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Flavoured e-juice contains chemicals that can cause health problems.

Vaping-related deaths call for the habit to be monitored and regulated, writes Kasmiah Mustapha.

FIFTY-SIX people have died in the United States, including a 17-year-old boy, due to vaping-related illnesses up to Dec 19 last year.

More than 2,000 people have been hospitalised due to shortness of breath, coughing, chest pain and gastrointestinal symptoms of abdominal pain, nausea, vomiting and diarrhoea. It was also reported that those who are hospitalised may need lung transplants.

According to the US Centre for Disease Control and Prevention, about 70 per cent of the patients were male, 80 per cent were under 35 and 16 per cent were under 18.

US health officials have found the cause — vitamin E acetate, which is used as a thickening agent in vaping products containing tetrahydrocannabinol.

In Malaysia, a teenager was recently treated at Labuan Nucleus Hospital for severe internal lung damage, initially suspected to be asthma. However, he also suffered from symptoms of rhabdomyolysis and kidney failure.

After thorough investigation, it was found that he had been vaping for two weeks before he was admitted to the ICU.

It was the first case of vaping-related illness in Malaysia.

Since the emergence of vape more than 10 years ago, medical experts have issued warnings on the possible health issues. However, at that time, they were yet to identify the implications.

The concern was that the flavoured juice could be more risky due to the unidentified chemicals used to create them and how they react when heated up and inhaled.

Another worry is that vaping is highly popular among teenagers and they are therefore likely to be more affected. US health officials have raised concerns that nicotine addiction from vape is putting them at risk for a wide range of health issues.

Nicotine alters their brain development, increasing the risk of addiction to other drugs. They are also more at risk of cardiovascular disease and chronic respiratory symptoms than their non vaping peers.

Last year, a survey found that 37 per cent of teenagers in the US were vape users compared to 28 per cent in 2017.

Although there is no data in Malaysia, it is believed that teenagers’ use of vape products is also on the rise.

SERIOUS DAMAGE

UM Specialist Centre consultant respiratory physician Dr Wong Chee Kuan says the chemical content in the juice of e-cigarettes can cause serious damage to the respiratory system, which includes the lungs.

Since there is no regulation on the chemical content, the risk of lung injury is much higher. This health-related illness can be more serious if the person has other conditions such as asthma.

“The juice contains nicotine but we don’t know the amount. In cigarettes, nicotine content is regulated between 6mg and 24mg. There is no regulation for e-cigarettes, so it could be higher than this and the result is, people get addicted very easily.

“You can inhale a lot more nicotine when vaping. The effect of nicotine is very, very fast because the particles are small and will immediately head to your lungs, bloodstream and brain.”

In addition to nicotine, the e-juice includes chemicals such as propylene glycol, glycerin, formaldehyde, acetaldehyde and acrolein. Formaldehyde and acetaldehyde are believed to have the potential to cause cancer.

Dr Wong says these chemicals — that have never been tested to determine if they are safe for human consumption — can destroy macrophage, which is the airways’ defence cells.

Eventually, these cells become weaker and are unable to protect the lungs. This can cause respiratory failure and lung injury.

“People should realise that the chemicals will be absorbed into the lung tissue, causing inflammation. The inflammation will impede gas exchange that can lead to lack of oxygen in the body. When a person does not have enough oxygen, he will suffer from respiratory failure.

“Inflammation can also lead to another severe condition known as popcorn lung. It is an irreversible condition where the airways in the lungs become obstructed and damaged. The disease is progressive and a patient requires a lung transplant because he can die from the condition.”

Popcorn lung, or bronchiolitis obliterans, is a serious and irreversible condition in which the tiny air sacs in the lungs become scarred and constricted.

A study published in 2015 in the journal Environmental Health Perspectives found that harmful chemicals associated with popcorn lung are present in many types of flavoured e-cigarettes, particularly fruit and candy that may appeal to young smokers.

This suggests a potentially dangerous level of exposure via e-cigarettes to chemicals that can cause severe lung damage.

Dr Wong says in teenagers, the impact of these chemicals is faster because their organs and immune systems are still developing.

They face more serious effects compared to adults. As such, there should be more awareness programmes among teenagers on the dangers of vaping.

Although vaping-related deaths so far have been confined to the US, it does not mean it won't happen in Malaysia since vaping has become popular among teenagers.

They are drawn to vaping because they think it is trendy and they want to be accepted by their peers. In addition, vape products are cheaper than cigarettes and they are not monitored or regulated.

It has even been claimed that vaping can help one stop smoking. However, the Health Ministry has refuted this claim, saying it has not found any evidence or studies which show that the use of vape and electronic cigarettes is safe to treat smoking addiction.

Dr Wong says various studies have proven that cigarette smoking can cause chronic obstructive pulmonary disease, lung cancer and pulmonary fibrosis.

“Addiction to vape is more difficult to control. I believe there could be vaping-related illnesses in Malaysia but they may be under-reported. Unless the patient reveals that he is using vape, we can’t determine if the condition is caused by vaping.

“Those who vape must be aware of the dangers. The authorities should implement more awareness programmes for teenagers on the dangers of vaping.”

NOT GIVING IT UP

SASHA first tried sisha two years ago before moving on to vaping and getting addicted in the process.

Puffing on sisha was trendy and hip, she believed, as most of her friends were doing it.

Although she suffered from shortness of breath and sore throat, Sasha was reluctant to give up the habit.

Instead, she turned to the portable vaping device, which was cheaper and easier to handle.

At that time, vape products were easily available and prices were reasonable, she says.

She spent between RM35 and RM40 monthly on a bottle of e-liquid (30ml) as well as maintenance of the devices.

Sasha, who is now 18 and a student at a private university, says she is aware of the chemical ingredients in the juice as most companies provide a breakdown including the percentage and strength.However, she believes they are harmless. There is no evidence to say they can cause any health-related issues when consumed in small quantities, she asserts.

She is aware of the vape-related deaths and illnesses in the United States but is unconcerned. “Users should use regulated products from established brands or manufacturers which have been declared safe for consumption. There is lack of education and awareness on the matter. I always buy my e-liquid or devices from reputable stores.

“I will continue vaping because it does not cause severe harm compared to cigarettes. However, if there is a conclusive study to prove that vaping causes severe health deterioration, I will consider stopping.

“As for now, I don’t have any health issues other than a craving for nicotine. I am confident about vaping as cigarettes contain substances such as tar, ammonia and methane. These are more dangerous substances. E-juice does not contain any of them,” she says.

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