Last Sunday morning, I went outside and sat in the warm south coast sun, enjoying the last weekend of summer while thinking about the concert we had seen the night before featuring The Four Tops and The Temptations in Cohasset, Massachusetts. As the first few bars of "My Girl" began to go through my brain, I noticed puffs of white smoke rising over the back fence. My neighbor, John, was outside so I assumed he was cranking up his grill early for the Labor Day weekend, but strangely, the puffs of smoke seemed to be moving. Just then, he came around the corner proudly showing me his new “vape machine” that, according to him, would help him stop smoking and start to “live healthy" once again.
“This is great stuff,” said John. “All natural, only thing going into my lungs and coming out is water vapor.” After 40 years of smoking, John had made a commitment to stop and felt that vaping would do the trick. But...just water vapor? Really?
John went on to tell me all the good things about vaping, citing medical literature and statistics that supported the health benefits of his newest activity. When I asked him who told him about the benefits of a vapor device, he told me it was "the young lady who sold it to me at the convenience store." Not a place where I would be comfortable seeking advice about something that I would be putting into my lungs, but apparently he felt comfortable.
My final advice to John was to do more research about vaping, citing that vaping is not an ideal way to quit smoking, but it fell on deaf ears as he went on and on about different flavors, water vapor, clean lungs, etc. The problem was, he believed what he believed and nothing I would say would change that. As they say in marketing 101, let not the facts get in the way of making a sale. Those companies that are selling vaping products, like the CBD oil marketers, have done a fantastic job of medical sleight of hand.
But let's expound on John's new found healthy lifestyle. Just what is vaping? In a nutshell, it is the act of inhaling and exhaling vapor from a small battery powered device containing liquid that may or may not contain nicotine or in some cases, may contain cannabis. When you inhale on the mouthpiece of the device, it activates a heating element. This heats up the liquid in the pod and turns it into vapor. You then inhale the vapor. This is why it’s called “vaping.”
To be fair, many medical experts agree that vaping appears to be a better choice than inhaling the smoke and tar that is contained in tobacco or cannabis cigarettes, but it is not without its dangers and older adults and seniors need to be aware that we are just beginning to see problems arise with vaping -- and also to understand that this phenomenon is just starting to catch on with baby boomers, a group already prone to respiratory issues as the normal process of aging.
This past Friday (September 6, 2019), federal authorities sent out a warning about the ever growing problem of serious lung related illnesses associated with vaping. The numbers, according to the Centers for Disease Control (CDC), have reached 450 possible cases with five deaths resulting. The common denominator in this severe respiratory disease is that all the victims used vaping products, however it is still unclear what chemical or device may be causing these illnesses and deaths.
According to the CDC, the sickness begins with a chronic cough, shortness of breath, chest pains and difficulty breathing. This is then followed by nausea, diarrhea, vomiting, fatigue and weight loss. Most cases involved young people in their late teens and twenties who have no underlying health issues.
Not only are we looking at an illness that even the CDC can't figure out, those who claim that vaping is "natural and healthy" need to consider some other facts, including:
The vape liquids, called “e-liquids”, are sold in convenience stores, gas stations and other “non-medical” locations and users have no idea what’s in those vanilla, cinnamon or cherry liquids. In fact, there is some concern that the illnesses being reported may be associated with these liquids being mixed in unsanitary and unregulated environments or "knock-off" liquids are being sold on the street or in corner stores;
Researchers have found some surprising things in those “healthy” fruit flavorings. Propylene glycol, the main ingredient in many of these vape liquids, turns into an entirely different chemical compound when heated and inhaled, causing lung irritation and promoting an environment where bacteria could grow freely. The problem here is that vaping is relatively new and we don’t know what the long term effects will be;
Although the sales people who sell these products tell you it is a harmless water vapor, the Surgeon General has found that ultrafine particles are created that are inhaled deep into the lungs;
A flavor in many liquids called diacetyl, has been linked to serious lung diseases including one called "popcorn lung";
Vape liquids include volatile organics heavy metals such as nickel, tin and lead;
It took decades to understand the dangers of smoking tobacco and at one point, medical doctors recommended cigarettes for their patients and even advertised the medical benefits of smoking;
Chemicals present include formaldehyde (a chemical associated with several forms of cancer) and acrolein (associated with pulmonary edema) has been found in some vape liquids.
There are also problems associated with the vaping devices themselves. According to Maciej Goniewicz, a leading researcher into vaping and e-cigarette products, the heating elements in these devices emit tiny particles, sometimes including metals, which can lodge deep within the lungs and get absorbed into the body’s circulatory system leading to cardiovascular toxicity. These particles have been studied extensively in the context of air pollution and tobacco smoking and have been linked to a range of cardiovascular issues, including heart attacks, high blood pressure and coronary artery disease.
Vaping has also been associated with an increased risk of developing Chronic Obstructive Pulmonary Disease (COPD). Studies done in 2016, 2017 and 2018 all discovered proteins in the airways of those vaping that are known to contribute to the development of COPD. All those in the study showed markers of oxidative stress associated with lung disease. For those with pre-existing COPD, vaping is obviously not recommended.
Researchers have also found that vaping can damage vital immune system cells and may be more harmful than previously thought. Researchers found that this activity disabled important immune cells in the lung and boosted inflammation resulting in asthma and chronic bronchitis.
As noted earlier, vaping is just now catching on with younger baby boomers. Consider this, if this newly seen illness associated with vaping in being seen in young people with healthy bodies and lungs, what effect will it have on an aging body? Let's check this out.
