Is Vaping Bad For You? Is It Safer Than Smoking? (podcast)

A Scripps pulmonologist explains the dangers of vaping

Scripps Clinic Pulmonologist Ni-Cheng Liang, MD.

Dr. Ni-Cheng Liang, Pulmonology, Scripps Memorial Hospital Encinitas.

A Scripps pulmonologist explains the dangers of vaping

According to the Centers for Disease Control and Prevention (CDC), vaping has been linked to more than 50 deaths across the country this year. In San Diego, people have come close to dying from vaping-related lung injuries.

In this episode of San Diego Health, host Susan Taylor and guest Ni-Cheng Liang, MD, a pulmonologist at Scripps Memorial Hospital Encinitas, discuss vaping in-depth, including why vape devices and e-cigarettes may be appealing to kids and the substance that’s thought to be causing widespread lung injuries: vitamin E acetate, which is used to dilute some e-liquids, usually containing THC.

The dangers of smoking have been widely publicized and vaping was initially seen as a method of tobacco cessation, but it has since turned into a fad among younger people who are not regular smokers. Vaping is in no way safer than smoking, and can alter immune response in the lungs, and has led to a slew of related lung injuries and several deaths. Dr. Liang urges smokers trying to quit to stick to more traditional means, such as nicotine replacement patches and gum.

If you’re interested in quitting smoking, talk to your physician about well-documented cessation products. It’s not worth your lung health — or your life — to vape.

Listen to the episode on how vaping affects your health

Listen to the episode on how vaping affects your health

Podcast highlights

What is vaping? (0:47)

Vaping is when someone chooses to use a device that basically heats a liquid into a vapor. It is usually contained in the form of liquid in a cartridge. When a person inhales, there’s a center that triggers a heating element within this device. It heats that liquid and transforms that liquid into a smoke that the person then inhales.

What ingredients are found in e-cigarettes? (1:14)

The e-cigarette contains many different compounds, including marijuana derivatives, such as THC and CBD, as well as nicotine, and a whole host of different flavorings that are available now and marketed toward children.

What is CBD in marijuana products? (1:34)

CBD is a chemical that’s found in the marijuana plant that does not give the person that’s using CBD the typical high from THC. CBD oil can be used topically and also ingested to help with pain and to help with sleep and induce relaxation.

Can you vape without THC, CBD, nicotine? (2:08)

Absolutely you can vape without having THC [the part that gets you high], or CBD, or nicotine or flavoring.

Why has vaping become so popular? (2:16)

With the bad press that smoking gets in general, vaping was initially thought to be a possible way for people to stop smoking. But it has turned into somewhat of a fad, a novelty for our youth, adolescents and high schoolers. In fact, the average e-cigarette user is much younger than that of smokers.

There’s a novelty component to it. The flavorings unfortunately attract a much younger user population. Flavorings for instance are raspberry, candy flavors, even menthol flavors, things that are the same flavorings found in candy in general.

Weren’t e-cigarettes supposed to be safer than smoking? (3:08)

Initially that was the thought and the hope. But technically, the FDA has never approved vaping or e-cigarettes as a modality to quit smoking. The literature actually suggests there’s a lot of conflicting results. Some results show that vaping did help people quit smoking, but a year later they were then addicted to the e-cigarettes. Other reports show that there’s no difference in using e-cigarettes to quit smoking compared to nicotine containing products and in terms of efficacy in quitting smoking.

Is vaping more popular among men or women? (3:56)

Epidemiological studies show it’s about 50 percent or a pretty even split among men and women using e-cigarettes, perhaps slightly increased among male users.


As far as age is concerned, it’s a much younger population of users, Forty percent of e-cigarette users are 18 to 24-year-olds.

Is vaping safer than smoking? (4:37)

No, absolutely not. The reason is that vaping products contain so many different additives. In the beginning of the advent of the e-cigarette, there were technically less chemicals found in the e-cigarette smoke that users would be inhaling compared to smokers. And so there was a thought that because of that, e-cigarette use was less dangerous than smoking. However, we found out later that e-cigarette use can also alter the immune system of the lung in dangerous ways. With the advent of e-cigarette or vaping-product-associated lung injuries across the United States, vaping is absolutely not safer than smoking.

