Smoking, Vaping and COVID-19 with Dr. Humberto Choi

Podcast Transcript

Deanna Pogorelc:  Hi, welcome to The Health Essentials Podcast brought to you by Cleveland Clinic. I'm your host today, Deanna Pogorelc. Now, we've all known for a long time that smoking is bad for our lungs and for our bodies, but the global pandemic has raised new questions about whether smoking and vaping can put someone at a greater risk for getting sick with COVID-19, a disease that primarily affects the respiratory system. So here to share what experts know so far about smoking, vaping, and COVID-19 is Dr. Humberto Choi.

He's a pulmonologist and smoking cessation specialist here at Cleveland Clinic. Welcome to the podcast, Dr. Choi. Thanks for being here.

Dr. Humberto Choi:  Thank you for having me.

Deanna Pogorelc:  And to our listeners and viewers, please remember that this is for informational purposes only and is not intended to replace your own healthcare provider's advice. Doctor Choi, since we're going to be talking about both smoking and vaping, can we start by talking a little bit about the difference between the two?

Dr. Humberto Choi:  Well, I think most people will know what a traditional cigarette looks like. Typically, it comes from a tobacco. Now, vaping can come in different forms. People know some brands that are very popular nowadays, but there are different devices. There are different liquids that people can use, but it's pretty much a device that heats up a liquid. Then that vapor is then cooled down, and that is exhaled by this device and someone will inhale that. And it's important to note that the devices can look different.

The e-liquid that someone can use can have different components, but most of them that are used out there do contain nicotine.

Deanna Pogorelc:  Okay. So then, is vaping less dangerous than smoking?

Dr. Humberto Choi:  That's a question that I'm asked often and right now we don't have a great answer for. I think when we talk about cigarettes, we think about, emphysema, COPD about the risk of cancer and the risk of strokes. But cigarettes have been around for several years, like decades or hundreds of years, depending on the cigarette. But electronic cigarettes and vaping have been around for a very short time, so we still don't know what would be the long-term consequences vaping or using electronic cigarettes.

But what we do know now is that even in the short term, it can be dangerous enough to cause a lot of inflammation in the lungs and to threaten somebody's life. And that's what happened last year when we had a big outbreak in the country from acute lung injury that was associated with vaping and electronic cigarettes. We know that in the short term, it can be very harmful, but now it's going to take a little bit of time to see what the consequences would be in the long-term. I think this is something that we'll continue to investigate.

There are some signs that there are some possible connections of vaping and electronic cigarette use with emphysema, for example. There are possible mechanisms that can connect to cancer. Now, if this will really translate into causing emphysema or cancer, that's something that we still don't know yet.

Deanna Pogorelc:  Do we know if vaping is addictive in the same way that smoking is?

Dr. Humberto Choi:  It can be. The vaping liquid can contain different substances and the most common one is nicotine, and nicotine is addictive. And it's important to know that sometimes the liquid or the cartridge that someone is using for vaping can contain more nicotine than an entire package of cigarettes. Sometimes people use that in one day or in a very short period. And yes, it can be just a few puffs and that can start the addiction process. So yes, vaping can be addictive, and this is one of the harms of vaping, the addiction itself.

Deanna Pogorelc:  And what have been the trends with smoking and vaping in the US? It seems like we see a lot more people vaping these days, but is that true on a national scale?

Dr. Humberto Choi:  Thanks to a very broad education campaign and a lot of efforts to curb the use of cigarettes, the rates of smoking, especially among adults, have been declining over several years and decades. We are actually in a very low rate right now compared to how we were 40, 50 years ago. But it's worrisome that the rates of vaping are going up, especially in young adults and teenagers. Every year we are seeing a slight increase in the use of vaping, especially in this population.

This is very worrisome, because if they start with an addiction so early in their lives, we worry about what could happen when they grow up.

Deanna Pogorelc:  You did mention a bit of this, but I want to ask more about some of the effects of smoking and vaping on our bodies, and specifically are they doing harm to us in ways that could affect our ability to fight an infection like COVID-19 or other infections.

