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Dr. Kevin Most: Cigarettes and Vaping

John Da Cosse and Dr. Kevin Most

Cigarettes

We know we have 45 million smokers in the US today, and each of them are inhaling over 70 known carcinogens each day. The impact of cigarettes on the lung and heart continue to show up in statistics as Heart Disease and Cancer remain the top 2 causes of death in the US. 70% of smokers will tell you they want to quit smoking, but nicotine is so addictive that the success rate is close to 3%. The business of quitting smoking is a billion dollar business and includes medical treatment, nicotine based gum, nicotine patches, vaping and some prescription medications as well.

Nicotine is the chemical that is highly addictive and as a chemical it has impact on our body beyond the psychological impact it has. The bodies changes with nicotine often are seen regardless of the route of delivery, gum, patches, smoking and vaping all deliver nicotine to the body.

1.) Nicotine impacts our heart rate by increasing our heart rate by 10-15 bpm as well increases our blood pressure.

2.) Nicotine also decrease the blood flow to our heart by constricting the vessels however it may make up for that decrease with the increased heart rate

3.) Nicotine causes inflammation not only in the lungs but also in our blood vessels

4.) Nicotine also decreases our good cholesterol and increases the levels of our bad cholesterol

5.) We also see an increase in diabetes in smokers

6.) Each of these changes impacts our heart health, and one of the reasons heart disease remains the #1 cause of death in the US

E Cigarettes- Vaping

There has been a lot in the news lately about vaping, most of it very concerning. As you all recall we have discussed this topic in the past. One of the marketing ploys has been to use this the e cigarette as a bridge for those who want to quit smoking. The CDC is supportive of this use and feel that the individual who uses e cigarettes as a way to quit smoking receive a substantial net benefit for their cardiovascular health versus attempting to wean with traditional cigarettes. However this appears to be a small portion of the current e cigarette users. It appears that many are using these as an alternative to tobacco or as their first exposure to nicotine.

We must realize that nicotine is very highly addictive, and that it does not take much exposure to nicotine to become addicted. We have seen a large increase in the use of vaping in teens and adolescents although the legal age to buy e cigarettes is 18. We know that many online sites will sell to an adolescent without asking for proof of age. We know that many children and adolescents are becoming addicted to nicotine thru the use of e cigarettes. Adolescents and teens don’t think they will get addicted, but after a short time of use they find it very difficult, one reason is the young brain is very sensitive to rewards and nicotine is seen in the brain as a reward. Nicotine is absorbed quickly thru the lungs and gets to the brain in about 10 seconds this results in the pleasure system being triggered. The body clears nicotine quickly and then the brain craves nicotine again and the addiction is started.

The concern is that these adolescents and young teens will use the e cigarettes to smoke marijuana as well as a transition to traditional cigarettes. Studies have shown that teenagers who have used e cigarettes are 3 times more likely to begin smoking traditional cigarettes within 6 months when compared to non-users. Over 60 % of teens using e cigarettes think that they only have flavoring in their fluids and do not understand that they are receiving nicotine as well. It is interesting that cigarette advertising has been banned since 1970 however teens are being exposed to e cigarette ads from all angles, retail, internet, movie, magazine and social media.

Although the age to purchase e cigarettes is 18 a study recently showed that 37% of 12th graders had vaped in the past year with the majority of them under the age of 18. The rate the year before was 28%, so we are seeing a drastic increase in young teens and adolescents. High Schools are fighting this issue daily as more students are using e cigarettes in the school with students acting as distributors to other students.

We know that with e cigarettes, as we see with traditional cigarettes that the nicotine addiction is very strong, and in e cigarettes it is even worse, as the amount of nicotine delivered is higher in many cases. Individuals need to understand the addictive nature of e cigarettes. Parents need to understand the dangers from vaping, not only the addictive nature of the e cigarette but also that it has been a gateway to both traditional cigarette use as well as marijuana use. Many parents think this is just water and flavoring and don’t know that their children are actually inhaling nicotine at high doses and often leading to addiction. Parents may think that these are safe as they have been marketed as a way to quit smoking. By all accounts they appear to be much safer than traditional cigarettes with less carcinogens, however the long term effects are not known at this time.

That being said e cigarettes have the advantage of being able to taper the amount of nicotine. For the individual who is trying to quit smoking, e cigarettes allow for a slow taper in the content of nicotine delivered. It can get to a point where there is no nicotine in the e cigarette. This flexibility allows for the individual who wants to quit to do so in a safe and gradual manner. We know that the hand to mouth motion that smokers use is a another portion of breaking the nicotine addiction as well. You may have heard of patients using vegetables as part of breaking the habit of smoking, this is breaking the hand to mouth portion of the addiction. This use of vaping can actually have a positive impact on the health of individuals who have the will power to break this addiction.

Adolescent and Teen Severe Lung Illness after Vaping

Recently in the news we have seen a very sharp increase in severe lung disease in adolescents and young adults in pockets across the country. Experts are still looking to find the cause of this severe lung disease. The only common thread is that each of these individuals used e cigarettes. The CDC has looked and cannot find an infectious cause to this illness. The illnesses started in June of this year in the Midwest and the cases continue to rise as do the locations of the patients. It was first noted in a handful of Midwest states including 22 cases in Illinois and now cases have been seen in 16 states and the number of cases creeps towards 200. The patients all confirm that they vaped nicotine or THC. The cases are not limited to one brand of e cigarette. They are now investigating what may be the common cause in the e liquid.

The patients have a range of illness and some have required oxygen and others to be placed on a ventilator and many are expected to have permanent lung damage. We know that the use of E cigarettes is fairly new and that the long term effects of them is not known. These cases however are being seen in young teens and adolescents and not in long term users. The CDC is looking to find the culprit behind these cases, it is thought that this may have been happening across the country for a while but it is now being noted by the media and the sporadic cases are now being reported.

One other concern is that the flavoring used in the liquid for e cigarettes has been tested on the impact of the intestines as flavoring has classically been used in foods, these flavorings have not been studied for their impact on lung tissue in a vaporized form.

Impact of a single non nicotine vape study

Another study that came out last week that showed that e cigarettes with no nicotine still has an impact on our blood vessels. The study published last week in the journal Radiology, showed that healthy individuals when allowed to use an e cigarette for the first time showed changes in their arteries after a single use. The changes were reversible after a short time. This study does raise the question of what are the long term effects of e cigarettes on all blood vessels in the body, this study looked at the main artery supplying blood flow to the leg, but what is it doing to the arteries that supply the heart and brain. It also raises the question, what is this doing to individuals who already have disease in their arteries, as this study was done on healthy young adults.

So overall we need a lot more studies and information on the long term impact on vaping. We need to make sure that the exposure of advertising for e-cigarettes is minimized. The use in teens and adolescents and the increased addiction is alarming and limiting the ability for individuals under the age of 18 to purchase these must be policed. Many are supportive of elevating the age of purchase for e cigarettes to 21 years of age.

The use of vaping as a substitute to traditional cigarettes is thought to be good as the number of carcinogens appear to be lower, however the e cigarettes still contain the addictive nicotine which has negative impact on the health of all users. The use of e cigarettes as a tool to quit smoking certainly makes sense with a gradual tapering of the nicotine in order to break that addiction. One would hope that e cigarettes will show higher quit rates success than the other options which have shown dismal results.

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