What is E acetate? Why is it linked to vaping-related lung illnesses? (6:04)

Vitamin E acetate could be one of the culprit ingredients that is found in the lung lavage samples of patients who have this lung injury that has been thought to be vaping induced. What vitamin E acetate does is it dilutes the e-liquid. It is often found with the THC. Many of the vaping-induced lung injury patients mentioned use of THC containing e-cigarettes vaping products. In many of those patients, the vitamin E acetate was found in their lungs. There are quantities of vitamin E that can be found in any e-cigarettes containing devices.

What are the symptoms of vaping-related lung illness? (7:23)

Symptoms can include coughing, shortness of breath, chest pain. In some patients, we’ve also seen people coughing up blood.

Are there vaping products without vitamin E acetate? (7:37)

Vitamin E acetate has been found more in the black market e-cartridges, and less so in the e-vaping products that are regulated. But trace amounts of vitamin E acetate have still been found in the more regulated e-cigarettes products too.


We don’t really know yet whether vaping products are less risky without vitamin E acetate. There are different additives in there that are known irritants to the lung. I think we’re just beginning the story. A lot remains to be seen with further research on other chemicals that could be associated with this type of lung injury.

Why is vitamin E so harmful in vaping but not in food, cosmetic products? (8:29)

The main reason for this is because the lining of the lung is very different than the lining of our gut and also our skin barrier. The lining of our lung sees the vitamin E acetate as honey, coating the airways and the air sacs. You can imagine if we took honey and put it in someone’s lungs. That wouldn’t be an ideal situation for breathing.

How are vaping-related lung illnesses treated? Can the lung heal? (9:21)

It’s partially reversible. Steroids are the mainstay of treatment. But we don’t even know what vitamin E acetate does to the lungs. This has never come up before. What we think it might do is cause a severe and rapid airway obstruction. It can also induce lung injury from damaging the air sacs within the lungs themselves.

What kind of vaping-related illnesses have you treated? (9:50)

I’ve treated people who have almost died from this type of lung injury. It’s been a huge wake up call for them and currently they’re doing much better. But it takes a lot of time and completely quitting e-cigarettes and vaping all together.


One of my patients actually needed to have a breathing tube stuck down his throat and be connected to life support to help him breathe. Other cases that I’ve seen, patients were able to take steroids orally and they got better.


Are there other ingredients in e-cigarettes that might be harmful? (10:37)

Unfortunately in a lot of the black markets products, there have been traces of pesticides that have been found and when this type of pesticide is heated, it can form hydrogen cyanide.

Would vaping be safer without the flavorings? (11:24)

Unfortunatelybecause what goes into these liquids is so unregulated, we can’t control it. Even the usual substances of propylene glycol and glycerin, which are considered to be relatively benign, are also known lung irritants.

What advice do you have for people who want to stop smoking e-cigarettes? (11:58)

I would say to please consider some of the more recommended ways of smoke cessation, such as nicotine replacement products, which include lozenges that are hard sucker candies that we can put in our mouth and suck on. We can also use nicotine gum, as well as nicotine patches and different pills that can also decrease our cravings for nicotine from smoking. 

Is there a way to vape safely? (12:43)

No.The bottom line is just absolutely no. If someone still chooses to continue to vape and to use e-cigarettes products, I highly recommend that the source be a reliable one, not from the black market, not homemade and not made by friends and certainly not illegally purchased.


If you’re interested in quitting smoking, please speak to your physician about all the well-documented ways that are safe to quit smoking, including nicotine replacement products. The bottom line is it’s not worth your lung health or your life to vape, or even try e-cigarettes. The only things you need to inhale are clean air and prescribed inhalers should you need them. That’s it, very simple recommendation.

Watch the San Diego Health video on the vaping crisis

Watch the San Diego Health video with host Susan Taylor and Dr. Liang discussing the dangers of vaping.

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