JUUL and E-Cigarette Side Effects

According to a 2021 study published in the International Journal of Environmental Research and Public Health, about 40% of people who use e-cigarettes daily reported experiencing common vaping side effects. The most frequently reported adverse effects were throat and mouth dryness and irritation, cough and headache.

In addition to these common side effects, epidemiological studies link e-cigarette use to overall mouth dryness, gum disease and irritation, according to a 2021 study published in Journal of Dental Research.

Most of the e-cigarette side effects in study participants were mild. But researchers noted that the relatively high proportion of reported side effects “confirms that e-cigarette use is not without health risks.”

While the CDC has said that e-cigarettes expose users to fewer toxic chemicals than traditional cigarettes, they aren’t a risk-free alternative.

The liquid in Juul and other brands of electronic cigarettes typically delivers a vaporized mixture of nicotine, propylene glycol, glycerin, various flavorings and other chemicals. According to a 2014 study in the journal Tobacco Control, both glycol and glycerin are “known upper airway irritants” that can cause irritation of the throat and mouth and trigger dry cough.

While serious side effects are rare, the long-term health effects of vaping aren’t entirely known and more research is needed to understand them. But researchers have linked vaping to serious side effects like heart, lung and neurological injuries that could cause long-term problems.

For example, two new 2022 NIH-funded studies found smoking e-cigarettes may damage blood vessels as much as traditional smoking. And when e-cigarettes are used with traditional cigarettes, the risks are even greater.

“In our human study, we found that chronic e-cigarettes users had impaired blood vessel function, which may put them at increased risk for heart disease. It indicates that chronic users of e-cigarettes may experience a risk of vascular disease similar to that of chronic smokers,” said study leader Dr. Matthew L. Springer, a professor of medicine in the Division of Cardiology at the University of California in San Francisco.

Studies also show that e-cigarette exposure can reduce lung function, increase airway inflammation and weaken the immune system, increasing the risk of respiratory infections, according to a 2020 review published in The Journal of Physiology.

“We won’t fully understand the range of vaping’s harmful effects for some time to come, although we are already seeing many,” Dr. Joshua Mansour, a Los Angeles-based oncologist, told Drugwatch. “Just like tobacco and cigarettes in the past, it took several decades for us to really understand what the full harmful effects of those products were.”

EVALI: A Potentially Deadly Lung Injury

EVALI – an acronym for e-cigarette, or vaping, product use-associated lung injury – is the most serious vaping-related side effect. Symptoms may mimic the flu or other respiratory or digestive conditions. Patients who are hospitalized often need a mechanical ventilator to breathe, and some patients have died after being released from the hospital.

As of Feb. 18, 2020, the CDC reported that a total of 2,807 people had been hospitalized, including 68 who had died from EVALI since it was first identified in 2019.

After a peak in EVALI cases in 2019, EVALI case numbers have decreased but health care providers should stay vigilant in screening for health problems associated with vaping, according to a 2021 review published in Virchows Archiv by Maxwell L. Smith and colleagues.

Popcorn Lung and COP

Although rare, some individuals have developed severe respiratory problems and lung diseases from vaping. Two of these are: Bronchiolitis obliterans, also called popcorn lung and cryptogenic organizing pneumonia (COP) — known formerly as bronchiolitis obliterans organizing pneumonia or BOOP.

Popcorn lung affects the lung’s smallest airways, the bronchioles. It may cause damage and inflammation leading to scarring that blocks the bronchioles, according to the National Institutes of Health. It’s linked to diacetyl, a chemical used to flavor some foods and e-cigarette liquids.

Like popcorn lung, COP also affects the bronchioles. However, it also causes inflammation in the alveoli — the air sacs at the end of the bronchioles — and the walls of the small bronchi.

E-liquids and Seizures

Until recently, researchers connected seizures to nicotine in e-cigarettes. But new findings suggest that other chemicals and vape juice contaminants or ingredients, such as vitamin E acetate, may lead to seizures.

More data on seizures and other neurological effects are needed and researchers urge medical personnel and the public to report any adverse experiences regarding e-cigarettes.

