After three years, vaping's toll on the lungs finally starts to emerge 

"The chemicals that you're breathing in when you vape are damaging your lungs."

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In the past two years, e-cigarettes have become so ubiquitous in the United States that they’re they’re the most common tobacco product used by teenagers. But what happens to the lungs of those teenagers after years and years of vaping has — until now — been a mystery. After three years of research, the outlook doesn’t look great.

An analysis of 32,320 people over three years reveals vaping has strong ties to serious lung diseases like emphysema, chronic bronchitis, asthma, and chronic obstructive pulmonary disease. Vape users were 1.29 times more likely to to have any one of those diseases after three years as compared to non-vapers.

The rate is still lower than in cigarette smokers, but the emergence of an association after just three years of use are worrying, researchers say. 

Whether someone picks up vaping as an adult to try to quit smoking or as a teen getting in on this hot trend, the results suggest the long-term costs may not be worth it, Stanton Glantz, the study’s lead author and professor at the University of California, San Francisco, says.

“Lungs are designed to breathe air, not propylene glycol, vegetable glycerin, nicotine, flavorants and other stuff” Glantz tells Inverse. “The chemicals that you’re breathing in when you vape are damaging your lungs.”

Vaping was tied to emphysema and other respiratory conditions. 

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The study was published this week in The American Journal of Preventative Medicine.

It provides some of the first solid, longitudinal evidence tying vaping to long-term lung problems. Previous work has only hinted at the costs of vaping on the lungs. An August 2019 study, for example, found that 14 vape users’ lungs contained high levels of protease enzymes, one of the markers of emphysema in smokers.

In a smoking study, you’d want to look at how things progress over about twenty years, Glantz says. But the fact that they saw changes after only three years is “very troubling,” he says.

Vaping and smoking: the long term risks

Vapers’ rates of lung disease were still far lower than those seen in cigarette smokers. Smokers were 2.5 times more likely to develop lung disease over the same period of time.

Perhaps unsurprisingly, people who vaped and smoked had the worst outcomes — that population was 3.3 times more likely to develop respiratory disease compared to people who had never smoked or vaped. The researchers found 91.2 percent of e-cigarette users also used combustible tobacco by the end of the study. If people try to start vaping in order to quit smoking, and end up with both habits, there could be additional risks.

After three years, vapers were more likely to have respiratory illnesses than non-vapers.

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The results suggest that e-cigarettes may not be the magic bullet that some smokers think they are. While e-cigarettes may be safer in the short term and don’t release the hundreds of toxic chemicals that combustible tobacco products do, long-term use could expose people to even more issues:

“The whole e-cigarette debate has been framed in absolute terms and it ignores how people actually behave: that is, the great majority of e-cigarette users continue to smoke cigarettes. If they do that, then they’re worse off,” Glantz says.

Who bears the long-term costs?

For people who don’t smoke cigarettes but are reluctant to give up their JUUL, the study paints a bleak long-term picture for lung health.

The group that stands to bear the brunt of these long-term effects are teens, who are turning to vaping in record-breaking numbers. The Centers for Disease Prevention and Control estimates that about one in every four high school kids in America use e-cigarettes.

These habits are difficult to break. E-cigarettes still contain nicotine, which has addictive properties and the same habit forming power that cigarettes do — one JUUL pod contains as much nicotine as about a 20-pack of cigarettes, the CDC estimates. In a separate study also published Monday in American Journal of Preventive Medicine, researchers found that, in a sample of over 14,000 teenagers, 75.1 percent of those who vape are using products that either contain nicotine or THC, the active ingredient in marijuana.

Nicotine habits can take years to break. Some studies suggest it can take some smokers as many as 30 attempts to quit cigarettes — if they quit at all. For teens who want to quit vaping, the options are far more limited, Gantz says.

“People have been trying to use the same techniques, but right now, especially for kids that’s an area of active research. Nobody knows the answer to that right now,” he says.

In light of the long-term risks to health this study identifies, there couldn’t be a better time to find that answer.

Partial Abstract:
Methods: This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013−2016 and analyzed in 2018−2019.
Results: Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.
Conclusions:Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

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