What does vaping do to the body?
Is it bad?
And if so, how bad?
And how does it compare to regular old cigarette smoking?
Same, better or worse?
We'll answer all those questions and of course take out some real human lungs to help us
with this discussion as well as show some other organ systems that you may not know
could be affected by vaping.
So, let's jump right into this.
[Intro] so, as we get into this discussion about vaping, I just want to quickly say thank
you to the sponsor of this video, Brilliant.
We'll put the link in the description below as well as talk a little bit more about Brilliant
at the end of the video.
But when it comes to vaping or bringing vapor into the body or cigarette smoke into the
body, we're just breathing in good old-fashioned oxygen - it's really important to understand
the pathways in which those substances will travel and therefore gives us an idea of how
they can affect the body.
So let's take a look at those pathways on the cadaver here.
This is a sagittal cut through the head and this will give us an idea of the upper airways,
and if we take a look here we can obviously see the nose, the mouth here.
Now, we can bring air in through the nose, and if it goes in through the nose, it'll
enter a passageway called the nasal cavity.
Now, this septum right here is just dividing the nasal cavity into right and left sides
but we can obviously bring air through there.
We can obviously bring in air also through the mouth and the oral cavity.
But both the nasal cavity and the oral cavity are going to end up going into the same place
- this area that we refer to as the pharynx, but most of us just call it the throat.
But as the vapor or the air moves down through the pharynx, we have to go one way or the
other.
There's this fork in the road.
The posterior tube often referred to as the food tube or the esophagus, that's not where
this stuff's gonna go.
We're gonna move the air or the vapor in to the trachea which is the anterior tube or
portion which is pretty crazy that you guys can see even a cadaver, you can see that - let
me pull it up a little higher - that the trachea stays open which makes a lot of sense because
we're breathing all the time, so the body's created these little cartilaginous rings to
keep the trachea or the airways open, where the esophagus, we're not eating 24 hours a
day (at least hopefully not) and this thing can collapse in between meals and no big deal.
But we're ending at the trachea on this particular cadaver, so I’ve got to show you a different
dissection here of a right lung and again, the trachea here.
So, let's just orient you - here's the trachea - the air is moving down through there but
then when we get down to the bottom here, we have a fork in the road.
This is only the right half or the majority of the right half here.
It could go left to the left lung or right to the right lung and when it branches here,
we call these the bronchi.
And as you can continue to see here, they just further branch into the lung tissue as
different types of bronchi or bronchus for singular.
As the bronchi continue to branch, they get smaller and we change the name to bronchioles
and then they go into these things called alveolar sacs made up of individual alveoli.
Now, that's your little anatomy lesson for how this air is going to go in, but the really
important part of this is the alveolar sacs and alveoli because those are the thinnest,
thinnest tissues within the lung or the thinnest part of the tubing, only one cell thick.
And that's really important because that's where we exchange oxygen and carbon dioxide
with the bloodstream and the alveoli and the bronchioles tend to be the most affected when
we're talking about vaping.
So, what exactly is vaping?
Well?
Vaping started with e-cigarettes which were originally designed to meek regular cigarettes.
However, the technology has dramatically changed over the last few years.
These devices tend to now be larger, rechargeable and they contain a cartridge that has a liquid
inside.
That liquid is then heated by being passed through an atomizer which vaporizes that liquid
and creates a vapor, hence the name "vaping".
But is bringing in that vapor to the human body a bad thing?
Well, it definitely can be.
You see, over the past few years, hospitals have seen an increase in patients with acute
lung injury due to vaping.
They've now termed this E-cigarette or Vaping product use Associated Lung Injury or EVALI,
and we'll use EVALI for the rest of the video.
But these patients were coming in with symptoms very similar to pneumonia.
But what they found is there was no infective cause to their symptoms...
Meaning when they would do testing, they couldn't find a viral cause or a bacterial cause to
their symptoms but found that they all had these similarities and they had recently been
vaping.
So, the idea was that something in that cartridge or that was being vaporized was causing some
harm to the lungs.
But before we get into what they think could be the products or the substances inside that
cartridge that were causing damage to the lung, let me tell you a little bit about the
symptoms that the patients were coming in with.
