Monthly Archives: April 2023

If you visit vape stores or vape websites, youre likely to see a wide selection of colorful pods, cartridges and bottles filled with flavored e-liquid, or vape juice. The vape juice is heated in e-cigarettes and vape rigs, and it creates an aerosol that users inhale.

Vape juice comes in a variety of flavors, including candy, bubblegum and childrens cereals. Johns Hopkins cardiologist Michael Blaha, M.D., M.P.H., discusses vape flavors and other e-liquid ingredients, and how they may affect health, particularly for children and teens.

Flavor is just one of the ingredients in e-liquid. Vape juices usually include nicotine and many other additives and chemicals, and Blaha says the unpredictable variety of ingredients is a problem. Even the heating coil, which allows the liquid to become an inhalable aerosol, releases new chemical substances and trace metals that go into the users lungs.

There are so many ingredients in e-liquids, and to date, no one is taking responsibility to account for them, notes Blaha. He explains that while there may be production standards for commercial e-cigarette companies, standards for vape shops, off-brand online vendors or homemade vape juice blends are less consistent.

Vape juice can contain a variety of things that could be toxic, Blaha says. There can be flavors, dyes, nicotine, THC (the ingredient in marijuana that causes a high) and other substances. There are all kinds of concoctions, he says. For example, there are reports that people may put essential oils, multivitamins or traces of medicines into e-liquids.

Some of these additives found in e-liquid are dangerous even deadly. For example, vitamin E acetate has been indicated in EVALI, which stands for e-cigarette or vaping product use associated lung injury. This is a potentially fatal syndrome associated with vaping, and it was on the rise in 2019. Vitamin E acetate is OK to eat, but dangerous to inhale.

Theres no doubt about it, Blaha says. Some of the chest X-rays of patients with EVALI show signs of oily chemical irritation of the lungs.

So when it comes to inhaling vape juice, we dont know whats safe. You may be able to eat something safely, but if you inhale it, there may be a harmful effect.

Blaha says theres limited evidence that vape juice flavors themselves are dangerous to individual users. But there are unknowns research suggests that flavors, when combined with other vape juice ingredients and heated, can create new compounds that may be harmful.

Inhaling harmful substances can affect more than just the lungs. Some vaping enthusiasts describe a phenomenon called vapers tongue, which causes a sudden full or partial loss of the ability to taste.

As a specialist in heart disease, Blaha treats patients who have urgent reasons to quit smoking cigarettes. These patients are often older adults who may have heart disease associated with smoking, and Blaha says they are motivated to quit. For the smaller group of adults who have unsuccessfully tried all strategies approved by the Food and Drug Administration to stop smoking, vaping and using e-cigarettes may help them kick the habit. Some prefer using flavored vape products as a way to help quit smoking, with the ultimate goal of complete cessation from all tobacco products.

But Blaha is particularly concerned about e-cigarette use and vaping among young people, and the surging incidence of vaping among kids who have never smoked. These young people are vulnerable to becoming addicted to the nicotine in vaping devices and e-cigarettes, and flavors may be making vaping more appealing to them. Blaha observes that the appeal of vape flavors, rather than flavor ingredients themselves, may have a broader danger to the public.

The key thing about flavors is that they seem to appeal to young people, he says. There is evidence that kids like the flavors like bubble gum, fruit and candy, and like trying new ones. For a lot of young people, it might be that the only reason they vape or use e-cigarettes is because they like the flavors.

While more research may determine the overall harm from vaping, it is already clear that using homemade or unregulated vape juices can introduce unknown and potentially harmful substances into users lungs. Another main concern is the addictive nature of nicotine in vape juice or any tobacco product.

Since smoking has a major impact on health, Blaha recommends discussing all nicotine use and tobacco cessation options with a doctor.

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Vape Flavors and Vape Juice: What You Need to Know

Vaping and e-cigarettes are sometimes promoted as ways to help cigarettesmokers quit. But what about the reverse? Can vaping lead to regularcigarette smoking later on?

A Johns Hopkins cardiologist shares his insights on the potential dangersof vaping, and why avoiding cigarettes and their electronicalternatives is the healthier choice.

Michael Blaha, M.D., M.P.H., a professor of medicine at Johns Hopkins, directs clinical research attheCiccarone Center for the Prevention of Cardiovascular Disease.

