American singer and actress Selena Gomez recently shared on an Instagram story that she heavily used an electronic cigarette containing nicotine. According to her, vaping changed her voice, and when she tried to stop, she discovered how hard it is to quit. She shared that she managed to stop using and that she hopes to stay the course.
Her story is a personal testimony, not a medical diagnosis from which one can deduce what exactly happened to her vocal cords. Nevertheless, it opens an opportunity to talk about the harms of vaping and the ways to cope with nicotine dependence.
These are not water vapors
To understand the risk, one must understand how an electronic cigarette works. The device heats a liquid and creates an aerosol inhaled into the lungs. Although it is commonly referred to as "vapor," this is not ordinary water vapor.
The aerosol may contain tiny particles, metals, and harmful chemical substances, including carcinogens. Its composition and the amount of substances in it vary depending on the product, the liquid, and the method of use. Most electronic cigarettes also contain nicotine, which causes addiction.
Repeated inhalation exposes the mucous membranes of the respiratory tract and the lining cells in the vocal cord area to substances that can provoke irritation and inflammation. Damage to this area may also manifest as a change in voice. Studies have found a link between electronic cigarette use and respiratory symptoms, including coughing, wheezing, and shortness of breath.
It is important to remember that harmful effects are not always felt immediately. The absence of a cough or discomfort does not indicate that vaping is risk-free. Alongside the concern of ongoing respiratory damage, long-term consequences are still being investigated, including the risk of malignant diseases. The mere exposure to carcinogens does not currently allow for precisely quantifying the future risk of cancer for a specific user.
Acute and life-threatening lung injuries associated with vaping have also been described. However, it is important to be precise: The prominent outbreak in the United States, known as EVALI, was primarily linked to vaping products containing THC and the additive vitamin E acetate, and all cases should not be broadly attributed to regular nicotine products.
Why are nicotine replacements a different matter?
Nicotine is a central factor in creating dependence. Therefore, the question occasionally arises: If one wants to quit it, why use preparations that contain it?
The difference lies in the route of administration and the therapeutic goal. Nicotine replacements deliver nicotine in a controlled dose, without inhaling the electronic cigarette aerosol or the combustion products of a regular cigarette. The patch delivers nicotine throughout the day, while gum or a lozenge can provide a response when the craving arises. A dedicated nicotine spray for smoking cessation also exists.
The preparations help reduce cravings and withdrawal symptoms. In smoking cessation from regular cigarettes, nicotine replacements are an established and accepted treatment, and sometimes a patch is combined with a faster preparation, such as gum or a lozenge. The choice of preparation and dose should be tailored to the patient and the extent of their use.
When the goal is solely stopping vaping, it is important to tailor a dedicated plan: The evidence base for vaping cessation treatments is still more limited than that existing for regular cigarette cessation.
Medications and accompaniment: You do not have to do this alone
Alongside nicotine replacements, prescription medications for smoking cessation exist. Combining drug treatment with behavioral accompaniment can help cope with both physical dependence and the habits tied to use.
Accompaniment can be provided in a group workshop or in an individual setting, face-to-face or by telephone. In Israel, cessation programs operate within the framework of the health basket and health maintenance organizations. It is important to distinguish between the service and the cost of the medications: Depending on eligibility conditions, program participants are entitled to an 85% discount on prescription medications and nicotine replacements included in the arrangement, in coordination with the family doctor. This does not mean that every preparation and every treatment framework is provided without payment.
One can also turn to the national smoking cessation hotline of the Ministry of Health, at telephone *6800, which offers personal accompaniment by cessation counselors. For those seeking to stop electronic cigarette use, it is worthwhile to check with the hotline or the health maintenance organization which program and which eligibility suit their condition. EfshariBriyot
Starting with a plan, and progressing step by step
Before beginning treatment with nicotine replacements or a prescription medication, it is worthwhile to build a plan: To choose a date for stopping, to identify when cravings arise, and to plan in advance how to cope with those moments.
Near-term goals, such as getting through the morning or the weekend without vaping, can make the task more practical. Behavioral and drug treatment should be tailored to the individual, their usage habits, and their medical condition.
And if there is a lapse, it does not erase the progress. One can check what led to it, modify the plan, and continue the process.
Gomez's confession reminds us that quitting smoking and vaping can be difficult. Alongside explaining the harms, it is important to offer those who wish to stop a practical path as well: Professional accompaniment, tools to cope with cravings, and tailored treatment as needed.
Dr. Ariel Rokach, an expert in internal medicine and pulmonary diseases, director of the respiratory care unit at Shaare Zedek Medical Center and chairman of the Medical Society for Smoking Prevention and Cessation in Israel