The lungs have two main functions in our bodies – to bring in oxygen and expel carbon dioxide. Our airways are made of stretchy tissue with bands of muscle wrapped around them that keeps each airway open. As air enters our lungs, it fills tiny air sacs and the blood that circulates around these sacs carries oxygen out to the body and carbon dioxide in to be exhaled. But as we age, this very efficient system begins to change.
The skeletal system also changes. As we age, the bones in our chest and spine begin to thin and change the shape of the rib-cage. As a result, the expansion and contraction that supports breathing begins to breakdown. There is also a muscle in the chest area called the diaphragm, which supports breathing and as it begins to weaken, it can prevent an older adult from breathing enough air in and out. These changes alone can lower the oxygen levels in the body and keep carbon dioxide levels higher, resulting in shortness of breath.
While this is occurring, changes are happening in the lungs themselves. The muscles and other tissues in the airways begin to loosen and struggle to keep the airways completely open, allowing them to close easily. Meanwhile, the air sacs begin to lose their shape and become baggy (imagine a latex balloon filled with helium on the fifth day). These changes cause air to become trapped in the lungs and break down the once efficient system of oxygen and carbon dioxide exchange.
The nervous system also begins to become less efficient, much like the wiring in an old house. The part of the brain that controls breathing begins to slow and the result is a lack of oxygen in the lungs and excess carbon dioxide causing a difficulty in breathing. The nerves that trigger the cough reflex allowing for the airways to be cleared becomes less sensitive resulting in a buildup of particles, germs and bacteria inside the lungs leading to an ideal environment for infection.
And as the immune system begins to fail, the body becomes less able to fight lung infections and other diseases and lung tissue has a harder time recovering after exposure to harmful particles.
And what about the argument that vaping helps a smoker quit? It's a claim that simply is not true. Although it offers some form of harm reduction for a smoker, it is simply replacing one product with another and not addressing the core issue. As someone who has worked with smokers for decades to assist them with smoking cessation programming, there are several myths that need to be discussed.
Although many people tie the smoking habit with nicotine and their addiction to that substance, if that was all there was to the smoking problem, it would be solved with the patch or gum, known as nicotine replacement therapy, but it can't work on it's own. Why? Because the biggest problem with quitting smoking is the “habit” and not the addiction to nicotine.
A habit is defined as “an acquired behavior pattern followed so regularly until it has become almost involuntary”. When such a habit is positively associated with other behaviors or satisfying activities, it becomes stronger or acquires something called “habit strengths”. With cigarettes, smoking is associated with many other activities where habit strengths and positive and rewarding associations(pairings) are developed. These include:
A cup of coffee and a cigarette;
Smoking after a meal;
Smoking after an activity;
Reaching for a cigarette to relieve stress;
Smoking after work and driving home.
We could go on, but you get the idea. Now, when you link these associations with an addictive substance nicotine, the habit becomes even stronger. And pair it with coffee and its addictive substance, caffeine, you have an even stronger association and physiological reinforcement.
But now imagine we replace the addictive substance -- nicotine -- with the patch. Although the substance is now in the body to deal with the tolerance to the substance that has developed, the associations still exist and research has shown that these associations/habits may be harder to break than the addiction to the drugs themselves. Unless habits and associations are addressed as part of an overall treatment plan for tobacco cessation, replacing nicotine is not enough. There must be a behavior plan that will replace the unhealthy pairings with healthier ones, like a cup of coffee and a magazine, a meal and exercise, etc.
Using a vape device in place of a cigarette does not address the habits and associations. In fact, those who use the vaping devices do so the same way they use cigarettes, with or without the nicotine in the liquids. So if a vaping device is not around, the user will quickly return to cigarettes because the habits and associations have never been addressed. One piece of interesting research when it comes to the claim that "vaping" keeps people from ever starting to smoke is this -- the CDC has reported that teens who vape are more likely to begin smoking than those who do not. Enough said about the strength of habits and the virtues of vaping.
So here’s the bottom line, although vaping may be considered less harmful than smoking tobacco, it still carries with it dangers to the aging respiratory system and should realistically be considered the “lesser of two evils” rather than a safe alternative to smoking. Remember, our lungs were meant to inhale clean air and nothing else. As we stated earlier, it took years to understand the dangers that cigarettes and tobacco products posed and if I were a betting person, I would wager the farm that we are heading down a similar path with vaping.
Don Drake oversees Connelly Law's Community Education Programming. He is a retired licensed clinician in the Commonwealth of Massachusetts with over three decades of experience working with older adults diagnosed with HIV/AIDS, substance abuse disorders, chronic homeless and mental illness. Prior to his retirement, he was the director of a unique treatment program for older adults with histories of mental illness, cognitive disabilities, and addiction at Shattuck Hospital in Boston. He was also a director at Steppingstone, Inc. in Fall River, Massachusetts where he was the clinical trainer, program and curriculum developer for the agency and oversaw treatment programming for older adults. He has over 40 years of human service and law enforcement experience and has worked as an administrator at programs in Boston, Hartford, Providence and Philadelphia, helping to structure, hire and train staff in providing behavioral and addictions treatments to adolescent and adult clients. Drake also worked as a trainer for the Massachusetts Department of Public Health presenting training on QPR, a suicide prevention curriculum for the general public, the Massachusetts Council for Problem Gambling and the Crisis Prevention Institute, an international training organization that specializes in the safe management of disruptive and assaultive behaviors. He is also a retired professional wrestler who is in the New England Professional Wrestling Hall of Fame. Drake can be reached at Connelly Law Offices, Ltd. at firstname.lastname@example.org