DocTalk Podcast: Dangers of Vaping with Dr. Rizzo

The current public spotlight on vaping and e-cigarette use may be shining brighter than it has on any public health issue in recent memory.

With The White House, the US Food and Drug Administration, and leading healthcare organizations all taking aim at the once “safer”, but now vilified alternative to cigarettes, e-cigarettes are a constant topic of discussion across the nation. 



As more and more information on e-cigarettes and vaping becomes available, many are often confronted with just as much misinformation. To get a breakdown on vaping, e-cigarettes, and the scope of their threat to public health, MD Magazine’s Managing Editor Kevin Kunzmann sat down with Al Rizzo, MD, chief medical officer of the American Lung Association, and the conversation that follows is available below as the newest edition of the DocTalk Podcast.

MD Mag: Hello, everybody and welcome to this edition of the DocTalk Podcast. I'm Kevin Kunzmann, managing editor of MD Magazine, and I'll be your host today as we talk about one of the most difficult public health issues in America today, electronic cigarettes. I'm joined by Dr. Al Rizzo, Chief Medical Officer of the American Lung Association and an expert in pulmonary health. Dr. Rizzo, welcome to DocTalk. If you could, please take a minute to introduce yourself and share any relevant disclosures you may have.

Rizzo: I'm Dr. Albert Rizzo a pulmonary physician in Wilmington, Delaware and Chief Medical Officer for the American Lung Association.

MD Mag: Great, thank you so much. And if we could start off the conversation, Dr. Rizzo. Recent data from the CDC showed that high school students e-cigarette use is up about 78% from 2017 to 2018. As such, the FDA has led to declaring an epidemic in the space. Could you talk more about what is actually driving this epidemic?

Rizzo: The concern we have as a public health organization, the American Lung Association, is that the E-cigarettes, the delivery of nicotine is developing another generation of people who are going to be addicted to a tobacco product. In this case, the electronic cigarette. Nicotine is a very addicting drug. It's been brought to the market without any really testing or regulation.

There are a lot of unknowns about the devices and certainly I think the reason children, both middle school and high school, are using it is because they don't know much about it. They think it might be safer than cigarettes. They're attracted by the flavors, that many of these devices are labeled as — bubble gum, Captain Crunch, unicorn. So, a lot of the tactics that the cigarette industry used for many years until they were regulated, are now being used by the e-cigarettes to attract youth to the e-cigarette. And there's been studies showing that individuals who use an e-cigarette are more likely to go on to use a true regular cigarette.

So, that's our concern from a public health standpoint, and the epidemic and the rise of individuals in the high school and middle school using it is a bad sign. I think it's up to almost 3.8 million youth who are now users of e-cigarettes. One in four in this country right now of those age groups.

MD Mag: Maybe you can dispel the rumor right now for us, is vaping safer than smoking?

Rizzo: It's commonly thought to be the case. We know first of all, we don't know a lot about e-cigarettes because we don't know what's in each product. There are hundreds of products, if not thousands of flavors. There are some that are cartridges, that are some that are self made, there's some that can be manipulated. So, each e-cigarette is almost different from the other e-cigarette. The concern is that without knowing what is in there, we can't be absolutely sure how safe they are. To paraphrase a tobacco researcher in California if tobaccos are the most dangerous, and that's like jumping out of a 40 story building? Well, if e-cigarettes are safer, it might be like jumping out of a 30 story building, the end result may be the same. So relatively safer than cigarettes is not a hard bar to be because that's the most dangerous and kills about half a million people each year due to tobacco related illnesses.

MD Mag: That's a perfect analogy. Regarding the secondhand smoke and the aerosol associated with these devices. What kind of effect are we seeing?

Rizzo: The term vaping doesn't mean that you're just having water vapor come out when you see that plume of smoke. We know that when the chemicals are heated in these devices, there are metals, nickel, tin, lead there are acid aldehydes there are what called diacetyls, which became popular with popcorn lung that used to be a flavoring and microwave popcorn that led to irritation in the lung and destroying lung tissue.

So, all these chemicals when they're burned, we really don't know what happens to them — same thing with the flavorings. They're not meant to be burned and then inhaled. The bottom line is, if you think about it, your lungs were not developed to inhale substances that were combusted or burned. It irritates the airway. And unfortunately, some of the very small particles called the ultra-fine particles are so small, they get deep into the lungs, they actually get into the blood vessels and contributors the rest of the body leading to other parts of the body being affected as well.

MD Mag: And with regard these significant population uses — pediatric and adolescence — what are some of the signs that we can look for as either physicians or family members, loved ones friends, that they actually are vaping?

Rizzo: Well, I think the important thing is to be aware of it. So, educating parents, school administrators, and teachers, about the fact that this is an epidemic in that age group becomes important. As well as educating the students themselves about the potential harms in the fact that these are not safer than cigarettes in general. We don't know what the short, mid-term, and long-term effects are and educating more and more about it is the important thing.

As far as signs of somebody having are using vaping, sometimes it can be something as simple as a little cough or a little bit of discomfort to an individual may complain of. They also may go through some of the nicotine withdrawal because they may not be having access to their vaping device so agitation can be assigned. And if you see someone who has some paraphernalia very similar to what paraphernalia is used for other substances, or things that look like junk drives that now look like e cigarettes, be cautious about it. And I think a discussion about vaping with the parent and the child is very important. The American Lung Association has a specific website called The Vape Talk that parents can utilize from our website to help bring up the subject with their child.

MD Mag: And that's a good segue to the last point — being support. I imagine parents and physicians alike have a critical role to play in that what more can they do to offer support?

Rizzo: So, I think the main thing is, like I said, Be aware, not to shy away from the fact that the FDA, unfortunately, failed the public health by not protecting individuals like the children we're talking about, or for that matter, any of us because these products got to market and are still on the market and the FDA has to act to help bring this under control.

MD Mag: That's well put. Anything else you'd want to add.

Rizzo: I think we covered a lot I think we did too.

MD Mag: Okay, so thank you so much, Dr. Rizzo. And that's all we have for today's DocTalk chat. For more insights and news in the world of respiratory Care, head over to MD magazine. com. I'm Kevin Kunzmann. Thank you for listening.