Dr. Humberto Choi:  Yeah, so our body's very smart and our lungs are very complex and smart too. And we have innate ways to defend ourselves from infections, from things that can irritate or cause inflammation in our lungs. When someone smokes or vape, those mechanisms don't work as well. We are more susceptible to infections when we vape or smoke. In general, when someone smoke cigarettes, they are more susceptible to bronchitis, to pneumonias. And this is something that we're seeing with COVID-19.

People who smoke and who vape seem to be more susceptible of having disinfection. And this can be because of those defenses that we already have are not working so well because of smoking, because of vaping.

Deanna Pogorelc:  Do we know that if people who smoke are more likely to get COVID-19 or to get very sick if they become infected?

Dr. Humberto Choi:  We are still in the middle of the pandemic. We are still learning a lot about this connections, but the preliminary data seems to suggest both of them, that people who smoke are more susceptible to acquire this infection. And once they do, the infection does seem to be more severe and more life-threatening compared to people who don't smoke. This is not a reason for someone to quit smoking and not a great reason to never start smoking if you don't, because you are more susceptible to having COVID-19. And if you do, you can have a more severe form of this illness.

Deanna Pogorelc:  Is it possible that smoking or vaping is playing a role in the spread of the coronavirus just by the nature of the action of exhaling smoke around others? Is that a risk at all?

Dr. Humberto Choi:  This is a good topic of investigation right now. This is something that we still don't know yet. It's unclear whether the virus will be connected to the droplets that someone exhale when they are smoking or vaping. It's possible that the risk is just because they are bringing their hand close their mouth, or they're exhaling in an environment with other people. It's not clear if the risk of spreading is higher just because you are close to someone who is smoking or vaping. This is a question that we don't know the answer very well yet.

Deanna Pogorelc:  And is there any other interesting research happening around this topic, or are there any big other questions that are still unanswered that would be helpful to you as a physician?

Dr. Humberto Choi:  Yeah. There are several things that we are looking into. One of them, for example, is those receptors that we have in the lungs, in the airways that connect to nicotine are responsible to having someone more susceptible to the infection, for example, if that irritation or inflammation that a smoke can cause or that vape can cause to the lungs contributes to the infection itself and that'll make it worse. And just like you asked, whether smoking or vaping somehow can affect our immune system, and in that way impair our ability to fight an infection like that.

              There are several things that we still don't know very well yet, but we all are looking into this answers. And we are still in the meat of the pandemic, so there are a lot of things for us to learn. And it's amazing how fast we are learning about all these things.

Deanna Pogorelc:  Absolutely. I want to ask you a little bit about quitting smoking and vaping. What's the first step for someone who feels like maybe they're ready to quit?

Dr. Humberto Choi:  Well, I think that the first step is already that, coming to a conclusion that it's time to quit. That is the best thing for them. So that's the major first step. It's important for people to know that most people are not successful in their first attempt. It may require more than one, so they shouldn't be discouraged by that. Most people do come to a conclusion that they need some help. So it's okay to contact your doctor, your primary care, your lung doctor, whoever can give you some help. We know there are medications that are effective.

              For example, there are different forms of gums, patches, and medications that we know that they work. And even if they didn't work in the past, it's okay to try again. They can be effective if someone tries again. I think not be discouraged if they were not able to quit their first attempt and looking out for help. There are different ways that someone can be helped. There is no one way to quit that is good for everyone. Everyone would have a different way that works better for them.

Deanna Pogorelc:  So is quitting vaping the same thing as quitting smoking, or are they kind of two different processes and two different things?

Dr. Humberto Choi:  It's very similar because the addiction that happens with vaping is mostly to nicotine. We are talking about the same substance that can cause dependence. Now, there are some differences, for example, especially on the way that people use electronic cigarette or vape, because that dependence. Nicotine sometimes can be even more intense because the concentration of nicotine can be even higher. And the access to vape can be higher just because people can feel they can vape any time because it doesn't cause a smoke.

              These are all things that we have to take into account when we are helping someone with vaping, just the differences of how they use nicotine. But overall, it's very similar because most of the time you're talking about addiction to the same substance, which is nicotine.

