E-Cigarette Side Effects

E-cigarettes have soared in popularity as a purported safer alternative to traditional cigarette smoking. But studies have revealed that e-cigarettes, and the e-liquid used in “vaping” devices, are associated with significant health risks, including nicotine addiction, nicotine poisoning and respiratory problems. What’s more, hundreds of people have been burned and some have even died from exploding batteries.

E-cigarette vape pen
E-Cigarette Side Effects
  1. Addiction Chronic use of e-cigarettes may lead to nicotine addiction.
  2. Nicotine Intoxication Overexposure to nicotine in vaping liquid can result in nicotine poisoning.
  3. Respiratory Problems Irritation of the throat and mouth and coughing are common side effects of electronic cigarettes. In some cases, more serious lung inflammation may develop.

The U.S. Food and Drug Administration began regulating e-cigarettes in mid-2016. Before that, little, if anything, was done to establish guidelines regarding sales, marketing and manufacturing of the popular devices and their e-liquid device counterparts.

Therefore, little was known about possible dangers, including a faulty design that contributed to lithium-ion battery explosions.

But over time, investigations have linked the devices to a number of potential health hazards.

Researchers found that users are actually being exposed to an assortment of potentially harmful chemicals, including nicotine, formaldehyde and heavy metals, such as lead. One chemical in many flavored e-liquids, diacetyl, has been linked to an incurable lung condition known as “popcorn lung.”

People who have suffered serious side effects or injuries from vaping have filed lawsuits against makers of the devices.

The U.S. Surgeon General also concluded that e-cigarette users were being exposed to potentially harmful chemicals, including:
  • nicotine
  • carbonyl compounds
  • volatile organic compounds

Additionally, the Centers for Disease Control and Prevention released data showing that e-liquid poisonings are “rapidly increasing.”

Common Reactions to E-Cigarettes

The liquid in electronic cigarettes typically delivers a vaporized mixture of nicotine, propylene glycol, glycerin, various flavorings and other chemicals.

E-liquid
E-liquid typically contains nicotine, propylene glycol and glycerin, plus various flavorings.

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.

Studies have found that these common side effects are more pronounced the first time a person uses an e-cigarette but appear to diminish with continuing use.

While serious adverse reactions are rare, the long-term risks of vaping aren’t entirely known. Although the devices contain fewer than the 7,000 chemical ingredients found in traditional cigarettes, they have been found to contain a variety of potentially harmful substances, including cancer-causing chemicals.

Nicotine Addiction and Poisoning

While e-cigarettes are touted as a method to help people quit smoking cigarettes, not everyone who vapes kicks the habit.

In fact, according to the CDC, most smokers who switch to electronic cigarettes are “not switching completely” and end up using both products — and some people end up smoking even more.

A 2018 study by researchers at UC San Francisco found that so-called “dual users” average one more cigarette per day compared to those who only smoke cigarettes. The researchers published their findings in PLOS One.

Did You Know?
A 2016 study by physicians at the University of California in San Diego found that nearly 44 percent of “dual users” were still using e-cigarettes two years after attempting to quit smoking cigarettes.

Teens Getting Hooked

Young people are particularly vulnerable to the lure of e-cigarettes. Nearly 36 percent of high school seniors reported vaping in the most recent Monitoring the Future survey, which tracks substance use by adolescents and teens.

“In some cases, our kids are trying these products and liking them without knowing they contain nicotine. And that’s a problem, because as we know the nicotine in these products can rewire an adolescent’s brain, leading to years of addiction,” FDA Commissioner Scott Gottlieb warned in a 2018 statement outlining a massive crackdown on the sale of e-cigarettes to minors.

According to the National Institute on Drug Abuse, studies suggest that e-cigarettes are a gateway substance that encourages young people to experiment with conventional cigarettes and other substances.

“In some cases, our kids are trying these products and liking them without knowing they contain nicotine.”

