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Speaker 1: Welcome to Live Well with UCI Health. My name is Gina Grad with Alt 98.7 and iHeart Radio. We are here today with two very special guests, Dr. Elsa Camarillo, a board-certified interventional pulmonologist, and Dr. Kelly Fairbairn, a board-certified thoracic surgeon. Thank you both so much for being here.
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Speaker 2: Thank you for having us. Thank you so much.
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Speaker 1: This is going to be very informative for all of us. And I'm just going to jump in with the question that I'm just going to assume everybody wants to know. First of all, what is a thoracic surgeon?
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Speaker 3: A thoracic surgeon is somebody that specializes in operative interventions for lung cancer, lung infections, esophageal cancer, any tumors in the chest, things like that. So.
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Speaker 1: The thorax is a thing.
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Speaker 3: The thorax is a thing.
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Speaker 2: Great.
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Speaker 1: I'm going to write that down. And pulmonologist, I assume, has to do with the heart, the breathing.
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Speaker 2: Yes, more so the breathing. So I specialize in interventional pulmonology. So we do a lot of advanced procedures involving doing biopsies in the lung. So oftentimes we see people that have lung nodules and we determine if we can just keep monitoring that or if we need to go and do a biopsy.
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Speaker 1: How would someone even know? that they may have lung nodules? How would they even know to get checked for something like that?
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Speaker 2: So majority of lung nodules are actually incidentally detected. Usually they go in and get a scan for something else.
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Speaker 1: Interesting.
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Speaker 2: And then it just happens to show a lung nodule.
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Speaker 1: So it's not like bronchial, like I'm having a hard time breathing. I hear a crackling noise. It's just one of those things.
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Speaker 2: Yeah, it's one of those things.
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Speaker 3: Yeah.
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Speaker 2: Wow.
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Speaker 1: Okay, well, we have a lot of questions about vaping because it feels like everybody's doing it. I haven't seen someone with a cigarette in their hand in like two decades, but I see everybody with an e-cigarette or a vape pen everywhere. So the very first question is, what is vaping? How does it work?
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Speaker 2: Yeah. So unlike conventional cigarettes where you're burning tobacco, vaping involves e-cigarettes. So they're battery-operated cigarettes that burn a liquid. And that liquid turns into a vapor, which is what you end up inhaling. So oftentimes, because you're inhaling a vapor, it gives the illusion that it's not as dangerous. But we really don't know that yet.
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Speaker 1: Well, and that's the thing. It still does feel new enough where everyone's just, you know, really jumping on the ignorance train, like, it seems fine. It smells like cotton candy. Like, how bad could it be?
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Speaker 2: Exactly.
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Speaker 1: But the question is, what are they inhaling? Do we know? So we do know.
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Speaker 3: So the liquid inside of the e-cigarettes contain a number of substances. They usually contain kind of whatever the drug is that you're trying to get. So either nicotine or THC or exactly whatever you're trying.
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Speaker 1: To And nothing else, right?
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Speaker 3: It also has some kind of a solvent, like a glycol or something like that to dissolve everything. But there are other carcinogenic materials in there. And it's also packaged very nicely in, like you said, cotton candy flavor or some kind of sugary flavor to make them taste better.
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Speaker 1: And that's the thing. I mean, because I work with a certain coworker who always has it plugged in at the table, and they look very sleek. and they're colorful, and they smell good. And we are, I think we're conditioned to think like, this is the safe alternative to smoking cigarettes, right? So are e-cigarettes safer than smoking like other tobacco products like cigarettes? Are they?
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Speaker 2: So in general, e-cigarettes have less toxins and carcinogens than conventional cigarettes.
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Speaker 1: However, it's.
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Speaker 2: We don't know the long-term effects from e-cigarettes yet, which is the big concerning matter. And it's not even necessarily the products that are within the liquid, but it's when you burn that liquid, all the byproducts that are produced. So there's a lot of organic volatile compounds and a lot of other toxins that are known carcinogens to the lung. Okay.
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Speaker 1: So when we just look at the list on our own, we're like, maybe we can live with that. But we're turning it into something else when we're burning it is what you're saying.
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Speaker 2: Yeah. Okay.
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Speaker 3: You're also burning the inside of the e-cigarette machine. So it's almost like putting plastic in a microwave and you're getting all of the byproducts from the plastic e-cigarette as well as the metals on the inside.
