E-cigarettes sky rocketed to fame as a purported safer alternative to traditional cigarette smoking. But studies have revealed that e-cigarettes, and the e-liquid used in the device to “vape,” are associated with serious side effects and complications, some of which can be deadly, including nicotine poisoning, a serious lung disease called popcorn lung, certain cancers, such as myeloid leukemia, and chemical burn wounds resulting from faulty batteries.
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 its e-liquid device counterparts.
Therefore, little was known about its potential dangers, including a faulty design that contributed to lithium-ion battery explosions.
But over time, investigations have found that e-cigarettes are linked to several serious side effects and health complications that extend beyond injuries incurred from exploding batteries and traditional nicotine exposure. Researchers found that users of e-cigarettes are actually being exposed to an assortment of chemicals, including formaldehyde, with the possibility of causing irreversible harm, even cancer.
Volatile organic compounds
Additionally, the Centers for Disease Control and Prevention released data showing that e-liquid poisonings are “rapidly increasing.”
One chemical in various flavored e-liquids, diacetyl, was found to cause lung damage that can become so severe, users may need a lung transplant to avoid life-threatening consequences.
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.
Accidental ingestion of e-liquids can result in poisoning, quickly affecting the cardiovascular, circulatory, gastrointestinal and nervous systems.
Nicotine poisoning is the result of too much nicotine in the body. A person’s response to the overdose can therefore vary based the person’s age, weight and overall health condition. Other considerations for nicotine poisoning involve the strength and combination of the ingredients ingested, whether the nicotine was swallowed or inhaled and what amount of the product was swallowed or inhaled.
Nausea and vomiting are the most common symptoms of nicotine poisoning, but some cases can be life-threatening.
A person’s outlook after nicotine poisoning typically depends on the amount of nicotine or nicotine-containing substance ingested, and how quickly treatment is received. While nicotine overdose can cause seizures and death, the faster a person gets medical help, the better their chances are for recovery. In the absence of complications, nicotine overdose rarely has long-term effects, but this does not diminish a person’s need for immediate medical attention.
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.
Formaldehyde is a colorless chemical that has a strong smell. It is a flammable substance that is found naturally occurring in the environment. It is produced in small amounts by most living organisms as a part of the normal metabolic process as well.
The potentially dangerous chemical is often used in the production of many household cleaners. It is also commonly used as an industrial fungicide, germicide and disinfectant, and as a preservative in mortuaries and medical laboratories.
Formaldehyde exposure primarily occurs by inhaling the substance as a gas or a vapor in the air. Additionally, exposure can occur by absorbing liquids containing formaldehyde through the skin. Formaldehyde is normally present in both indoor and outdoor air at low levels, according to a 1997 report by the U.S. Consumer Product Safety Commission. This presence is usually less than 0.03 parts of formaldehyde per million parts of air (ppm).
The most significant household or indoor sources of formaldehyde include pressed-wood products, cigarette smoke and the use of unvented fuel-burning appliances, such as gas stoves, wood-burning stoves and kerosene heaters. One source of outdoor exposure can include automobile emissions.
When individuals are exposed to levels of formaldehyde exceeding 0.1 ppm, they may experience adverse reactions associated with the increased exposure to the potentially harmful chemical.
Burning sensations in the eyes, nose and throat
Sensitivity to formaldehyde exposure can vary from one person to the next, with some having more severe reactions to the exposure while others experience no symptoms at all with the same amount of exposure to the substance.
Formaldehyde is classified as a group 1 carcinogen by the International Agency for Research on Cancer, meaning long-term exposure to the chemical through vaping may lead to cancer.
Clinical studies conducted in 1980, showed that formaldehyde exposure could lead to nasal cancer in lab rats. And since the chemical’s classification as a “probable human carcinogen” under conditions of unusually high or prolonged exposure by the U.S. Environmental Protection Agency (EPA) in 1987, studies using human subjects have suggested that formaldehyde exposure is associated with certain types of cancer in humans as well.
