Recent reports by the media of e smoking – a disturbing trend that is now spreading especially among the youth of our little island nation of Sri Lanka with dangerous health risks to their health, causing injuries to their lungs and affecting their respiratory system especially when practiced over a long period, has raised alarm bells among our health officials.
The Sunday Observer spoke to the Senior Consultant Respiratory Physician, National Hospital for Respiratory Diseases. Welisara, Dr. Wathsala Gunasinghe to get more insights into this emerging trend, what makes it so addictive especially to young people, and why it is so dangerous to their health.
Excerpts
Q: Vaping is now a rising trend especially among young people today and is currently reaching levels of a global health epidemic according to recent media reports. For the benefit of our readers who are still not familiar with this particular health issue, could you tell us what exactly is Vaping?
Dr. Wathsala Gunasinghe
A. Vaping or e cigarette use is the practice of inhaling and exhaling a vapour produced by a device designed for this purpose. This vapour contains various additive substances such as nicotine, flavourings. The vapour is produced by heating a liquid called “vape juice” or e liquid usually through a battery operated atomiser. This practice simulates smoking and earlier vaping devices resembled cigarettes but now most of them are not easily identifiable and can look like every day items such as USB flash drives, Lipstick.
Q: Health officials have expressed concerns of the adverse health impacts of this disturbing new trend. What in your opinion are some of the most toxic substances that vaping devices contain, and what makes these substances so dangerous to human health?
A. Most of the vaping devices contain Nicotine which is now accepted by most health officials as a substance that has dangerous consequences on human health. Nicotine is extracted from Tobacco. This substance affects the neurotransmitters in your brain and due to its addictive nature drives you to continue to use the substance despite knowing the harm it can do to your health. To give some examples, Nicotine can harm the developing brain such as in youth and children and causes an increase in blood pressure, heart rate, narrowing of the arteries and in turn, may lead to a heart attack. Some studies have also shown that vapes/e cigarettes deliver even more nicotine than traditional cigarettes. Can vaping also lead to lung injuries?
Q: Evidence of a link between lung injuries and vaping has found that vaping can also lead to lung injuries. Do you agree?
A. Yes. There is now evidence that outbreaks of lung injuries and deaths have been found to be linked or associated with vaping. For instance In February 2020, the Centre for Disease Control and Prevention (CDC), USA confirmed 2,807 cases of e-cigarette or vaping use-associated lung injury (EVALI) and 68 deaths attributed to that condition. These cases are thought to be related to other chemicals that are in the vape juice or created during the heating process. More than 30 chemical compounds have been identified in vape juice and some have carcinogenic properties. In addition, Vaping is also identified as a risk factor for COPD due to environmental causes.
Q: Any other health risks from e smoking you would like to add to the list?
A. Apart from these risk factors there are also health risks due to the device itself such as burns and explosion injuries. We have also heard reports of accidental exposure to liquid from e-cigarettes which has caused acute nicotine poisoning in children and adults. The danger is that Vaping tries to normalise the habit of smoking and this is a significant social and health hazard. Teens who vape are more likely to begin smoking cigarettes as adults
Q: Who are those most at risk age wise and gender-wise?
A. Mostly young people as they are always looking out for new things to experiment with.
Q: So what are the substances that make it so addictive to them?
Chest X-ray of a patient with vaping-associated lung injury (EVALI) showing bilateral
infiltrates upon ICU admission.
A. Nicotine is the main addictive substance. Even the e cigarretes devices which claim to be non nicotine (nicotine free have been found to have small amounts of it. In addition there are hundreds of flavouring some of which are very attractive to children and youth such as candy, strawberry. So even the devices without nicotine when repeatedly used exposes the child or youth to the health risks of the other compounds in it.
In addition, Vaping devices are found to generate ultrafine particles that can be inhaled deep into the lungs and many volatile compounds. Flavouring like diacetyl are linked to serious lung injuries and cancer causing chemicals and heavy metals are also detected in the vaping devices tested
Q: What in your opinion are the most common sites of the body that are damaged by Vaping?