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Speaker 1: Out of all of the thinking I have done about this over the past few years, that has never occurred to me. So with everything else we're inhaling, we're also inhaling the burning plastic. I literally never thought about that. Is it true that each vape pen contains as much nicotine as a pack of cigarettes, or does it just matter what vape you get?
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Speaker 2: It does matter.
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Speaker 3: Yeah, it does matter exactly what vape you get. They come in different concentrations. A package of cigarettes has between about 20 to 40 milligrams of nicotine that actually hits your body. And depending on the concentration, you can get up to 60 milligrams in an e-vape pod. So it can actually even be higher depending on the concentration.
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Speaker 1: I just, I can't imagine. I think I'm a very jumpy person by nature. I don't even drink coffee. So if I hit that, I mean, I would be in the hospital like immediately. I don't know how one gets, not only
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gets used to that, but like craves it. And I guess I'm just lucky to not know.
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Speaker 3: I think in addition to that, another thing that's very important is the rate that it hits your body. When you burn a cigarette, when you combust the cigarette, it hits your body very quickly. It makes it very susceptible to wanting to continue to get the high that you get from the nicotine. The first generation e-cigarettes were a much slower absorbing process. Really? But the newer generation, kind of the modern day e-cigarettes are getting that same Quick absorption. Exactly. And so you're getting the same high from the e-cigarette that you used to only be able to get from a cigarette.
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Speaker 1: So it literally is not– it's not like, but, you know, if you're trying to slow down, I guess the e-cig is the way to go. Those days are over. They figured out– they tweaked it so you'd get the same high.
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Speaker 3: Exactly.
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Speaker 2: Okay.
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Speaker 1: I'm going to throw out a word or a combination of words that I have heard this referred to. If you have not, it just means that you don't run in the same insane circles as I do. Have you heard of the phrase popcorn lung? Yes. Okay. So my friends didn't make that up.
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Speaker 3: No.
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Speaker 1: Yes.
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Speaker 2: No, they did not.
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Speaker 1: Is that a real thing? And does that happen with these cigarettes? It is.
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Speaker 2: It's unfortunately a real thing.
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Speaker 1: Can you tell us what that is?
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Speaker 3: Yeah.
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Speaker 2: So those toxins and carcinogens, they break down your lungs defenses. And so it leads to recurrent infections, but it can also lead to fibrosis, scarring of your lungs. And that's irreversible. And unfortunately, the treatment for that, it's actually very treatment resistant.
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Speaker 1: What would the treatment even be? How would you even try?
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Speaker 2: Typically, if it progresses to the point where, you know, you can't breathe anymore, a lot of times the people need a lung transplant. Wow.
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Speaker 1: And would this also come into like where like maybe a tracheotomy would happen or that's different?
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Speaker 2: Tracheostomy can happen for a lot of different reasons. But typically it's more, it's a little separate. Okay.
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Speaker 3: Yeah.
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Speaker 1: And like you said, it is irreversible. If you put it down tomorrow and pray to all of the gods and run around the block a thousand times, you're not going to reverse anything.
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Speaker 2: No. Wow.
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Speaker 1: Okay. Because that's the thing. A certain friend of mine who has this, you know, attached to him at all times, he gets sick a lot. And, you know, the rest of us don't. So I'm Not a doctor, but I'm going to go out on a limb and say that those things might be related.
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Speaker 2: Yeah, they've found that the mechanism that the e-cigarettes affect your lung is very similar to the way COPD develops as well. Really?
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Speaker 1: Oh my God, that's scary. So have e-cigarettes been effective at helping people quit smoking tobacco products? Because Everybody I know who smokes e-cigarettes does it because this was their idea of a step-down program. And, you know, they're just, they could quit anytime they want. They just really like the step. So how do we even look at that now?
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Speaker 3: Yeah, so actually that was why they were sort of introduced into the public.
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Speaker 1: Right.
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Speaker 3: And there was a recent review with about 4,000 patients that actually did show that it does help you quit. So of patients that go on e-cigarettes versus, you know, the traditional products like the gum or the patched, A higher percentage of patients actually do quit smoking. But the problem is at one year, a higher percentage of those people are still using e-cigarettes than the people that were using the gum or the patch. And so they're not getting the same amount of nicotine and the e-cigarette people still are.
