews, C. (April 5, 2019). Vaping – A Journey Through its History in Vaping daily. Recovered from https://vapingdaily.com/what-is-vaping/vaping-history/. Access on December 15, 2019.
[11] FDA. (December 9, 2019). Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS) at FDA tobacco products. Recovered from https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends. Access on December 15, 2019.
[12] Myers, B. (April 25, 2017). What’s inside vape juice? In Wired. Recovered from https://www.wired.co.uk/article/whats-inside-vape-juice. Access on December 15, 2019.
[13] Nguyen, D., and Aamodt, G. (January 10, 2014). The Chemical Composition Found in the Liquid Refill Cartridge at Dentalcare.com. Recovered from https://www.dentalcare.com/en-us/professional-education/ce-courses/ce451/the-chemical-composition-found-in-the-liquid-refill-cartridge. Access on December 15, 2019.
[14] Naftulin, J. (September 27, 2019). Nicotine vape juice may contain ingredients like formaldehyde and a chemical used in weed killer. Here’s what they can do to your body. In Indiser Health. Recovered from https://www.insider.com/what-chemicals-in-nicotine-vapes-can-do-to-your-body-2019-9. Access on December 15, 2019.
[15] López, K. (November 19, 2019). Vape juice chemicals: What are you inhaling? In KCBD. Recovered from https://www.kcbd.com/2019/11/20/vape-juice-chemicals-what-are-you-inhaling/. Access on December 15, 2019.
[16] Mammoser, G. (November 15, 2019). Chemicals Used in E-Cig Flavors Are Toxic and We’ve Known for Decades in Healthline Health News. Recovered from https://www.healthline.com/health-news/vaping-may-be-worse-for-your-lungs-than-you-think. Access on December 15, 2019.
[17] Blaha, M. (November 2019). 5 Vaping Facts You Need to Know in Johns Hopkins Medicine. Recovered from https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping. Access on December 15, 2019.
[18] Johnson, J. (September 27, 2019). Does vaping without nicotine have any side effects? In MedicalNewsToday. Recovered from https://www.medicalnewstoday.com/articles/326489.php. Access on December 15, 2019.
[19] Shmerling, R. (September 4, 2019). Can vaping damage your lungs? What we do (and don’t) know at Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734. Access on December 15, 2019.
[20] Macarthur, S. (Undated). Vaping: the good, the bad and the popcorn lung on MPHonline. Recovered from https://www.mphonline.org/vaping-public-health/. Access on December 15, 2019.
[21] CDC. (September 6, 2019). Severe lung disease associated with electronic cigarettes in IntraMed. Retrieved on https://www.intramed.net/contenidover.asp?contenidoid=94839. Access on December 15, 2019.
[22] American Academy of Pediatrics. (October 9, 2019). Information for parents about electronic cigarettes and the effects of exhaling their steam on Healthychildren.org in Spanish. Recovered from https://www.healthychildren.org/Spanish/health-issues/conditions/tobacco/Paginas/Facts-For-Parents-About-E-Cigarettes-Electronic-Nicotine-Delivery-Systems.aspx. Access on December 15, 2019.