By Karen Kier
Pharmacist on behalf of the ONU HealthWise team
The idiom “where there’s smoke, there’s fire” appeared in John Heywood’s Proverbs from 1546 when he wrote there is no fire without smoke. The saying means if unpleasant things are being said about something or someone, then there is probably a good reason. As others have indicated, there is some foundation to the rumor.
The CDC reports about 480,000 deaths occur in the United States related to tobacco, with an additional 41,000 from secondhand smoke. Tobacco continues to be the leading cause of preventable disease. The CDC estimates that one of every three cancer deaths is related to tobacco, while one of four heart disease deaths are from smoking. The CDC reports eight of ten chronic obstructive pulmonary disease (COPD) cases results from tobacco.
COPD is a group of airway diseases resulting in difficulty exchanging air. The two types are emphysema and chronic bronchitis. Emphysema is damage to the air sacs where oxygen and carbon dioxide are exchanged resulting in an inability to push carbon dioxide out. Chronic bronchitis causes damage to the airways with mucus buildup and a chronic cough. About 16 million Americans live with breathing difficulties related to COPD. I had a colleague who demonstrated the difficulties by asking students to breathe through a coffee stirrer straw to replicate getting breaths with COPD.
Ohio’s rate of COPD cases and deaths are some of the highest in the country. Although COPD deaths have started to decline, there is serious concern with e-cigarettes or vaping among young adults.
Vaping solutions can contain nicotine or be free of nicotine. The FDA is concerned about vaping labels because a study of vaping solutions showed many claimed to be nicotine free but actually contained nicotine or other illegal drugs. Buyer beware!
The Youth Risk Behavior Survey evaluating e-cigarettes and vaping has shown an alarming increase. Nearly 30% of high school seniors have tried e-cigarettes or vaped. Many consider the flavoring components as a contributing factor. Vaping has been linked to a condition called E Vaping Acute Lung Injury (EVALI). Damage to the lungs has been associated with chemicals used in e-cigarettes, but some consider vaping to be less dangerous than cigarettes.
A study in the Journal of the American Medical Association evaluated patterns among adolescents, young adults and adults in the US using nicotine-free e-cigarettes. The study found most e-cigarette users used nicotine-free and nicotine types with the highest use in young adults. The popular flavors were sweet, dessert, mint and candy. Almost 40% reported use of tetrahydrocannabinol (THC) and cannabidiol in their vaping device. Another 22-28% added melatonin, caffeine and essential oils for inhalation into the lungs.
On May 13, 2022, the NEJM Evidence published a case series of four patients who developed COPD from e-cigarette use. The four had a history of use for 3 to 8 years prior to presenting with shortness of breath, difficulty breathing and chest pain. The first patient was a 25-year-old female who vaped for 3 years. The second was a 50-year-old female who vaped for 6 years. The third was a 65-year-old female who vaped for 4 years despite a history of asthma and COPD. A 63-year-old male was the fourth who had vaped for 8 years. All four used different vaping devices and different solutions. All patients were former smokers who had switched to vaping in the context of quitting smoking. One patient was able to quit nicotine, but not vaping as a substitute. All patients underwent lung function tests and biopsies to confirm the lung damage.
Although some say that vaping is safer than cigarettes, neither are without damage. The scarier part of this series is a patient as young as 25 years who can develop a lifelong lung disease from a combination of smoking cigarettes from age 18 to 22 and then vaping for 3 years.
A Johns Hopkins study published in the American Journal of Preventive Medicine found vaping increased blood sugar in youth and young adults. Vaping increased the risk of developing prediabetes by 22%, which can lead to the development of diabetes.
In December 2018, the United States Surgeon General declared vaping in our youth as an epidemic. Sadly, this trend has not changed. The risk of lung damage from vaping could become a larger epidemic as these youth age and we learn more about the dangers to overall health such as the increased risk of diabetes. The combination of lung damage in our youth from COVID-19 only contributes to this long-term issue. Several studies show lung damage in those with no symptoms of positive-tested COVID-19 as well as those with mild disease. Some scientists have even suggested patients presenting with EVALI in late 2019 and early 2020 may have been COVID-19 related, brought on by vaping.
Many substances are not meant to be in our lungs and result in damage. Where there is smoke, there could be fire.
Talk to your healthcare professional or an ONU HealthWise team member to discuss quitting smoking or vaping.
ONU HealthWise is offering COVID-19 including boosters Monday through Friday from 10:00 a.m.- 5:00 p.m. Call the pharmacy for an appointment for other time slots. The ONU HealthWise pharmacy offers Moderna and Pfizer COVID-19 vaccines.
ONU HealthWise Pharmacy
419-772-3784
www.onuhealthwisepharmacy.com