A. As the vapour is inhaled the airways and the lung tissue including air sacs are the first part of the body to be exposed to the harmful effects of vape. Then the substances get absorbed and are carried throughout your body affecting the heart, brain etc
Q: Other than these areas of the body does vaping also damage other sites like the eyes, sense of taste and smell? Does it lead to loss of appetite?
A. Vape juice and smoke has been found to irritant to eyes, skin and vapor to the throat etc
Q: Does it also slow down cognitive development in unborn children exposed to tobacco smoking and vaping if a pregnant woman is exposed to vaping?
A. All health authorities advise against the vape use by pregnant females due to the risk to fetus and lack of scientific data. Nicotine is well known to cause similar side effects in young.
Q: e cigarettes use has increased steadily and rapidly across the world and in the Asian region as well . How does Sri Lanka compare with these figures?
A. As well as many parts of Asia, Sri Lanka also lacks formal data since this is an illegal practice and banned in many countries. However informal communication with parents, youth groups has shown us that youth including school children are using vape. The vaping devices are available and these can be obtained online as well as in shops mainly in the urban areas of the country.
For example a Google search will show you many places that sell vape, giving the readers the impression that this practice is safe due to their lack of knowledge. As these devices are being offered to children and youth in parties, social gatherings etc. we are now seeing that the use of vaping devices is increasing in the country
Q: Recent Studies have also shown that vapes re made with untested / unsafe chemicals even if the labels say nicotine free also contain nicotine. So how does a smoker know what is genuine? How can he ensure he is not buying these untested imports?
A. Some of the vaping devices are disposable and some are re fillable. Refilling is a concern as it may be an illegal/handmade product and may contain toxic material. What is important to remember, is that the use of vape or e cigarette is only considered by world health authorities in the context of smoking cessation program as a complete substitute of cigarretes, So using a safe product is not a option and use by any other adult or youth is not recommended as there are no safe vape products and data and studies are lacking on long term health effects of these products.
Q: So is the belief that Vape/ E- cigarretes can help you to quit smoking, a myth?
A. Although some devices are promoted as smoking cessation aids, Food and Drug Authority (FDA) USA has not approved vaping as a method of smoking cessation. Many studies have shown that individuals continue to smoke despite using a vape.
Q: If a young person wants to quit vaping how long will it take for him/her to do so?
A. More research is needed on this area. but vaping has become a problem worldwide. In the western world the problem has grown even to the extent that teens are vaping covering their faces with books while teachers are teaching! So the addictive properties should not be taken lightly
Q: So what is the solution? Awareness raising?
A. Being knowledgeable in many levels is essential if you are to control this menace. The policymakers, health officials, health care workers, teachers and parents should be educated that this practice is not safe and has dangerous health consequences. Legislative measures should also be implemented to ban all e -cigarettes use including products with nicotine (ENDS) and without nicotine (ENNDS) in Sri Lanka and control measures should be taken to prevent online illegal sales etc
Q: What are some of the recent interventions that the Sri Lanka Pulmonology Association of which you are a member has put in place so far to raise more awareness among all vulnerable groups starting from school level upwards?
A. The Sri Lanka College of Pulmonologists has been rallying against vaping over the last few years and we are collaborating with the Ministry of Health SLMA and other relevant stakeholder to implement early controlling measures to stop this dangerous health trend in its tracks.
Q: Do you have a message especially to young people on vaper addiction?
A. Vaping is neither a safe nor “cool” practice to experiment with. There is still a lot we don’t know about these new devices and their long term health risks .So do try to resist the temptation of experimenting with them and if you have already become addicted to it please stop.
As this may be difficult initially for you to do it alone, seek help from a qualified doctor or trained counsellor. Remember that quitting the habit however hard it may be will lay the foundation for your future wellbeing and health.
