Smoking, e-Cigarettes, Nicotine, & Lupus

Many of the dangers of smoking cigarettes, including cancers, COPD, and emphysema, are well known. For Lupus Warriors, it’s also important to understand the impacts of nicotine on the immune system.

Cigarette smoke, including secondhand smoke, is well-known as a risk factor for different kinds of cancers, infections, cardiovascular problems, lung diseases, and autoimmune diseases – including lupus. In fact,  studies and the Surgeon General’s Report have found a causal connection between smoking and autoimmune conditions (including rheumatoid arthritis, multiple sclerosis, and SLE) even 20 years after quitting!

Smoking cigarettes can also adds new symptoms to the mix. In a 2009 study with 276 participants (primarily caucasian women), smoking was associated with a 95% chance of having skin symptoms such as scarring, alopecia (hair loss), and rashes. You can read more about the skin symptoms of lupus and cutaneous lupus in general here.

The risks don’t stop with the skin. Smoking cigarettes also makes it harder to heal from wounds and bone damage, and it may also make lupus medications such as tumor necrosis factor alpha (TNF-a) inhibitors and antimalarials less effective. This weakens the body, and makes it vulnerable to damage and infection.

e-Cigarettes & Smoking in 2019

Cigarettes are the number 1 cause of preventable death in the United States, killing 480,000 people every year – more than HIV, heroin, methamphetamine, cocaine, alcohol, motor vehicle accidents, and firearms combined. New research and advertising campaigns brought the dangers of smoking into focus for people. But, after years of decline, new technologies like e-cigarettes and vapes are causing a resurgence.

The risks associated with e-cigarettes are not entirely understood despite their popularity. Long-term studies are needed to understand the potential dangers. Unlike traditional cigarettes, e-cigarettes do not give off carbon monoxide, hydrogen cyanide, and tar — a major source of carcinogens. Still, they contain nicotine, a highly addictive substance that impairs prefrontal brain development during adolescent development.

Unfortunately, nicotine isn’t all that you get when you inhale on an e-cigarette. E-cigarettes are made-up of 4 elements:

1. Cartridge
   1. This holds the e-liquid containing nicotine, flavoring, and other additives
2. Atomizer
   1. Heats the e-liquid into an aerosol
3. Mouthpiece
   1. User inhales the aerosol
4. Battery
   1. Powers the device

Cartridges are often flavored using a chemical compound called diacetyl. Research has shown that diacetyl is associated with bronchiolitis obliterans, a rare and permanent lung condition. Additionally, there is a concern that the glycol and glycerol in the e-liquid may be transformed into formaldehyde by higher-wattage vaporizers.

Nicotine is addicting, but is it bad for you?

Nicotine is the part of smoking that gets you hooked. Dr. Neil Benowitz, a researcher at the University of California, San Francisco shared that, “from a scientific standpoint, nicotine is just as hard, or harder, to quit than heroin.”

Many of the dangers noted above are unrelated to nicotine. The problem is, nicotine is not all that that cigarettes provide. There are over 7000 other chemicals in cigarette smoke, and their effects on the body – especially when heated, inhaled, and in-contact with each other – are deadly.

The rise of e-cigarettes and electronic nicotine delivery systems are prompting new research that will impact both health and public policy.  A 2015 review explored published papers on Medline and PubMed for the impact of nicotine. The researchers found that nicotine:

• increased the risk of cardiovascular, respiratory, and gastrointestinal disorders
• negatively impacted reproductive health
• affects cell proliferation, oxidative stress, apoptosis, and DNA mutation which can leads to cancer
• can negatively impact the effectiveness of chemotherapy
• decreases the immune response

The finding that nicotine acts as an immunosuppressant is corroborated in other research as well. Nicotine is linked to the regulation of T cells. But, nicotine leaves the body quickly. This will leave you reaching for another cigarette and offsetting any benefit with a mountain of negative consequences.

If you need another reason to quit, being outside on cold days for a smoke break may make lupus symptoms worse. Read more about cold weather and lupus here.

Quit smoking today

It’s time to quit smoking. Consult your lupus treatment team to see if strategies (such a nicotine patches or e-cigs) may help you or potentially conflict with your medications or therapies. Fortunately, there are a wide range of smoking cessation techniques and products, and many insurance plans will cover the costs. You can read more about smoking cessation and insurance here.

It’s not too late to quit: Within weeks after quitting, people experience fewer day-to-day symptoms like coughing and shortness of breath. After a year, the risk of coronary heart disease falls to half of that of an active smoker. It can be difficult to quit, but the benefits are worth it.