Electronic Cigarettes and The Potential Harm Caused

The purpose of this paper is to discuss the risks of using electronic cigarettes, as well as how participating in such smoking may cause harmful effects throughout early to late development.  Inhalation of any foreign substance may be detrimental to one’s health.  Prolonged inhalation over months and years may show adverse effects on the lungs.  This does not only impact older adults, but also the youth and the development of their lungs and possibly other parts of the body.  Introducing potentially harmful chemicals that have not been tested extensively demonstrates harmful effects on both the user and third party user.

What is E-Liquid?

E-liquid is the substance used within a vaping device that, when heated, releases chemicals and nicotine into one’s body.  The study by HHS (2016) describes it as:

E-liquids produce chemical reactions that may result in the formation of new, harmful compounds. Carcinogens (e.g., formaldehyde, acetaldehyde, and acrolein) and toxic heavy metals (e.g., lead and cadmium) have been found in e-cigarette aerosols in laboratory tests conducted at temperatures within the range of most e-cigarette products. (p. 138)

Effects on Pregnant Women

Inhalation of chemicals that have not been tested thoroughly may be harmful for the user.   In this case, a pregnant woman is particularly at risk and should use caution.  This is because the woman is not only taking in the chemicals into her own lungs and affecting her body, she is putting her child, who shares the chemicals that she introduces to her body, at risk for harm.  The unborn child relies on the mother to provide necessary nutrients for natural growth.  This does not include introducing potentially harmful chemicals.

Impact on Unborn Child

In this day and age, many believe that smoking or vaping electronic cigarettes is safer than smoking traditional tobacco products.  This may not be the case, because most electronic cigarettes contain a much higher level of nicotine per milliliter than regular cigarettes.  Nicotine is a very harmful chemical that causes a decreased blood flow, which leads to decreased oxygen flow systemically.  This may result in damaging effects on the unborn child (Orzabal et al. 2019).  An example of this is provided by Orzabal’s research, which describes that if a pregnant woman decides to vape during pregnancy, it may affect the lung development of the woman and fetus (Orzabal et al. 2019).  This decreased pulmonary growth of the fetus will lead to developmental issues in the future, which may include difficulty breathing naturally and stunted growth systemically.  If the unborn child does not develop as expected in the womb, there may be a decreased chance for survival once born.  Unfortunately, the child might not make it outside of the womb. There have been cases where mothers who decided to vape during pregnancy, have experienced sudden infant death syndrome (HHS, 2016).

Accessibility for Youth to Young Adults

E-cigs are not only popular amongst adults, but also adolescents to young adults.  As anything that may be popular, the companies want to make the product accessible to all ages to make money.  For this reason, the companies include many fruity flavors to attract youth.  Many stores too, make it easy for anyone, regardless of age, to purchase such products in order for them to make money.

Impact on Younger Generation

Since there is an increased use of this product, we may begin to see some adverse side effects presenting itself.  The problem here, is that the youth are still in the critical stages of development.  This may lead to a harming or stunting of natural growth, especially in the lungs.  As the adolescent smokes and inhales these chemicals, the vessels in the lungs constrict and prevent proper oxygen flow throughout the body, which can lead to a slowed growth and or damage to the organs that are not receiving the oxygen needed to survive.  Carlsen reports in his journal that something needs to be done to prevent deterioration of the lungs before it is too late (Carlsen et al. 2018).   This vaping does not only affect the adolescent, but also the friends nearby.  Second hand vaping has caused decreased oxygen flow, failed respiratory functioning and gastrointestinal issues  in those who are not directly inhaling the vape’s contents (Carlsen et al. 2018).  There is something not right about these chemicals being inhaled.

Reasons for Further Research

So far, it is apparent that vaping fad is not as safe as one would think.  People, with very little knowledge on the new invention, took in the idea of vaping as a method for smoking, believing that it would be less harmful.  The problem is, that many of the products on the market are not FDA regulated, meaning that it has not been tested properly to whether it is safe for entering one’s body.  To continue, one may not know how much to use and what may be considered a lethal dose.  Carlsen’s report states that if you match 0.5 mg per kg in adults via inhalation, this would be considered a lethal dose; for adolescents, it is a mere 0.1 mg per kg (Carlsen et al. 2018).  This shows that, besides all the other negative effects that vaping could bring, it could kill if not measured out and taken seriously.  This is the main reason why these chemicals need to be tested for safe use.

Conclusion

It is disappointing that, after so much research that has already been done, people still lean towards vaping regardless of what evidence reveals.  Of course more evidence is needed to fully understand the complete harmful effects of inhaling foreign chemicals that appear poisonous.  These chemicals are affecting everyone from the unborn fetus to the older adult who decided to quit tobacco smoking.  The chemicals lead to mainly respiratory issues as well as heart issues due to the nicotine trigger to vasoconstrict many vessels and even death in some cases.  In conclusion, these chemicals that are being inhaled, are not being properly tested and may lead to harmful effects on both the user and the non-user.

