Respiratory Health & Vaping: Interview with an Expert

“We’re seeing that people in their late teens or early twenties, who have been vaping for even a short period of time, can have lungs that are in the condition of a 70-year-old’s,” says Jeff Pardy, RRT, the department chair for Oregon Tech’s respiratory care program, which is offered both online and at its Klamath Falls campus, where the story of Hadynn Outcalt-Arends hits close to home.

“People think that vaping, because it doesn’t have smoke, is less harmful,” Pardy says. “But it’s misleading.”

In January 2018, the National Academies of Science, Engineering, and Medicine (NAM) released a report on e-cigarettes and vaping, based on 800 different academic studies. Of the report’s 47 conclusions, very few are a cause for optimism. The studies show conclusive evidence that e-cigarettes contain a number of toxic substances, and that the use of e-cigarettes causes health risks.

“Think about a sponge with all the little holes in it,” Pardy says. “That’s what the outcome is for our lungs with vaping. It’s not smoke damage, it’s oil-residue damage.”

Replacing tobacco with vape liquid means there are numerous new substances being inhaled into the lungs, and they can be extremely detrimental to a user’s health. One major offender appears to be vitamin E acetate. A recent study in the New England Journal of Medicine found that 48 out of 51 EVALI patients had vitamin E acetate in the fluid collected from their lungs. By comparison, none was found in a control group of healthy patients.

“Even though some of them have been FDA approved, vaping liquids are very loosely regulated,” Pardy says. “You really don’t know what you’re getting. Some of it can be very, very nasty, with long-term health impacts to users.”

The risks are as varied as the possible ingredients in a given batch of vape liquid. A study from the University of North Carolina found that propylene glycol and vegetable glycerin—two common ingredients in e-cigarettes—are toxic to cells, with the damaging effects being cumulative. Yet another study found that some e-cigarettes also include acrolein, a herbicide that can cause acute lung injury, COPD, asthma, and lung cancer. These studies are damning, but they still don’t tell the full picture, which could be even grimmer.

“Vaping is still relatively new,” Pardy says. “We really won’t know all the risks until a certain amount of time goes by, and more research can be done on the short- and long-term effects.”

Even Kevin Burns, former CEO of e-cigarette maker Juul, admitted that he and his company had no way of knowing the long-term effects of using their product; the data set simply didn’t, and still doesn’t, exist.

What Juul did seem to know from the start, however, was that they had a marketable product on their hands. Until as late as fall of 2019, the first line on Juul’s Wikipedia page read: Juul rhymes with cool. It’s since been edited. But, at first glance, the product does have an inherent coolness for certain users, including younger smokers. A blend between a USB stick and a vintage iPod shuffle, Juul’s e-cigarette delivers smokeless, vaporized nicotine salts—in flavors like mango and peppermint—directly to the user’s lungs.

That coolness was its own kind of branding, and it hit the segment of the population that parents and authorities try to protect the most from addictive and harmful substances: teenagers. E-cigarette and vaping use amongst high school students increased at an alarming rate of 78 percent from 2017 to 2018; for middle school students it went up 48 percent.

According to a National Youth Tobacco Survey, two of the top three reasons kids gave for picking up the e-cigarette/vaping habit were the availability of desirable flavors and the belief that it was less harmful than traditional smoking. By 2018, the US Surgeon General has called e-cigarettes and vaping an epidemic among American teenagers.

As Juul CEO, Burns also played up the idea that Juul should be seen as a way to quit smoking cigarettes, thereby tapping into a market segment that contributed heavily to Juul generating $2 billion in 2018 revenue. Vape vendors have been making the same argument for years. It doesn’t hold water. Another study in the New England Journal of Medicine found that while vaping was slightly more effective than other methods of quitting smoking cigarettes, 80 percent of subjects continued to vape long after they’d quit cigarettes.

“There are safer ways to quit,” Pardy says. “There’s nicotine gum. There’s medication, such as Chantix. There’s the nicotine patch. There’s smoking cessation programs. That being said, there’s no easy way to quit. The biggest choice someone has to make is to actually want to quit. That’s half the battle right there.”

In late 2019, Juul removed its Instagram and Facebook pages, which had been seen as directly advertising to children. Kevin Burns has been removed as the company’s CEO. The most cloying flavors of its nicotine salts have been pulled off the shelves. These steps may seem like victories for proponents of respiratory health, but they’re mere skirmishes in a much larger war.

Today’s nicotine user may not remember the days when cigarette packs came without warning labels, or when billboards featured the cowboy-clad Marlboro Man. It took decades to do the research and fight the monied interests to make such restrictions and regulations possible.

Given the rapid onset of EVALI and the epidemic of vape usage amongst youth in America, things need to move more quickly this time around.

The respiratory care degree program at Oregon Tech ranks as one of the best in the nation, both in its online degree-completion program and its traditional on-campus offering. Culminating in a bachelor of science degree in respiratory care, it prepares students for, and makes them eligible to take, the National Board for Respiratory Care (NBRC) certificate examination (CRT) and registry examination (RRT). Oregon Tech grads have a 97.7 pass rate for the CRT, a 93.5 percent pass rate for the RRT, and a 97 percent employment rate within six months of graduation. In 2015, the Commission on Accreditation for Respiratory Care (CoARC) awarded the program its Distinguished Registered Respiratory Therapist (RRT) Credentialing Success Award.