Many of the patients would have fever, chills and even that generalized icky feeling - also
cough, shortness of breath and chest pain and even hemoptysis in some cases - hemoptysis
just being a fancy pants name for coughing up blood and it makes sense if we're breathing
something in that we could affect the lung tissue and have symptoms that would be symptomatic
of a lung issue.
However, up to 80% of patients with EVALI would have GI symptoms - meaning, affecting
the GI tract and they would have things like nausea, vomiting, diarrhea and just generalized
abdominal pain.
So the cause...
What do they think is inside these cartridges and therefore the liquid in the vapor that
could be linked or causing EVALI and therefore the symptoms in these patients?
Well, the challenge is, this isn't a highly regulated industry.
So the ingredients that one manufacturer might use compared to another manufacturer might
not be the exact same.
However, they have found a lot of common ingredients in these substances some of which include
things like nicotine which we know can cause substance dependence or be addictive, also
containing things like propylene glycol or glycerol.
Those are known as humectants which help moisturize the ingredients within the liquid in the cartridge.
We also see things like tetrahydrocannabinol, which is THC, even CBD oils and also they
found vitamin E acetate.
They can also include over 7000 flavors and some have found little traces of metal like
tin, nickel, chromium, manganese and even arsenic.
But out of all those ingredients, are some of them more problematic than others?
Did they find any specific links to certain ingredients?
And the answer is yes.
So let's go back to that hospital example: when clinicians were going in and seeing these
patients, they'd often observe tachycardia, tachypnea - which is a rapid heart rate, rapid
breathing, low oxygen saturation - they'd often get a chest X-ray or CT scan which would
show infiltrates in their lung or what they refer to as opacities, and the clinicians
are thinking "This looks like pneumonia".
And then they would go do cultures and see no bacterial cause or they do viral panels
and couldn't see a viral cause and that caused them to think "What's going on here".
And so, in some cases, they would do this procedure called a bronchoalveolar lavage.
A bronchoalveolar lavage is pretty cool - it's when you take a scope or a fiber optic camera
down into the respiratory passageways, going down into the trachea and again, it would
go down into these further airways and you'd take the tubing or the camera within the tubing
of the lung tissue or the bronchial tree to see if you could view things.
Now, what they would also do is inject - literally inject saline, which is kind of a salt water
mixture, into those terminal airways - bronchoalveolar lavage so into the bronchioles and the alveoli
and then they'd literally suck it up and then they would take that fluid and analyze it
to see what they'd find.
Again, they didn't find pathogens but the majority of people with EVALI they found vitamin
E acetate and THC.
So, what do we do with this information about vitamin E acetate and THC?
And since when is vitamin E a harmful substance?
Well, it's typically not when we use it in lotions and creams and apply it to our skin
or even ingest it, but remember, when we ingest and it goes down the food tube or the esophagus,
that's going to be processed a lot differently than if it goes down the airway or into the
trachea and down into the respiratory passageways and into the lung tissue.
The idea is, could it be that this is - this oily kind of thickening substance that coats
the lining of the tubing or into the lung tissue that causes an inflammatory response?
Is it interacting with the cells in another way that's causing a problem?
Well, we don't know the exact mechanism yet, so more research is needed on that.
However, because of the strong link of vitamin E acetate to patients with EVALI, the CDC
has recommended that vaping companies don't use vitamin E acetate in their products or
you just don't pick a product that has vitamin E acetate.
They're also recommending, unfortunately for those that like this stuff, that people don't
use products that contain THC again because of that link of how many people have it found
in their bronchoalveolar lavage and had EVALI.
I’m sorry to be the bearer of bad news.
So, how does it turn out for patients with EVALI?
If we're talking about numbers, up until February of 2020, the CDC gathered data and they found
2807 people were hospitalized with this.
Out of those 2807, 68 people died.
If we do the math on that, that's about 2.4%.
Now, to be clear, that's not 2.4 percent of people who vape are going to die, that's 2.4%
of people who get EVALI from vaping.
So, based on those numbers, the majority of people will recover.
Now, while they're being treated, many of them will get antibiotics, again because of
that close link to pneumonia.