Blaha says that although vaping may not be as dangerous as smoking, itsnot a safe practice.

Some e-cigarettes and vape juices contain nicotine, an addictivesubstance in tobacco. As of 2016, the Food and Drug Administration (FDA)classifies e-cigarettes and nicotine-laced vape juice as tobacco productsand regulates them accordingly.

Blaha says that while the FDA has recently taken a stance that is moretoward what it calls modified risk tobacco products that cause less harmthan smoking, vaping is certainly more harmful than not using anything atall.

Kids have such a poor understanding of vaping products itsextraordinary, he says. Sometimes they dont know that theres nicotinein them or what the dose is, or what the impact of the flavorings might be.

But because using these products is more socially acceptable than smoking,they might think that electronic cigarettes are perfectly safe.

In addition to nicotine, artificial flavorings and other chemicals thatusers inhale, Blaha is concerned about some of the behavioral aspects ofvaping.

I think perhaps the #1 concern about vaping right now is theso-called gateway effect. Our own literature suggests that 2 million youngadults use electronic cigarettes as their first nicotine-based product.Theyre not trying to quit smoking theyve never smoked before.

Nicotine in any form is highly addictive. Vaping, using nicotine-lacedproducts, can become a tenacious and expensive habit, and kids might notstop there.

Blaha says theres evidence that young people who vape are more likely togo on to use illicit drugs and tobacco products such as cigarettes.

We might be causing the next smoking epidemic through young people gettingaddicted to electronic cigarettes early in life, he says.

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Will Vaping Lead Teens to Smoking Cigarettes? - Johns Hopkins Medicine

For both studies, the researchers caution that they werent designed to show that vaping directly causes lung disease, but only whether doing so was associated with an increased likelihood of having disease. The researchers also didnt distinguish between vaping tobacco compared with cannabis. They also cautioned that self-reports via telephone surveys may not be wholly reliable. However, they say their findings demonstrate the need for continued research with e-cigarette users over time to confirm and clarify the risks.

Although e-cigarettes may turn out to be safer overall than traditional combustible cigarettes, our studies add to growing evidence that they carry health risks, says Michael Blaha, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine. These studies are the first in a series of larger and long-term studies that will more definitively provide evidence to inform tobacco users and regulators.

Asthma, marked by inflammation of the airways and shortness of breath, affects an estimated 25 million Americans, and life-threatening episodes can be triggered easily by pollution, allergies and smoking. COPD, which affects some 16 million Americans, describes a group of disorders including emphysema and chronic bronchitis that make it hard to breathe due to permanent damage to the lungs over time. Rates of asthma and COPD are rising worldwide, according to the World Health Organization. Most cases of COPD result from smoking traditional cigarettes.

A study published by Blaha earlier this year in the Annals of Internal Medicine estimated that 1.4% of people, or about 1.9 million people in the U.S., solely use e-cigarettes. Scattered reports have linked the practice to a spike in respiratory illnesses dubbed EVALI (e-cigarette, or vaping, product use-associated lung injury), affecting more than 2,500 people and associated with numerous deaths, according to the Centers for Disease Control and Prevention. Because vaping and the products inhaled with it are still relatively new to the market, its safety remains unclear.

To shed some light on the risk, the researchers took advantage of national survey data gathered by the Behavioral Risk Factor Surveillance System from 2016 and 2017. This annual survey, commissioned by the U.S. Centers for Disease Control and Prevention, consisted of telephone interviews of more than 400,000 adult participants and provides data on health-related risk behaviors and chronic medical conditions.

In the analysis published in BMC Pulmonary Medicine, the investigators analyzed data from 402,822people who identified themselves as never smokers, meaning they said they had smoked less than 100 combustible cigarettes in their lifetimes. Of these, 3,103 reported using e-cigarettes or vaping, and separately 34,074 people reported having asthma. The average age of e-cigarette users was 1824. About 67% of e-cigarette users were men. Approximately 57% of e-cigarette users reported that they were white, 19% were Hispanic and 12% were black.

Almost 11% of the e-cigarette users reported having asthma, compared with 8% of those who had never used e-cigarettes. Those people who reported being current e-cigarette users were 39% more likely to self-report having asthma compared with those people who said they never used e-cigarettes. Those who said they used e-cigarettes some days were 31% more likely, and daily users were 73% more likely to report asthma, compared with non-e-cigarette users.