Strokes, Heart Attacks and Vaping

More studies are needed to better define the link between cardiovascular disease and e-cigarettes. But existing research has linked vaping to potential heart problems, especially in people who vape and smoke traditional cigarettes.

“The odds of a heart attack increase by 42% among e-cigarette users compared to non-smokers,” according to a 2017 survey cited in a 2020 article published by Penn Medicine. In addition, results of a 2019 study published in The American Journal of Medicine suggest that dual users of e-cigarettes and combustible cigarettes have “significantly higher odds of cardiovascular disease” than those who only smoked traditional cigarettes.

Research on e-cigarettes and stroke risk is still lacking. Studies have shown that vaping affects the lining of the blood vessels and stiffens them and this is a risk factor for stroke. But increased risk of stroke has so far only been seen in dual users of e-cigs and traditional cigarettes, according to a 2021 article in Annals of Public Health and Research.

According to the CDC, e-cigarette use is unsafe for kids, teens and young adults. Because e-cigs contain nicotine, they may make young people more likely to smoke cigarettes in the future.

In addition, nicotine can harm brain development. A single Juul pod contains as much nicotine as a pack of 20 regular cigarettes, according to the CDC.

Some of the ingredients in vape juice may be safe to ingest but not to inhale and they can cause lung damage. One 2021 study published in the International Journal of Environmental Research and Public Health found e-cigarettes were associated with an increased frequency of dry cough and wheezing.

Another 2021 study in Scientific Reports found e-cigarettes were associated with a higher prevalence of asthma.

Vaping while pregnant isn’t safe, according to the CDC. Nicotine damages a baby’s brain and lung development and may affect other organs. In addition to nicotine, flavorings and other chemicals in e-cigarettes may also negatively affect a baby’s development.

A 2021 study conducted by Annette Regan and colleagues at the UCLA Fielding School of Public Health found that women who used e-cigs during pregnancy are 33% more likely to give birth to low-birthweight babies.

So far, research suggests that e-cigarettes pose a smaller cancer risk than smoking traditional cigarettes. But people who vape may have a greater risk of cancer than those who don’t smoke cigarettes.

Even if levels of toxins and carcinogens are lower in e-cigarette users compared to tobacco smokers, vapor from e-cigarettes contains several potentially carcinogenic compounds in addition to nicotine such as: Formaldehyde, acetaldehyde, acetone, chromium, acrolein, N-nitrosamines and others.

Research linking e-cigarettes to cancer is lacking and scientists are still studying the risk, but some animal, lab and human studies have linked vaping to several types of cancer. Scientists exposed cells from various parts of the body to e-cig vapor and found the chemicals caused DNA damage, inflammation and cell death.

In addition to possibly causing cancer, vaping also affects people who are undergoing cancer treatment. E-cig use during chemotherapy may reduce chemotherapy effectiveness.

A March 2021 study published in Scientific Reports found that head and neck cancer cells exposed to e-cig aerosol were more resistant to the chemotherapy drug cisplatin. Study authors found nicotine and other chemicals in e-cigarettes contributed to therapy resistance.

Juul pods contain more nicotine than a cigarette, and the amount of nicotine in e-cigarettes can be difficult for consumers to measure. Nicotine makes the brain release a chemical called dopamine in the brain, which leads to a pleasurable feeling. This reinforces the act of vaping to keep getting the nicotine “hit.” The more a person vapes, the more addicted they become.

“Unlike oral or intraperitoneal routes of administration, in which only 30% nicotine gets into the systemic circulation due to first-pass metabolism, inhaled aerosolized nicotine is quickly absorbed into the pulmonary circulation and the heart, then into the coronary and systemic circulations, and the brain,” according to a 2019 study published in Chest Journal.

Nicotine is a stimulant and this quick absorption affects breathing, circulation and seizures. Accidental ingestion of e-liquids can result in poisoning, quickly affecting the cardiovascular, circulatory, gastrointestinal and nervous systems. Nausea and vomiting are the most common symptoms of nicotine poisoning, but some cases can be life threatening.