Source: FDA Commissioner Scott Gottlieb in a 2018 statement

A 2018 study in the Pediatrics journal, for instance, found that e-cigarette use among youth doubles the risk of marijuana use a year later.

Nicotine Poisoning

Nicotine can be toxic to humans when consumed in large, concentrated amounts, such as those sometimes found in e-liquid cartridges. Liquid nicotine used in e-cigarettes is absorbed far more quickly compared to nicotine from tobacco in traditional cigarettes. While most e-liquids are sold with concentrations at 2 percent, others can go as high as 10 percent.

Liquid Nicotine Poisonings
In 2018 alone, poison control centers handled at least 2,555 exposure cases related to e-cigarette devices and liquid nicotine.
Source: American Association of Poison Control Centers

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.

Other signs and symptoms of nicotine poisoning include:
  • Abdominal cramps
  • Depression
  • Burning sensation in the mouth
  • Drooling, or increased saliva
  • Fainting or coma
  • Convulsions (seizures)
  • Headache
  • Muscle twitching
  • Vomiting
  • Weakness
  • Breathing that may be difficult, rapid or stopped
  • Agitation, restlessness, excitement or confusion
  • Palpitations (a heartbeat that is fast and pounding and often followed by a slow heart rate)

Individuals with nicotine poisoning may initially develop symptoms associated with over-excitation of the central nervous system, such as elevated heart rate and blood pressure, anxiety, muscles spasms and seizures. Later on, as the poisoning progresses, the patient will develop slow breathing, a slowed heart rate, lethargy and paralysis.

Serious Respiratory Problems

Although rare, some individuals have developed severe respiratory problems from vaping.

Patient Story
A chest CT scan revealed nodes in the lungs of 27-year-old man who used e-cigarettes for seven months.
Source: American Journal of Respiratory and Critical Care Medicine

A 2016 case report published in the American Journal of Respiratory and Critical Care Medicine describes a 27-year-old man with no other health problems who went into respiratory failure after seven months of using an e-cigarette. According to the case report, he was using the device in an attempt to stop smoking traditional cigarettes.

The man’s symptoms included shortness of breath, a bloody cough and a fever. A CT scan of his chest revealed “innumerable” nodules in his lungs. The patient had to be intubated and placed on a breathing machine.

A lung biopsy eventually showed he was suffering from a rare condition known as bronchiolitis obliterans organizing pneumonia (BOOP), which his doctors concluded was caused by his e-cigarette use. He recovered with high-dose steroid treatment and was discharged from the hospital two weeks later.

There have also been reports in medical literature of individuals developing acute respiratory distress syndrome (ARDS) from using e-cigarettes. The life-threatening condition, also known as “wet lung,” occurs when fluid builds up on the lung’s air sacs and disrupts oxygen exchange with the bloodstream.

E-Cigs May Double Heart Attack Risk

Using electronic cigarettes on a daily basis may nearly double a person’s risk of a heart attack, according to a 2018 study by researchers at UC San Francisco and George Washington University.

The results of the study, which were based on national health interview surveys with more than 70,000 people, showed that heart attack risk was five times greater among dual users, who smoke traditional cigarettes and e-cigs.

Proponents of e-cigarettes have criticized the study. They say the study did not differentiate between individuals who had heart attacks before they started vaping versus those who had heart attacks after taking up the devices.

Unknown Health Risks: Popcorn Lung and Cancer

Flavored e-cigarettes may also pose other unknown long-term risks. Chemicals commonly contained in vaping liquid have been linked to cancer and a rare and irreversible lung disease. Scientists say more research is urgently needed to determine what health risks the devices pose.

Popcorn Lung Questions

Harvard University researchers tested 51 types of flavored e-cigs and cartridges for three chemical substances called diacetyl, 2,3-pentanedione and acetoin. These flavoring agents are used in the manufacture of many flavored foods, but are also known to cause a serious lung disease called bronchiolitis obliterans when heated, vaporized and subsequently inhaled.