For the study published in the American Journal of Preventive Medicine, the researchers analyzed the same data from all the questioned participants. From the more than 700,000 interviewees, about 61% reported being never smokers, about 9% were current smokers, 30% were former smokers, more than 3% said they currently used e-cigarettes, and 2% said they used both e-cigarettes and smoked. The e-cigarette users were more likely to fall in the age range of 3034, almost 60% were men, 72% identified as white, 8% as black, 3.5% as Asian and 11% as Hispanic.

Of those who said they used e-cigarettes, about 11% said they had chronic bronchitis, emphysema or COPD, compared with 5.6% of people who said they had never used e-cigarettes. Among never smokers, current e-cigarette users were 75% more likely to report having COPD, compared with those who had never used them. Those who said they used both e-cigarettes and smoked cigarettes were almost six times more likely to report having COPD, compared with those who had never used either, whereas just using combustible cigarettes alone increased the odds by three times.

As a physician, I am most worried about those who use both e-cigarettes and combustible cigarettes because they may end up taking in the most nicotine, which may do the most damage, says Albert Osei, M.D., M.P.H., a postdoctoral fellow at the Johns Hopkins University School of Medicine and lead author on the study. Through public health campaigns, we finally had smoking levels down in some populations, but now with the current vaping epidemic, I foresee a whole new previously tobacco-nave, young generation becoming dependent on nicotine if we do not intensify public health education efforts.

According to the CDC, of the 16 million people in the U.S. who have COPD, 38% of them still smoke.

Additional authors on these studies include Mohammadhassan Mirbolouk, Olusola Orimoloye, Omar Dzaye, S. M. Iftekhar Uddin, Zeina Dardari and Shyam Biswal of Johns Hopkins; Andrew DeFilippis and Aruni Bhatnagar of University of Louisville; Emelia Benjamin of Boston University; and Michael Hall of University of Mississippi Medical Center.

This study was supported by a grant from the American Heart Association Tobacco Regulation and Addiction Center, which is funded by the National Heart, Lung, and Blood Institute/U.S. Food and Drug Administration (2U54HL120163).

COI: Defilippis receives funding from Astra Zeneca and consults for Radiometer America, Inc.

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Vaping Increases Odds of Asthma and COPD - Johns Hopkins Medicine

Skin Burns

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Vaping burns are rare, but they can be serious, according to the FDA, especially if the device catches on fire while in the owners pocket. Heres what you should know if you get burned by a vape pen or e-cigarette.

Julie Ann Caffrey, D.O., M.S., assistant professor of plastic and reconstructive surgery and director of the Burn Fellowship Program at Johns Hopkins Bayview Medical Center, notes that vape burns are getting more attention among burn professionals. She adds that the injuries are probably underreported.

Caffrey says, The majority of patients that our team has seen with these types of injuries have been treated with local wound care. However, a smaller number have required surgery to heal their burn wounds, including surgical excision and skin grafting.

Vape burns can happen suddenly. For minor burns (those smaller than the size of a quarter), Caffrey suggests a cool compress (not ice). Then, each day, gently cleanse the area with mild soap and water and apply a layer of antibacterial (first aid) ointment and a clean, non-stick bandage.

Watch for signs of infection, such as fever, and call your doctor if you notice increasing redness, swelling or pain, or if there is a yellowish or foul-smelling discharge from the burn.

If a burn has the following features, Caffrey urges patients to seek medical help right away:

If youre with a person whos been burned and waiting for help:

Smoking electronic cigarettes is often considered safer than regular smoking. Learn why vaping is still harmful, and why you should rethink taking it up.

If your clothes catch fire, remember the STOP, DROP and ROLL rule: Smother flames as quickly as possible by dropping to the floor where you are, covering your face, and rolling over and over, focusing on the area thats burning.

Do not run or wave your arms, and dont wrap yourself up in anything that could catch fire.

If theres a fire extinguisher nearby, use it. Immediately cool the area with water and make sure the fire hasnt spread.

Vaping and e-cigarettes are sometimes promoted as ways to help cigarette smokers quit. But what about the reverse? Can vaping lead to regular cigarette smoking later on?

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How to Treat a Burn from a Vape Pen | Johns Hopkins Medicine