Vaping before surgery can increase the risk of complications, according to the American College of Surgeons. Expert panels from the American College of Surgeons (ACS) Clinical Congress 2020 urged patients to quit vaping before surgery.

“Studies show smoking and vaping before an elective operation doubles the risk of postoperative pneumonia and increases the risk of a heart attack by 70%,” Dr. Jonah Stulberg, a general surgeon and health services researcher at Northwestern Memorial Hospital, Chicago, said in a statement at the 2020 Clinical Congress.

They added that smoking cigarettes, vaping and smoking marijuana can increase the risk of respiratory complications.

Nicotine and other chemicals in vapes negatively affect several systems in the body, especially your lungs, brain and oral health. While some chemicals might be safer to eat, they become toxic when heated up, vaporized and inhaled.

Researchers are still learning about all the parts of the body that vaping affects. Second-hand vapor isn’t harmless, either. It may contain nicotine, benzene and diacetyl.

If you vape and have pain, breathing difficulty, dental problems or cognitive or mood problems, don’t ignore it. Make sure to tell your medical provider right away.

There is no safe way to vape. While flavored e-liquids or vape juice that contain nicotine may be more harmful than vapes that don’t use them, other aerosolized toxic chemicals exist in vape juice.

The best way to minimize vaping side effects is to quit. Quitting vaping may be difficult but you don’t have to go through it alone. You can get support at smokefree.gov and other local programs in your state.

While rare, some people reported e-cigarette battery explosions. These rare explosions can cause serious injuries. The FDA isn’t sure exactly what causes these explosions.

The most common injuries among those treated were flame burns, which occurred in 80% of patients, but a third of patients suffered from chemical burns and more than a quarter experienced blast injuries. Many required surgery and skin grafts, as well as wound care.

So far, there has been one publicized death. In 2018, a Florida man died after his vape pen exploded. The 38-year-old man suffered burns to 80% of his body and was killed by two pieces of his vape pen that penetrated his skull.

Vapers can check the FDA’s page, Tips to Help Avoid “Vape” Battery Explosions, to get safety recommendations.

While vaping is still unsafe, it may have benefits for some smokers who switch to e-cigarettes and stop smoking tobacco cigarettes.

One 2019 UK study of 114 adults published in the Journal of the American College of Cardiology found long-term smokers who switched to vaping improved blood vessel function. However, study authors couldn’t say whether this benefit would be sustained long term.

In October 2021, the FDA authorized the marketing of three of R.J. Reynolds (RJR) Vapor Company’s Vuse e-cigarette products. The agency said it determined the products may help smokers quit or significantly reduce cigarette use. Despite this decision, the FDA maintains that e-cigarettes are not safe.

“It does not mean these products are safe or ‘FDA approved.’ All tobacco products are harmful and addictive and those who do not use tobacco products should not start,” the agency said in a statement.

Is vaping worse than smoking?
Vaping may be a safer alternative than smoking for adults who already smoke, but the CDC states that e-cigarettes are not safe for people who don’t currently smoke, pregnant women, teens and other young adults. Research is still being conducted on the dangers of e-cigarettes.

How do I know if I have EVALI?
Symptoms of EVALI are similar to the flu, and the illness can be hard to distinguish from other respiratory conditions. If you believe you have EVALI, consult with your doctor about your vaping habits. In addition to asking you questions about your e-cigarette use, your doctor may perform a pulse oximetry test and a chest x-ray before diagnosing you with EVALI.

Am I eligible to file an e-cigarettes lawsuit?
Lawyers are currently accepting cases from people who experienced serious lung injuries or diseases, suffered a stroke, became addicted before they turned 18, or had seizures after e-cigarette use. People filing suit are also claiming that Juul and other e-cigarette makers knowingly marketed their products to teens. Lawyers are also accepting cases from people who were injured after their Juul vaporizer caught fire or exploded. The number of e-cigarette lawsuits is expected to continue to grow. Contact a Juul lawyer to see if you qualify.