Vaping vs smoking lungs
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Vaping vs. Smoking: Impact on Lung Health
Introduction to Vaping and Smoking Lung Health
The debate over whether vaping is a safer alternative to smoking has been ongoing, with both practices having significant implications for lung health. This article synthesizes recent research to compare the effects of vaping and smoking on the lungs.
Acute and Chronic Lung Inflammation from Vaping
Acute Effects of Vaping on Lung Inflammation
Recent studies have shown that vaping, particularly at high wattages, can induce acute lung inflammation. For instance, vaping propylene glycol and glycerol aerosols, with or without nicotine, has been found to increase serum club cell protein-16, a biomarker of lung epithelial injury, and decrease transcutaneous oxygen tension in young tobacco smokers1. This suggests that even short-term vaping can cause significant airway epithelial damage and impair gas exchange.
Chronic Inflammation and Proteolysis
Chronic use of e-cigarettes has been linked to increased levels of neutrophil elastase and matrix metalloproteases (MMPs) in the lungs, which are enzymes involved in tissue remodeling and inflammation. Elevated levels of these proteases can disrupt the protease-antiprotease balance, potentially leading to chronic lung diseases such as bronchiectasis and emphysema8. This indicates that long-term vaping may not be safer than smoking in terms of chronic lung inflammation.
Respiratory Function and Gas Exchange
Comparative Impact on Respiratory Function
Both vaping and smoking have been shown to negatively affect respiratory function. Studies comparing vapers, smokers, and non-users found that both vapers and smokers had lower forced expiratory volume in the first second (FEV1), peak expiratory flow, and other spirometric measures compared to non-users2. This suggests that vaping, like smoking, can impair lung function.
Gas Exchange Disturbances
Vaping has also been associated with disturbances in gas exchange. For example, heavy smokers who vaped without nicotine experienced a significant decrease in arterial oxygen tension, indicating impaired oxygen uptake1. This effect was observed to be transient but highlights the potential for vaping to disrupt normal respiratory physiology.
Vaping-Associated Pulmonary Illness (VAPI) and EVALI
Clinical Manifestations and Risks
Vaping has been linked to a condition known as vaping-associated pulmonary illness (VAPI) or e-cigarette or vaping product use-associated lung injury (EVALI). This condition can present with symptoms ranging from isolated pulmonary issues to severe respiratory failure requiring invasive support7 10. The 2019 EVALI outbreak underscored the potential acute risks associated with vaping, particularly with products containing THC and other additives6.
Pathogenesis and Treatment
The pathogenesis of VAPI/EVALI involves the inhalation of harmful substances that cause lung inflammation and damage. Treatment typically includes corticosteroids and supportive care, with a focus on avoiding further use of vaping products10. The presence of vitamin E acetate in bronchoalveolar lavage fluid has been implicated as a potential cause of lung injury in vapers5.
Conclusion
Both vaping and smoking pose significant risks to lung health. While vaping is often marketed as a safer alternative, research indicates that it can cause acute and chronic lung inflammation, impair respiratory function, and lead to serious conditions like VAPI/EVALI. Therefore, neither vaping nor smoking can be considered safe for lung health, and further research is needed to fully understand the long-term effects of vaping.
Sources and full results
Most relevant research papers on this topic
Fourth generation e-cigarette vaping induces transient lung inflammation and gas exchange disturbances: results from two randomized clinical trials
High-wattage electronic cigarette vaping with or without nicotine can cause airway epithelial injury and decrease transcutaneous oxygen tension in young tobacco smokers, and temporarily impair arterial oxygen tension in heavy smokers.
RCT
Rigorous Journal
Highly CitedImpact of vaping and smoking on maximum respiratory pressures and respiratory function
Vaping and smoking both negatively impact lung function, suggesting they may not be a healthier alternative to smoking.
Observational StudyInhalation Toxicology of Vaping Products and Implications for Pulmonary Health
E-cigarettes may not be harmless and may cause cellular alterations similar to traditional tobacco smoke, with potential adverse respiratory outcomes and EVALI outbreaks.
Highly CitedHow beneficial is vaping cannabis to respiratory health compared to smoking?
Vaping cannabis reduces respiratory exposure to toxic particulates, but the reduction in lung health harms is smaller than that from substituting e-cigarettes for smoked tobacco.
Rigorous JournalCurrent Developments of Smoking and Vaping, Is Vaping Safer?
Vaping appears to be "safer" than smoking, but both have their own health risks, and neither is considered safe for use.
Literature ReviewImpact of vaping on respiratory health
Vaping is not without risk, and further investigation is needed to establish clear public policy guidance and regulation.
Literature ReviewRigorous JournalElectronic cigarettes and vaping associated pulmonary illness (VAPI): A narrative review.
Vaping associated pulmonary illness (VAPI) can rapidly progress and require invasive respiratory support, highlighting the need for more research on its etiology, treatment, and prevention.
Systematic ReviewChronic E-Cigarette Use Increases Neutrophil Elastase and Matrix Metalloprotease Levels in the Lung.
Chronic vaping increases protease levels in the lung, potentially increasing the risk of developing chronic lung disease, suggesting it may not be safer than tobacco smoking.
In Vitro StudyRigorous JournalHighly CitedChronic E‐Cigarette Exposure Alters the Human Bronchial Epithelial Proteome
Chronic vaping significantly alters the human bronchial epithelial proteome, potentially leading to the development of chronic lung disease.
In Vitro StudyHighly CitedE-cigarette or Vaping- product associated lung injury: A review.
E-cigarette or vaping-product associated lung injury (EVALI) is a growing epidemic in the US, with over 2600 cases and 60 deaths reported since March 2019.
Literature ReviewHighly Cited