Teaching with a Twist – Thoughts on E-cigarettes and Vaping

This article was written by Stephanie Williams, BS, RRT. Stephanie is the Director of Community Programs and Volunteer Management for the COPD Foundation.

“Just the facts, ma’am.” Who remembers that line from the good old days of the Jack Webb TV series, Dragnet? I must confess that I am not old enough to have watched it when it aired originally, but because it was a favorite of my dad’s, I have watched my fair share of reruns on late-night cable TV. Those characters are so easy to see in my mind’s eye – dark suits, crisp white shirts, thin black ties, and cigarettes.

One night a few months ago, I was reading an article about the harmful effects of e-cigarettes and vaping. That article was a little frightening. It stated that some of the components of the e-liquid degrade into chemicals like formaldehyde and acetaldehyde – both of which are cancer- causing agents. It also included instances of the lithium batteries that power the devices unexpectedly exploding into the face and eyes of the smoker. This article also linked to another, which pointed to more startling findings, such as some of the flavored e-liquids having been linked to a serious and permanent lung disease called bronchiolitis obliterans (BO) or “popcorn lung.” (Here is more information about bronchiolitis obliterans if you are interested.) Those articles got me thinking about my Teaching with a Twist series and how we might have an open discussion about a touchy subject.

I started reading articles about the impact of popular culture and influential people on the rates of smoking in the U.S. and it took me down some interesting paths. Back in the 1920s through the mid-1950s, advertising for cigarettes was front and center in magazines. Tobacco companies even used phrases that characterized smoking as a wholesome activity. Many advertisements showed pictures of doctors smoking and declaring that they preferred a certain brand over others. Can you imagine going to see your pulmonologist nowand having him encourage you to switch to his favorite brand of cigarettes? No way! But at one time this kind of promotion happened – a lot.

The medical community has data that prove that cigarette smoking or other forms of tobacco use are dangerous and can lead to health problems. We can agree that no doctor will encourage smoking and will even offer advice or programs on how to quit tobacco use. Again, the articles I read about e-cigs and vaping came to my mind, and I wondered what the medical community is saying about those devices.

One article, published on February 1, 2019, in JAMA Network Open, said that American teens who use e-cigarettes are 4 times as likely to light up with a regular cigarette than the teens who had never tried an e-cig. E-cigarette use in teenagers has dramatically increased. Advertising pushes this trend. The risks going forward seem obvious.

And here is an interesting article about the use of e-cigarettes as a tool to help people quit smoking. This article, published in the New England Journal of Medicine, states that e-cigarettes may be helpful in getting people to quit smoking if the individuals only use the electronic device and stop using combustible cigarettes altogether. A major concern however is that those using E cigarettes appear to continue to use those E cigarettes.

By and large, people use e-cigarettes in addition to their regular smoking habits. Maybe it is helpful as a tool to quit smoking, but the misinformation spreads as one person tells another, “My doctor told me to use the e-cigarette” without the full context of what the doctor intended or what the details of using the device to quit tobacco altogether. The listener in that scenario may be left thinking that doctors are condoning the use of vaping devices – which is not the case at all. This is not solving the smoking problem, but instead adding fuel to the fire.

Based on conversations I have with the public, people will say that vaping isn’t as bad for you as smoking regular cigarettes, but honestly, there isn’t enough research to back up that claim. Please don’t mistake the lack of long-term studies for a passive statement that vaping is OK. Remember what I mentioned earlier about the early days of regular cigarettes? How doctors even appeared in advertisements for tobacco products? I believe we need to be cautious and use good judgment about these new devices. If using chemicals for cleaning or air fresheners can cause lung irritation, does it seem reasonable that heating nicotine and other chemicals to turn them into a mist via e-cigarette might also be irritating to the delicate lung tissue?

Some sources are reporting that tobacco products are being seen broadly in a variety of media where children and youth are watching and wanting to do what they see their “role models” doing. This is not terribly different from watching Joe Friday, Rod Serling, Audrey Hepburn, or Shirley MacLaine, but there is a lot more exposure to these influences today than in years past. It worries me that we will have a whole new kind of lung disease in the future - one that will add different types of problems that complicate the treatment of COPD. Then we will have to learn how to treat the more complex breathing problems in the same way that we are learning more about COPD and effective treatments for it today.

Here are a few questions I have for those of you who are former or current smokers:

1. What do you think when you see young people smoking?
2. If you could share some ‘quit smoking’ advice with them, what would it be?
3. What were your reasons to quit? Or if you are trying to quit, what are your reasons to quit?
4. Are there ways you can share your story to encourage others to quit, or to inform teens to never start smoking?

If you would like to learn more facts about e-cigarettes/vaping and young people, here is a link to the CDC page with more information.

Now for the Twist!

I will put a name of a TV show and a character from that show. The next person will list another TV show/Movie that character was in and so on.

Here is an example:

• Magnum, PI – Tom Selleck
• Tom Selleck – Friends
• Friends – Elliot Gould
• Elliot Gould – Ocean’s 11

Here we go!

• The Golden Girls – Betty White