Bronchiolitis obliterans is a different disease than bronchiolitis obliterans organizing pneumonia (BOOP). Also known as “popcorn lung,” it causes irreversible inflammation and scarring of the lung’s smallest airways, called bronchioles.

Call For Urgent Action
Harvard researchers have called for “urgent action” to evaluate the extent of diacetyl exposure and “other related flavoring compounds in e-cigarettes.” The chemicals have been linked to a rare and irreversible lung condition known as popcorn lung.
Source: Environmental Health Perspectives

The nickname “popcorn lung” came about after eight former workers of a microwave popcorn-processing plant became ill with the disease in May 2000. Their illness was linked to their inhalation of diacetyl, which is used to give popcorn and other foods their buttery taste.

Symptoms of the condition — such as coughing, wheezing and shortness of breath — are often mistaken for other lung diseases, such as chronic obstructive pulmonary disease (COPD) and asthma.

Can E-Cigarettes Cause Cancer?

While e-cigarette vapor is generally recognized as less hazardous than cigarette smoke, a growing body of evidence suggests that vaping still exposes users to cancer-causing agents.

Formaldehyde is a known cancer-causing agent that can be formed during the vaping process, according to an analysis published by the New England Journal of Medicine (NEJM) in 2015.

The analysis examined many samples of propylene glycol and glycerol, two base substances present in e-liquids. Results showed that when these substances are heated in the presence of oxygen to temperatures reached by e-cigarettes at high voltages, more than 2 percent of the mixture is converted to formaldehyde-releasing agents.

Inhaled formaldehyde has been linked to an increased risk of nasopharyngeal cancer and leukemia. Researchers found no elevated risk of a formaldehyde-related cancer when people use low voltage e-cigs. But they concluded that the lifetime risk of developing a formaldehyde-related cancer is five to 15 times higher with high-voltage vaporizers than with cigarettes.

A 2018 study in the journal of Pediatrics, meanwhile, found elevated levels of carcinogenic compounds in the urine of adolescents who vape. The levels of the compounds were up to three times greater than study subjects who did not use e-cigarettes. Adolescents who smoked cigarettes and vaped had levels of toxicants three times higher than those who just vaped.

Exploding E-Cigarette Batteries

In 2016, physicians at the University of Washington Medical Center in Seattle reported treating 15 patients for injuries resulting from e-cigarette explosions between October 2015 and June 2016.

The explosions resulted from faulty lithium-ion batteries, the doctors explained in a letter to the New England Journal of Medicine.

The most common injuries among those treated were flame burns, which occurred in 80 percent 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.

Most Common Injuries
Patients experienced injuries to their face, hands, thighs and groin, with explosions causing flame burns in 80 percent of those treated, chemical burns in 33 percent and blast injuries in 27 percent.
Source: The New England Journal of Medicine

In 2018, a Florida man died after his vape pen exploded. The 38-year-old man suffered burns to 80 percent of his body and was killed by two pieces of his vape pen that penetrated his skull.

Please seek the advice of a medical professional before making health care decisions.

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Nurse Amy Keller
Written By Amy Keller Registered Nurse

Amy Keller is a registered nurse and award-winning journalist with 22 years of experience writing about politics, business, health and other topics. At Drugwatch, she draws on her clinical experience and investigative reporting skills to write about consumers’ health concerns such as the safety of online pharmacies. She also provides informed analysis on complex health issues. Some of her qualifications include:

  • Recipient of USF’s Nurse Alumni Nightingale award for excellence in nursing
  • Guest Faculty Speaker, “Moving Forward with Patient- and Family-Centered Care Intensive Training Seminar”
  • Member of Sigma Theta Tau International Honor Society of Nursing
Edited By
Medically Reviewed By
Dr. John A. Daller
Dr. John A. Daller American Board of Surgery

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