References

• Carlsen, K. C. L., Skjerven, H. O., & Carlsen, K.-H. (2018). The toxicity of E-cigarettes and children’s respiratory health.
  
  Paediatric Respiratory Reviews
  
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  28
  
  , 63–67. doi: 10.1016/j.prrv.2018.01.002
• Orzabal, M. R., Lunde-Young, E. R., Ramirez, J. I., Howe, S. Y., Naik, V. D., Lee, J., … Ramadoss, J. (2019). Chronic exposure to e-cig aerosols during early development causes vascular dysfunction and offspring growth deficits.
  
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  207
  
  , 70–82. doi: 10.1016/j.trsl.2019.01.001
• U.S. Department of Health and Human Services (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

Introduction

Patient A is a 49 year old female of 76 kilograms and height of 161.5 centimetres. The patient has attempted to diet but has gained 11.3 kilograms in the previous months. The patient also sleeps for 14-16 hours a day. Her movements were slothful. The patient’s signs consisted of a slight enlargement of the neck area, coarse textured hair and dry skin. When her blood sample was analysed it showed that the hormone T4 (thyroxin) levels were 3.2 micrograms/millilitre which is lower than the normal range, 4.2-11.2 micrograms/millilitre. In addition to this her TSH (thyroid stimulating hormone) levels were high.

Diagnosis

The analysis of the weight gain using the diagnosis table shows that this could be as a result of hyperthyroidism or Cushing syndrome or hypothyroidism. The slothful behaviour could be caused by Addison’s disease or hypothyroidism. The dry skin of the patient is consistent with the hypothyroidism condition.

The swelling on the neck could be a goitre which results from a lack of iodine in the thyroid gland. Overstimulation causes the thyroid gland to swell. This swelling could also be a result of hyperthyroidism whereby the thyroid gland secretes too much thyroid hormone and the swelling also results, or it could be a thyroid tumour which also causes the swelling. [1,2]

The signs and symptoms are consistent with either hypothyroidism or hyperthyroidism and are on the thyroid gland.

Cross-section diagram of the neck showing the thyroid gland (106.gif)

http://www.patient.co.uk/health/Hypothyroidism-Underactive-Thyroid.htm

Analysis of blood samples and effect of hormones on homeostasis

The hormone T4 speeds up metabolic rates regulates the amount of oxygen used up by cells and regulates body heat. [3] The patient’s weight gain could be as a result of a decrease in the rate of digestion. Low T4 levels mean that not enough digestive juices are being secreted because T4 controls metabolic rates resulting in the slow movement of smooth muscles lining the stomach. T4 promotes the normal development of muscle tone and normal functioning of skeletal and cardiac muscles. This possibly explains why the patient is experiencing slothful movement. [1] In addition to this T4 also promotes the hydration of the skin, secretion of the exocrine glands and the growth of hair. The consequences of low T4 could explain why the patient’s hair is coarse and why the patient has dry skin. [1]

To distinguish between hyperthyroidism and hypothyroidism a T4 and TSH test have to be done. [4] The TSH test is normally chosen for the evaluation of the thyroid function and for the symptoms of hyperthyroidism or hypothyroidism. It is often done with or after a T4 test.

The results of the tests performed show an elevated TSH level and a low T4 level which show that the patient has hypothyroidism.

Condition

Normal

Hyperthyroidism

Hypothyroidism

Hypothyroidism Secondary

TSH

Normal

Low

High

Low

T4

Normal

High

Low

Low

[4]

WHAT IS HYPOTHYROIDISM

Hypothyroidism is a condition caused by the underactive functioning of the thyroid gland whereby the thyroid does not produce enough or does not even produce triodothyronine (T3) and thyroxin (T4). [1] The thyroid gland is a butterfly shaped organ which is found inferior to the Larynx and in front of the neck. [1] If the thyroid is underactive hypothyroidism appears. They are two types of hypothyroidism and these are primary and secondary hypothyroidism. [4] Primary Hypothyroidism is when the thyroid does not produce T4 and T3 hormones at all. [4] Secondary Hypothyroidism is when the thyroid produces amounts of T3 and T4 which are below the normal levels. [4] The thyroid gland swells up in as a result of it trying to achieve homeostasis. The body has low T4 levels therefore the gland works even harder to try and produce more hormones and this causes an increase in the size of the gland.

Causes

95% of the time the thyroid gland is not secreting sufficient thyroid hormone and this could cause the hypothyroidism.

