Vaping and Diving

Is there any research about the effects of vaping and diving? I am an instructor and would like references to give to students who vape. They usually dismiss studies about smoking and diving because the research is not specifically about vaping.

While we do not know about any research that deals specifically with vaping and diving in combination, recent research is available on vaping itself. Although it has not yet been translated to diving, some findings will need consideration. The residuals of incomplete burning (carbon monoxide, carbon dioxide) are not the major concern in electronic cigarettes, but vapor does contain putative carcinogens (polycyclic aromatic hydrocarbon, high concentrations of nanoparticles) and toxicological compounds (carbonyls, metals, volatile organic compounds). No long-term studies for chronic diseases (e.g., chronic obstructive pulmonary disease, COPD) or cancer connected to vaping are available yet.
 
We will not completely understand what the aerosols from e-cigarettes do to the lungs until long-term studies are available. Other factors concern us in research related to decompression sickness (DCS) that have also recently been discussed in papers about e-cigarettes.

Cardiovascular symptoms. Cardiovascular symptoms (especially in adolescents) of varying severity occur after e-cigarette use. Animal studies using mice and rats have found an increased arterial stiffness in animals exposed to e-cigarette vapor. This finding is of interest for divers because cardiovascular health is a prerequisite for fitness-to-dive examinations and because a substantial amount of research has been undertaken in the effect of endothelial (inner layer of the blood vessel) function in DCS and breath-hold diving. Flow-mediated dilation tests have shown that diving itself already decreases arterial function.

Inflammation. Sufficient data suggest e-cigarette aerosols cause inflammation and lower immune system efficiency. It has become clearer over the past few years that the immune system and inflammatory processes are a major player in the understanding of decompression stress.

Genotoxicity. Vapor seems to cause oxidative stress (overproduction of free oxygen radicals), which in turn — if it becomes too much — can lead to DNA damage; in the case of e-cigarettes it has been shown to decrease DNA repair capacity, especially in the lungs. The effects of oxidative stress and oxidative damage in the human body are manifold and not predictable, reaching from reversible interactions with cell membranes to the development of chronic or degenerative disease.

Lungs and respiration. Literature on vaping describes increased airway resistance and upper and lower respiratory tract inflammation. Anything that tampers with the lungs and their vital capacity has the potential to be harmful for diving.

We cannot yet give you direct insight into diving and vaping, but some evidence indicates that e-cigarette vapor — although in many ways less harmful than cigarette smoke — is of greater concern than we expect today. Quitting smoking altogether is by far the best risk reducer for divers.
— Frauke Tillmans, Ph.D.