In 2011, formaldehyde was named as a “known human carcinogen” by the National Toxicology Program, which is an interagency program of the Department of Health and Human Services.
Various studies conducted by the National Cancer Institute (NCI) since the 1980s, have linked formaldehyde exposure to different types of cancer including:
Brain cancer originates in the tissues of the brain (primary) or starts somewhere else in the body and spreads to the brain (metastatic). When brain tumors are malignant, meaning cancerous, the cancer cells typically grow quickly. Treatment options often involve a combination of therapies including: Surgery, radiation therapy, chemotherapy and targeted therapy, which uses substances to attack cancer cells without causing harm to healthy cells.
The types of leukemia experienced by individuals exposed to formaldehyde generally include myeloid leukemia, as well as cancers of the hematopoietic and lymphatic systems.
Leukemia is cancer of the white blood cells, which are used to help the body fight infection. Myeloid leukemia is the most common type of leukemia in adults, sometimes caused by smoking. This type of cancer usually gets worse quickly if it is not treated right away.
Nasopharyngeal cancer is a cancer that starts in the nasopharynx, or the upper part of the throat located behind the nose and near the base of the skull.
The approximate five-year survival rate for patients diagnosed with this type of cancer in its earliest stage (stage I) is about 72 percent. Once the cancer has progressed to its final stage (stage IV), only about 38 percent of patients will still be alive in five years after treatment.
The majority of individuals with this type of cancer (3 out of 4) will be bothered by a lump or mass in the neck. These lumps are typically painless, but may be the result of enlarged lymph nodes due to the cancer spreading to the nearby glands.
Harvard University researchers found that flavored e-cigarettes may carry unknown long-term risks. The 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 (or “popcorn lung”) when heated, vaporized and subsequently inhaled.
Popcorn lung is a rare condition that causes damage to the lung’s smallest airways, called bronchioles. The condition starts with inflammation and eventually leads to scarring of lung tissues and narrowing of the airways, causing irreversible lung damage and resulting breathing problems.
The nickname “popcorn lung” was established following a case of eight former workers of a microwave popcorn-processing plant who became ill with the disease in May 2000. The chemical responsible for the serious condition, diacetyl, was once commonly used to flavor food products, such as popcorn, caramel and certain dairy products, giving these foods their buttery taste.
Popcorn lung is also known as obliterative bronchiolitis, bronchiolitis obliterans or constrictive bronchiolitis.
Symptoms of the serious lung condition may be mild at first and therefore, easily overlooked. Popcorn lung can also be mistaken for other lung diseases, such as chronic obstructive pulmonary disease (COPD), which shares a lot of the same symptoms, like coughing, wheezing and shortness of breath. People with other conditions affecting the lungs, especially chronic conditions like asthma, may not be able to distinguish new symptoms of popcorn lung from existing long-term symptoms.
When symptoms do present, they typically develop about two to eight weeks after exposure. These symptoms will gradually progress slowly over weeks to months.
There is no cure for bronchiolitis obliterans (popcorn lung), and lung tissue scarring associated with the condition is irreversible. However, treatment can help stabilize the condition and slow its progression. Treatment options can vary based on the severity of the condition and its underlying cause. In the most severe cases, a lung transplant may be needed.
Supplemental oxygen may also be used to manage symptoms of popcorn lung such as difficulty breathing.
In 2016, the New England Journal of Medicine reported that the facility treated 15 patients from October 2015 to June 2016 for injuries resulting from e-cigarette explosions due to battery failure. 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. Such injuries resulted in the following outcomes: Tooth loss, soft tissue loss, surgical procedures, skin grafting, wound closures and exposure to chemicals.
Kristin Compton is a medical writer with a background in legal studies. She has experience working in law firms as a paralegal and legal writer. She also has worked in journalism and marketing. She’s published numerous articles in a northwest Florida-based newspaper and lifestyle/entertainment magazine, as well as worked as a ghost writer on blog posts published online by a Central Florida law firm in the health law niche. As a patient herself, and an advocate, Kristin is passionate about “being a voice” for others.