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Speaker 2: Yeah.
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Speaker 1: So they're just kind of stuck on that step. Correct. And the other thing I've seen people talk about is just for the habit of doing something and the oral fixation. the e-cigarettes that have nothing in them, but it's the habit of, you know, taking the big inhale and holding the thing in your hand. But now I can't stop thinking about the burning plastic. Exactly.
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Speaker 3: Exactly.
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Speaker 1: So that's more of a concern now than I ever thought.
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Speaker 3: You're still ingesting and inhaling all of those vapors. And so you're still getting that same carcinogenic potentially effect.
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Speaker 1: Inside of you. Well, and you know what one liar said to me, somebody who really didn't want to quit? I said, you know, I don't know what's in it, but you know, it can't be good for you. And I always talk about how I'm constantly, because I talk for a living and not for a living, it never stops. So I'm always like over a vaporizer or over, you know, a humidifier. And they go, well, you do that all the time. What's the difference? And I didn't have the answer at the time. I mean, mine's not full of nicotine and formaldehyde, I hope, but otherwise it's, it's, People convince themselves like, well, it's just inhaling vapor.
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Speaker 3: I think air and water vapor are very different than what's inside of an e-cigarette.
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Speaker 1: Thank you. That's what I'm going to tell them. So lung cancer. is the leading cause of U.S. cancer-related deaths. Has vaping been linked to lung cancer or other lung diseases, or are we not there yet? Like, do we not have enough information to talk about that?
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Speaker 2: So lung cancer is one of those things that happen after long-term use of cigarettes or long-term use of e-cigarettes, which we don't know yet. So it's a long-term effect we don't yet know.
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Speaker 1: And what would you consider a long-term effect? How many years is it? Are we talking?
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Speaker 2: I would say if it's similar to cigarettes, it's usually we go by 20, what we call 20 pack years. So we don't even have that defined at this point for e-cigarettes.
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Speaker 1: And that's like almost a generation. So we would have to wait for kids to grow up and just see what happens.
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Speaker 2: Yeah, exactly.
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Speaker 1: But are we seeing, but you could always kind of, I mean, you're in the medical field and know way more than we do. I'm sure you can kind of always tell the way the wind is blowing. Would you imagine that this is, this is going to cause similar results as cigarettes? Or we just, we cannot say that yet. We just don't know.
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Speaker 2: We just don't know. We don't know. We just, we do know it causes lung diseases. You know, like I mentioned earlier, it breaks down your lungs defenses. So it can lead to a lot of recurrent infections. Bronchitis can lead to the popcorn lung. And then we all heard in 2019 about the EVALI cases. So the acute e-cigarette vaping lung injury.
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Speaker 1: Oh, yeah.
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Speaker 2: So in 2019, a lot of young adults were being hospitalized because of that lung disease. And it was linked to a certain product that was in the e-cigarettes. But there were still people at that time that who used e-cigarettes that didn't have that specific vitamin E acetate who still developed this lung injury.
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Speaker 1: While you were saying that, you know, bronchitis kind of caught my attention because I think like, you know, when you tell kids stuff, they're like, okay, old lady, like whatever, this doesn't affect me. I'm immortal. I'm 14. And I'm trying to think like, what would I say? Because I have a young son who's almost at that age and, you know, his friends and all this stuff. What would I say to a kid to get them to actually stop and like think about something like this? Because they all think like, whatever, it tastes like cherry. Thanks anyway for your advice. But when you said like kids get sick all the time, I think we just probably have to show them a picture of a popcorn lung. But when you give data and you give stats, I'm taking them in. But I'm just trying to think, how would you tell a young patient if maybe a daughter or a nephew or somebody was hanging out in your car and yanked out there, he's sick, what would you say?
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Speaker 2: I think the biggest thing is just Informing them. Knowledge is power. So letting them know the potential side effects. Because they're young, they have so many more years of life left. And without us knowing what those long-term effects are, it's very scary, right? It's an unknown at this time.
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Speaker 1: It's so scary. It's You know, it's like when you look at something from the past and you can see the beginning, middle, and end of that disease and put it back on the shelf. This is scary because, like you said, we're in the dark and we won't have that information until, unfortunately, a lot more people use it and get sick.
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Speaker 2: Correct.