Deanna Pogorelc:  How can we support someone in our life who's trying to quit smoking or vaping/

Dr. Humberto Choi:  I think when someone is trying to quit cigarettes or vape use, there are a lot of emotions that come around that. We may not realize, but someone who is trying to quit might be feeling shameful, can be feeling guilty for doing that. I think the first thing is avoid that. To demonstrate support, but not being judgmental about it and offering help in the best positive way possible. Often for someone to be able to quit, they need to change their entire lifestyle, because there are several things that can remind them of smoking.

              Sometimes it can be a cup of coffee. Sometimes it can be watching TV or going out to work. They need to sometimes structure the entire day, because the entire day is around smoking or vaping. In a practical way, they can help with that, to help eliminate those cues that lead to smoking or vaping.

Deanna Pogorelc:  Can you talk a little bit more about some of the specific strategies that people seem to find helpful or that are scientifically backed when it comes to quitting smoking and vaping?

Dr. Humberto Choi:  Yes. Well, first of all, there is no one way that helps everyone. So everyone has a different way that they will try and will be successful. Now, something that we know, that there are several different medications that are effective. For example, nicotine replacement therapy, which is the use of patches and gum or lozenges, for example. These is something that is effective and helps to control withdrawal symptoms from nicotine. And there are medications like varenicline and bupropion that people can also use.

              And something that we try to do is a combination of these therapies of these medications with some form of behavior support. For example, here at Cleveland Clinic, we always try to combine a clinical visit where someone can talk about medication strategies, and then combine that with support, which is what our health coaches do. Patients are followed on the phone or via email for several months, and they receive advice and tips on how to control the craving, how to manage their medications.

              We know that when you combine those two things, the chance of someone quitting is much higher. There are other strategies that are not as effective, but are popular. For example, hypnotherapy or even acupuncture. Those things are not typically our first treatment by default. It's controversial, even if they are effective or not, but it's a good conversation to have with your clinician about this medication.

              I think a good first step after someone decides that they want to quit is really have a conversation with a clinician and see what resources they have in the community. We do have some resources here at Cleveland Clinic that we can offer. We have a little bit for everyone.

Deanna Pogorelc:  And with those medications that you mentioned, is that something people are going to be temporarily on? Are they going to be on it forever? How does that work?

Dr. Humberto Choi:  So it really depends from person to person. Some people just need it for a short period and they don't need it anymore. But some people may require, for example, a patch or gum to use for several weeks or sometimes even months, depending on how severe the dependence to nicotine was and how severe the craving can be and the withdrawal symptoms.

Deanna Pogorelc:  And when someone quits, are their lungs going to heal themselves? Or is any of the damage that's been done to the body, can it be undone? Or what's going to happen in the body when someone quits?

Dr. Humberto Choi:  There are several things that will happen in the body as soon as someone quits. There are forms of inflammation in the body, especially in the lungs that will get better when someone quits. The risk of having heart disease or stroke will go down after a while when someone quits. There are short-term and long-term benefits. But unfortunately, there are some things that don't go away. For example, when someone smoke cigarettes and they develop emphysema, and that is something that we can see in an x-ray or a CT scan, unfortunately, that doesn't go away.

              It may not get worse and the worst thing may slow down, but unfortunately, that doesn't go back to normal. But there several other things that will improve or normalize, so there are multiple reasons to quit smoking.

Deanna Pogorelc:  And is there anything we haven't talked about yet that we didn't touch on that you think is important to leave our listeners and our viewers with?

Dr. Humberto Choi:  Well, I think it's always good to have an open conversation about it, especially parents with their young kids. I think it's a healthy thing to talk about this. Parents may not know that their kids are being exposed to that in different ways, even if the kids are not talking about it. Maintaining the dialogue open, talking about the possible harms, the possible reasons that may lead someone to try something like this, so I think maintaining that open dialogue, the communication channel open is very important, especially when we're talking about vaping.

Deanna Pogorelc:  Absolutely. Well, thank you so much for being here and for taking all those questions. And if you or a loved one is thinking about quitting smoking or vaping, you can get more information about our smoking cessation program at ccf.org/stopsmoking. To hear more interviews with our Cleveland Clinic experts, please visit ClevelandClinic.org/hepodcast or subscribe wherever you get your podcasts. You can also follow us @ClevelandClinic on Facebook, Twitter, and Instagram for more health tips, news, and information. Thanks for joining us.