Hypothyroidism could be an autoimmune disease. The immune system protects the body from foreign substances and infection. However, in this case the immune system mistakes the thyroid gland cells and enzymes, as foreign objects and attacks them resulting in the low production of thyroid hormone. [5]

Hypothyroidism could also be as a result of Hashimoto disease (chronic thyroiditis). This is a genetic autoimmune disease which could also result the enlargement of the thyroid gland causing goitre. Goitre is a cyst like fibrous growth in the neck region and is caused by an immunologic dysfunction or by an infection and requires lifelong treatment. Stress, poor dieting and strenuous exercise could also cause an imbalance of hormones and leads to hypothyroidism. [6]

Hypothyroidism can also result from low iodine concentrations in the body. Iodine is required for the proper and normal functioning of the thyroid gland’ hence insufficient amounts would cause a dysfunction. [5] The enlargement of the gland is an attempt by the thyroid gland to trap more iodine. X-ray radiation, drug abuse and pesticide residues also contribute to having an underactive thyroid gland. [7] Another way of acquiring hypothyroidism could be the after effect of a surgery for example on the removal of thyroid glands. The surgery could be performed on a patient with cancer or the Grave’s Disease but if partially removed it could fail to produce enough thyroid hormone necessary to regulate normal and necessary bodily functions. [7-8] Surgery could also be performed on the pituitary gland which sends instructions to the thyroid gland on how much thyroid hormone should be produced. [5] Any damage to the pituitary gland or the hypothalamus could cause hypothyroidism as they both play a role in sending signals to the thyroid gland so that it produces more thyroid hormone.

In some cases the condition could arise from the use of drugs such as amiodarone, lithium interferon alpha, and interkulin-2. These drugs stop the thyroid gland from producing the thyroid hormone at a normal and are likely to trigger hypothyroidism especially in patients with a genetic tendency to auto immune thyroid disease. [5]

Possible Treatment methods

To treat hypothyroidism artificial hormones such as Levothyroxine or Liotrix can be administered to the patient so as to replace the hormones; T4, TSH or T3 that are lacking in the body. Iodine supplement’s or iodised salt for those with iodine deficiency can be effective as well. [9-10] The doses of the drugs are not fixed hence the medicine is only formulated when the amount of hormone in the patient has been determined, therefore the patient has to return for constant check-ups after 6 week intervals so that the blood samples and the hormones can be analysed again so that the dosage can be changed. [7-10]

When treating the elderly that have a history of heart disease, low doses of the drug have to be administered as this could lead to a greater/increased risk of heart attack. [10]

For the short term treatment of hypothyroidism, T hormones are used to inhibit the synthesis of TSH in the body. Hormone replacement is predominated by the prolonged effect of T hormones on the level of TSH present.

For those who do not prefer drug therapy for hypothyroidism homeopathic remedies are also available. The homeopathic remedies such as Thyax and Thyroidinum 6C can be used to stimulate the thyroid gland to start to produce its own hormone. [11-12]

Prognosis

If the condition of hypothyroidism is detected early there is a high chance that the condition can be completely controlled using medicine.

After treatment with drugs, the levels of thyroid hormones usually return to normal after several months, whereas in other individuals suffering from hypothyroidism, the disorder is a lifelong problem. [13] Their treatment should be taken consistently every day for the rest of their lives. [14]

If hypothyroidism goes untreated it could lead to other complications. Low thyroxin levels cause the level of lipids and cholesterol to rise, causing the patient to suffer from heart disease. [13] In pregnant women there is an increased risk in having anaemia, still birth and serious bleeding after birth or it could lead to a myxoedema coma, which arises due to the low levels of thyroid hormone. [13-14]

Advantages and disadvantages of chosen treatment methods

With allopathic remedies there is a chance that if the drug dosage is too low it could cause hypothyroidism and if the drug dosage is too high it could lead to hyperthyroidism.

The homeopathic remedies are the best treatment methods as compared to the supplementation medications as it aids the gland to function properly, whereas in the supplementation medications the gland could become too dependent on the drugs and throw the other glands in the body off balance. [12] If the doses of the artificial hormones are not check or changed, with time this could lead to hyperthyroidism.

Prevention methods

There are no medication preventative methods for hypothyroidism, but a healthy diet can protect and preserve one’s health. The patient can take iodine supplements in their food and this reduces the risk of them contracting it. Exercising, getting enough sleep, relaxation are ways in which hypothyroidism future problems can be avoided. Exercise is another activity that boosts the levels of thyroid hormone therefore reducing the risk of hypothyroidism. [15]

Conclusion

There is no cure to the condition therefore the patient will have to keep taking medicine for the rest of their lives. The patient will have to go for constant check-ups in order to change the dose according to the thyroid hormone levels that they have, and the misuse of the drugs could make their condition worse. [16]