How does vaping impact your lung health?

Can vaping damage the lungs?

E-cigarettes – also known as ‘vapes’ – are often recommended for people trying to quit smoking. Switching from inhaling smoke to breathing in vapour laced with nicotine helps smokers to give up an activity which is known to damage respiratory health and cause lung cancer. However, as vapes are a relatively new phenomenon, we’re still learning about their potential effects on the lungs. Professor Pallav Shah, consultant physician in respiratory medicine, explores how vapes can help smokers to give up cigarettes, and what long-term impact of vapes may be.

What’s in a vape?

Government research shows that between 3.1 and 3.2 million adults in England vape, including 18% of 18-year-olds. Surveys also show that 15% of 16–17-year-olds regularly vape. The rise of vaping – especially when it comes to teenagers – is particularly highlighted by vaping figures among 15-year-old girls rising from 10% in 2018 to 21% last year.

Public Health England states that vaping is 95% safer than smoking, as it exposes users to fewer toxins at lower levels than cigarettes. However, the NHS acknowledges that vaping “is not completely harmless.” Although vapes don’t contain tobacco or carbon monoxide – two of the most harmful substances in cigarette smoke – recent news reports have highlighted the potential effects of some chemicals found in e-cigarette vapour.

Vapes work by a battery (either rechargeable or disposable) heating e-liquid to turn it into a vapour, which is then breathed in by the user. The e-liquid usually contains propylene glycol, vegetable glycerine, flavouring and nicotine, with any flavourings and amounts of nicotine varying between devices, according to the preference of the user.

Although there are numerous types of vapes in various styles, some vape manufacturers have been criticised for producing vapes with colourful packaging and fruity flavours. Research has found that these are more likely to appeal to teenagers and may even encourage them to take up vaping when they didn’t previously smoke. This is against both NHS and government advice on the use of vapes.

To analyse the true contents of popular vapes, the Inter Scientific laboratory, which offers regulatory and testing services, looked at a selection of vapes confiscated from school pupils. They examined them to ensure that the UK Tobacco and Related Products Regulations were met, but what they found were high levels of metals in the e-liquid which far exceeded safe exposure levels.

Results from the 18 vapes analysed showed the following metal content:

• Lead – 2.4 times safe levels
• Nickel – 9.6 times safe levels
• Chromium – 6.6 times safe levels

“The World Health Organisation says that high levels of lead exposure in children can also impact brain development and the nervous system,” explains Professor Shah, “which makes these findings particularly worrying.”

While all e-cigarettes need to be registered with the Medicine and Health Care Products Regulatory Agency, the agency actually has no power to investigate unregistered products, or to verify claims made by vape manufacturers. This potentially explains how harmful substances like metals have gone undetected in vapes.

Despite this lack of regulation in the UK, 40 countries worldwide have completely banned vapes. Other countries have introduced regulations around the marketing, packaging, flavours and age restrictions to make them less appealing and available to children.

Does vaping cause lung and breathing conditions?

Overall, vapes are seen as a very useful tool to help smokers give up cigarettes. However, the NHS revealed that 40 children in England last year were admitted to hospital with vaping-related disorders. Two years previously, this figure was just 11 children, highlighting just how much vaping has grown in prevalence, especially among teenagers.

Vaping-related disorders can range from lung damage to worsening asthma symptoms, which include wheezing, coughing and chest tightness. Asthma is very common, with over 8 million people in the UK diagnosed with some form of the condition.

The most severe negative effects of vaping have resulted in people being connected to artificial lungs (extra-corporeal membrane oxygenation machine (ECMO)) after experiencing lung failure, which occurred in a case profiled by the BBC.

“ECMO treatment is required in cases where the lungs have failed, and the blood contains carbon dioxide as a result. Tubes remove blood from the body, extract the carbon dioxide before adding oxygen, and then pump the blood back into the body,” explains Professor Shah.

The doctors working on this case say that the patient’s regular vaping caused him to develop hypersensitivity pneumonitis. This is a condition where breathing in certain substances can trigger an excessive inflammatory immune response, leading to respiratory failure over time.

In some cases, this inflammatory response can be overwhelming and lead to permanent scarring on the lungs. Symptoms of scarring on the lungs include shortness of breath and a persistent dry cough, which can worsen over time and lead to other issues such as chest infections and heart failure.

Further to this, a 2016 study found that vaping products which contain nicotine can also trigger lung inflammation and tissue damage, both of which are associated with chronic obstructive pulmonary disease (COPD) development.

COPD is a term which covers a group of lung conditions that cause breathing difficulties. People with COPD may experience coughing, breathlessness, chest tightness, wheezing and excess mucus production. The symptoms can periodically worsen in an event known as a COPD exacerbation or flare up.

A 2017 study of e-cigarette smokers also found proteins in the participants’ airways which are known to contribute to COPD. However, as COPD can take decades to develop in smokers, and people affected are usually aged over 40, it may be several years until we know for certain that vaping can lead to COPD.

Could vaping cause lung cancer?

“While we’re very familiar with the negative health impacts of tobacco, vaping is still in its relative infancy,” explains Professor Shah. “We don’t know what the long-term effects of vaping are and, while it’s a much safer alternative to smoking, it may be years before we fully understand its impact.”

In fact, Cancer Research UK’s chief clinician notes that it could be a decade before we know for certain that vaping doesn’t lead to lung cancer. Given that it took decades to recognise the links between cigarettes and cancer, it’s unsurprising that there is little research to go on currently.

A 2022 study in the British Medical Journal highlighted the parallels between discussions around vaping now and cigarette use in the 1940s, particularly when looking at long-term use. The authors noted that while regular smokers and vapers don’t all develop acute lung injury in the short term, the long-term effects of smoking are very well documented.

The NHS notes that around seven out of 10 cases of lung cancer are caused by smoking, and cigarette packets even warn of this fact now. “A host of other lung conditions are also linked to smoking cigarettes, such as COPD, including both chronic bronchitis and emphysema, and asthma,” adds Professor Shah.

When it comes to assessing the potential long-term effects of vaping, research reveals that vapes produce several chemicals such as acetaldehyde, acrolein, and formaldehyde. The aldehydes are thought to contribute to lung disease, while acrolein may lead to lung cancer. Acrolein is a respiratory irritant which is typically generated in cooking and can also be found in tobacco smoke.

Studies have suggested that acrolein may contribute to TP53 gene mutations (the most frequently mutated gene in cancer) in lung cancer. These mutations can lead to normal cells becoming cancerous, the development of tumours, and resistance to treatment, all of which worsen a patient’s prognosis.

However, Cancer Research UK says that there is currently no good evidence that vaping causes cancer and highlights that it’s a useful tool to help people give up smoking – which is proven to cause cancer. While it acknowledges that vaping is not entirely risk-free, only time will tell what the long-term effects of inhaling the vapour are – including whether they lead to lung cancer or not.

“Ultimately, the advice is that if you do not currently smoke and are not trying to give it up, you shouldn’t start vaping. However, if you are addicted to smoking and are looking for a way to quit, vaping may help to ease the transition period,” says Professor Shah.

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