E-Cigarette Side Effects

Serious health risks associated with e-cigarettes and the e-liquids used in vaping devices include seizures, nicotine addiction, nicotine poisoning, respiratory problems, heart conditions and stroke. The U.S. Surgeon General reported that e-cig users are being exposed to potentially harmful chemicals, including some linked to serious lung disease.

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 soaring popularity of e-cigarettes has exposed potential health risks of the devices once considered safer than tobacco cigarettes.

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.

The U.S. Surgeon General 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.

Seizures and Other Neurological Conditions

The FDA alerted doctors and health care providers in April 2019 that e-cigarette use may be associated with seizures, a known symptom of nicotine toxicity.

The agency had uncovered 35 reports of e-cigarette users having seizures since 2010. Most of the people affected were teens or young adults.

“Seizures have been reported among first-time e-cigarette users and experienced users,” the FDA’s original statement from April 2019 read. “Seizures have been reported as occurring after a few puffs or up to one day after use.”

The agency appealed to e-cig users to come forward with new reports if they had suffered seizures, fainting or tremors.

In August 2019, the FDA announced it had received 127 reports of e-cigarette users suffering seizures or other neurological symptoms. The agency said it was continuing to investigate a link and seek detailed reports from e-cigarette users who may have suffered symptoms.

“Seizures have been reported among first-time e-cigarette users and experienced users. Seizures have been reported as occurring after a few puffs or up to one day after use.”

Source: U.S. Food and Drug Administration

A 15-year-old North Carolina teen had to be taken by ambulance to an emergency room after a seizure his family blames on an e-cigarette habit, according to a 2019 report by NBC News. Luka Kinard was spending $150 a week on vaping products at the time.

Some e-cigarette lawsuits mention seizures. Erin and Jared NesSmith filed a lawsuit in 2019 on behalf of their 15-year-old daughter identified in the complaint only as A.N. They claimed the Florida teen became addicted to nicotine after using a JUUL e-cigarette. Their complaint said she suffered seizures and other side effects as a result.

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.

Popcorn Lung and Other Serious Respiratory Problems

Although rare, some individuals have developed severe respiratory problems from vaping. Chemicals commonly contained in vaping liquid have been linked to rare and irreversible lung diseases. Scientists say more research is urgently needed to determine what health risks the devices pose.

Potential Respiratory Risks of Vaping
Bronchiolitis obliterans

Also called popcorn lung, it 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.

Bronchiolitis obliterans organizing pneumonia

Abbreviated as BOOP, it affects the bronchioles, the tiny air sacs along those air passages called alveoli and the walls of the small bronchi. It may also be called cryptogenic organizing pneumonia, or COP, according to the American Lung Association.

Popcorn Lung

Bronchiolitis obliterans’ 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.

Call for Urgent Action
Harvard researchers have called for urgent action to evaluate the extent of diacetyl exposure and related flavoring compounds in e-cigarettes. The chemicals have been linked to a rare and serious lung disease called bronchiolitis obliterans, or popcorn lung.
Source: Environmental Health Perspectives

Harvard University researchers tested 51 types of flavored e-cigs and cartridges for diacetyl and two other chemical substances called 2,3-pentanedione and acetoin. The researchers detected at least one of the three flavoring agents in 92 percent of the flavors tested.

The chemicals are used in the manufacture of many flavored foods, but also are known to cause bronchiolitis obliterans when heated, vaporized and subsequently inhaled.

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.

E-Cig User Diagnosed with BOOP

While the Harvard researchers suggested e-fluid chemicals could cause popcorn lung, doctors have actually diagnosed bronchiolitis obliterans organizing pneumonia (BOOP) in an e-cig user.

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 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 in the lungs’ air sacs and disrupts oxygen exchange with the bloodstream.

E-Cigs May Cause Stroke and Double Heart Attack Risk

Recent studies have associated e-cigarette use with stroke and heart attack risks.

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

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.

Research presented at the American Stroke Association’s 2019 international conference found e-cig use increases a person’s risk of heart attack, stroke and coronary heart disease. It was the largest stroke and e-cigarette study to date, tapping into a database 400,000 people from all 50 states. More than 66,000 people who participated were regular e-cig users.

American Stroke Association: Increased Risks for E-Cig Users Compared to Non-Users
  • 71 percent higher stroke risk
  • 59 percent higher heart attack or angina risk
  • 40 percent higher coronary heart disease risk

Research showing a link between e-cig use and significantly higher heart attack and coronary artery disease was also presented at the American College of Cardiology’s 2019 scientific session.

American College of Cardiology: Increased Risks for E-Cig Users Compared to Non-Users
  • 56 percent more likely to have a heart attack
  • 44 percent higher risk of circulatory problems
  • 30 percent more likely to have a stroke
  • 10 percent higher risk of coronary artery disease

The American College of Cardiology study also found e-cig users were twice as likely to suffer from depression, anxiety or other emotional conditions.

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, RN 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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