Until they can fully rule out pneumonia, they kind of do it for a precautionary measure.
But again, once they confirm there's no infective pathogen, the antibiotics aren't going to
do anything.
And so, we're talking mostly supportive therapy.
Some clinicians have noticed that they've had some improvement with their patients with
giving them anti-inflammatory steroids which could help calm down the inflammation.
Many of the - the majority of the patients, I should say, if they're in the hospital are
likely going to get supplemental oxygen - how much that is depends on the severity and then
as the severity increases, we may be knocking on the door of things like ventilation.
But the majority of patients will have a noticeable improvement in their symptoms within about
a two week period.
They may still have some residuals and need a few more weeks after that to feel like they're
fully recovered, but again, over that two to three to four week period, you're probably
looking at "I might feel like myself again".
Now, the long-term effects, we still don't know.
And the last thing we need to talk about - how does vaping compare to regular old cigarette
smoking or smoking tobacco?
There is a general consensus in the medical community that if you had to pick between
the two, smoking is worse than vaping.
Now, granted we have a heck of a lot more data on cigarette smoking and its long-term
effects when we compare it to vaping, we don't have a lot of long-term studies because it's
such a new thing and we're still even trying to figure out the exact mechanism of how vitamin
E acetate and THC gets involved any valley and those symptoms.
But if I gave you guys an example - let's say a clinician had a patient that says "Hey,
I want to quit smoking" and their patient says "Can I try vaping instead?"
now the clinician would probably say "I prefer you to do neither and we can use these other
medications to help manage the nicotine dependence in another way because these medications have
a lot more research on their efficacy and safety".
But if the patient's like "No, I’m not touching medications.
These are your choices for me clinician?
What are you gonna have me do?", the clinician would say "Okay, completely stop smoking and
do vaping".
There's a specific recommendation in the CDC that when patients try to use vaping in place
of smoking to not mix the two because you just have to get the cigarette smoke out of
there and then when we use the vaping, there's this idea that we could eventually get to
smoking cessation and it's a lesser of an evil or lesser damage to the actual lung tissue.
But what about people who have never smoked and don't plan on smoking but want to vape
or are currently vaping?
Well, the recommendation is again, stay away from the vitamin E acetate and the THC.
The perfect world scenario would be - don't inhale any of these foreign substances into
your lung tissue.
There is a huge increase in vaping in the younger population, especially junior high,
high school kids, people in their early 20s and there's a major concern that this could
be a gateway into cigarette smoking.
They do have enough data to show that if you are vaping, you are more likely to try cigarette
smoking which again, we've just talked about, is known to be even more harmful than potentially
just vaping.
So, I apologize to those who vape, who may think I’m being a negative Nancy or the
bearer of bad news, but you know, we only get two of these organs - these amazing lungs
that help us breathe and exchange oxygen and carbon dioxide, so we should probably take
care of them.
But if you must vape, avoid vitamin E acetate.
And it's probably best that you get THC from a qualified medical professional or through
means that are consistent with your local state law.
If you're interested in going into the medical field, you're gonna have to learn a little
bit more than just anatomy and physiology - you'll have to get into other topics like
chemistry, physics and math.
And that's why I want to take the time to say thank you to the sponsor of this video,
Brilliant.
Brilliant is an interactive online learning platform for stem subjects - that is math,
logic, science and computer science.
Brilliant helps you develop both knowledge and problem solving skills through hands-on
lessons, so you'll be able to think creatively, ask the right questions and apply that information
to real world situations, and this is one of the most important things that you can
do as part of your education process.
Brilliant allows you to explore those important topics of chemistry, physics and math so that
you can apply them to medicine and the human body - whether it's understanding the physics
and dynamics of blood flow or complex chemical reactions at the cellular level or maybe even
weight based calculations for medications for a patient, Brilliant has got you covered.
If you're interested in learning about these important topics, visit Brilliant.org/instituteofhumananatomy
or click the link that we'll put in the description below.
First 200 people will get 20% off their annual subscription to Brilliant.
And again, thanks for watching our videos, blow up the comment section below and we'll
see you in the next video.