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Speaker 1: It's scary. Now, e-cigs are the most commonly used tobacco product by high school, middle schoolers, like we're talking about, especially the flavored ones. So does vaping increase the risk of developing that stuff? Why are kids... at greater risk for the e-cigs than the adults? Is it just because they have a longer, they have extra years to use it? What are we talking about?
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Speaker 3: I think it's kind of twofold. I think one, nicotine is very, very highly addictive. It's one of the most addictive substances that there is. Then, like I said before, we're packaging it in a bright, shiny, flavorful, unicorn sparkly, delicious, sugary, product and we are marketing it to kids whose brains aren't fully developed. And so they see this and they don't make decisions the same way that adults do. And so they get hooked earlier and earlier and they're kids that maybe would have never picked up a cigarette in the first place. And so I think both the time and sort of the phase.
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Speaker 1: Of their life makes it- No, that makes sense.
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Speaker 2: Yeah.
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Speaker 3: It's estimated that about 1.6 million middle and high school students are using vape pens.
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Speaker 1: Are you serious? Oh my God, that's crazy. I was watching some random guy on Instagram because who else is on Instagram are random guys. And I'm so glad I came across this because he was giving advice to younger people about how to say no to stuff. And I'm a grown woman. I was like, I'm taking this advice because I'm terrible at that. You don't want to hurt anyone's feelings. You don't want to seem like you're not engaged with them. And this is perfect for something like this because he said, when someone offers you something, don't waffle back and forth. Just go, no, I'm good. Keep eye contact. And that is a whole sentence.
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Speaker 3: That's great advice.
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Speaker 1: And I was, yeah, I was just like, that was easy. You don't have to break out your PowerPoint presentation and lecture your friends and, or, you know, just hope that they're going to stop asking. So I'm going to tell my son to say, no, I'm good. And then hopefully they'll leave him alone.
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Speaker 3: That's perfect.
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Speaker 1: Because that's the thing. He's such a good kid and he's such a rule follower, but like what kid doesn't want to look cool to their friends? And we're so close to that age, it terrifies me. So I think I know the answer to this, but I'm just going to ask it anyway. Do you think there's a need to further regulate e-cigarettes? Or you think we're just doing a bang up job right now?
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Speaker 3: Yeah, I think, you know, in general, there's about 7,000 different e-cigarette products on the market and only about 45 of them are regulated by the FDA.
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Speaker 1: 45 of them? 45 of the 7,000.
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Speaker 2: Wow.
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Speaker 3: So, you know, I think we're doing a pretty poor job of regulating them. I think in general, we're also making it look cool to kids. And I think we're not doing a very good job of helping cigarette smokers transition off of the vape pen as they're trying to quit cigarettes. So I think There's kind of a threefold approach that we need to really help regulate these better.
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Speaker 1: And if you could just wave your magic wand and say, you know what? I'm in charge of tightening up these regulations. Just what kinds of things would you throw out there? And this is for both of you because I'm sure it'll give us all really good ideas. Stop making them unicorn sparkles. Exactly. Start there. Yeah.
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Speaker 2: Removing the flavorings.
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Speaker 3: Yes. I think higher fines or punishments for places that are selling unregulated vape pens and pods as well.
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Speaker 1: And, you know, I think cigarettes are doing this now. I always, when I think of cigarette machines, I think of, like, bowling alleys with, like, the thing you pull and it drops. So I know they didn't have them back then. But, like, really, really obnoxious, super inconvenient, unsexy warnings on the box I think is also helpful.
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Speaker 3: Pictures of lung cancer.
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Speaker 1: Yes. Yeah.
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Speaker 3: Truly, yes.
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Speaker 1: So– We have a long way to go in regulating, but we also have a long way to go in figuring out what the heck this is even doing to us. Absolutely. So again, I don't want to put words in your mouth, but I'm going to go ahead and assume as professionals, you would both just tell us to err on the side of caution and take these out of our mouths.
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Speaker 3: Just say no.
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Speaker 2: Just say no, exactly.
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Speaker 1: Thank you so much for educating us and for reminding us that, you know, things that a lot of us probably already know, but we're just kind of looking the other way because we like doing what we like doing, right?
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Speaker 3: Absolutely.
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Speaker 1: Oh, we appreciate your time. Thank you both.
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Speaker 3: Thank you very much.
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Speaker 1: Absolutely.