Jul 07 2020 . 11 min read
Elevating the Conversation with pulmonologist Dr. Del Mundo
Elevating the Conversation with pulmonologist Dr. Del Mundo
A specialist in pulmonary and critical care medicine, Las Vegas native Dr. Lloyd Del Mundo is the director of the intensive care unit at North Vista Hospital, and he is the respiratory director at several area long-term acute care and skilled nursing facilities. Dr. Del Mundo specializes in diagnostic lung cancer procedures for Pulmonary Associates and is a member of the clinical faculty at Valley Hospital and Touro University Nevada.
How does smoking or vaping harm lung health?
Our bodies have cilia, and those are designed to clear your nose and lungs from any dust or allergens. When you smoke or vape that can highly effect those. So, the clearance of these particles whether they are toxic to you or not are significantly impaired from smoking and that is just when you inhale. That has nothing to do what is in the content of these things but only in the inhalation.
What does smoking do to your lungs?
In the content it is much easier to define what smoking does. Smoking can attack the cells that protect your lungs and get those inflamed. In turn, they don’t function as well, you can’t really breathe in and out as well because it affects cells in your body that help you breathe in oxygen and breathe out carbon dioxide. Then the tar can also implant in your lungs, and there’s a lot of carcinogens which we all know can induce cancer. Smoking is well-known to cause COPD, which is the difficulty when you breathe out and you can’t blow off your carbon dioxide and blowing off carbon dioxide is how we breathe.
What about the effects of vaping on your lungs?
The data on vaping is not as plentiful as with smoking. Vaping in the last year has increased significantly, and it can cause a lot of lung diseases. From 2017 to 2018 the incidence of smoking increased from 12% to 21%, according to the CDC (Centers for Disease Control). It can cause inflammation in the lungs which we call pneumonitis; basically, your lung reacts poorly to whatever fluid you are inhaling causing inflammation in your lungs making it difficult for you to breathe. You can get fluid in your lungs from vaping. The inflamed cells get angry and cause the capillaries in your lungs to start leaking fluid and that’s basically how you retain fluid in your lungs and get pneumonia.
This statement causes a lot of controversy, but it is exactly correct. If you get Covid and you are a smoker, you are two times at the risk of a normal non-smoking person to get worsening respiratory symptoms. Meaning you will end up on the ventilator, you will get more damage to your lungs. So, more end stage disease process is more likely to hit you if you are a smoker.
Is someone who vapes at higher risk of becoming infected with Covid?
In terms of vaping there is zero data right now. What we talk about with vaping is the inability to protect yourself. Maybe sharing the vape, how this disease process is spread through contact and droplets so you can get it by touching your mouth and hands.
As far as Covid-19, will a vape user have similar concerns to a cigarette smoker?
Vaping in itself is still in its youth, there’s no data and no real research on the effects of it with Covid-19. Your concern would be the same as with any vaping, when you vape and when you smoke your immune system shuts down and you are allowing a virus or even a bacterial infection to come into your lungs because you have a decreased defense system. So, you do put yourself at risk to getting the virus just by the action of the vape, as with smoking, because you decrease your immune system.
For diehard smokers is there anything they can do to boost their immunity and lung health?
Zinc is a very well-known anti-viral supplement people have been taking for years. For my patients in the hospital, if their symptoms are quite mild, I give them vitamin C and zinc. Studies on vitamin D have shown some type of protection toward the coronavirus. Pepcid AC has become popular during the pandemic, which is curious since not everybody has heartburn. The generic name of Pepcid is famotidine and it’s been shown to have anti-viral properties that could actually protect you from getting Covid.
There is research showing people who ingest nicotine are less likely to get infected with Covid-19.
Yes, there’s a study, actually two, one in China and one in France, that tries to show that people who smoke were less likely to get Covid-19 than non-smokers. The data shows that 482 people who were Covid-19 positive, which was only 5% of the Covid-19 positive patients in this one hospital in Paris who were daily smokers, the rest of them weren’t. So, the researchers were thinking why are all of these people who were smoking not getting the virus?
In terms of the France study, what they were attributing it to was that nicotine may share the same binding site on a cell as the SARS 2 coronavirus does. So basically, nicotine and Covid-19 actually share a similar binding site, so when the nicotine binds it doesn’t allow a place for the virus to bind too. It’s not necessarily the smoking that’s making it so that you are not obtaining the virus, it’s more the nicotine. So, France is actually trying to do a study with nicotine patches to see if people who wear nicotine patches are less likely to get the SARS-2 COVID virus.
What do you think about nicotine being a preventative method for Covid-19?
You don’t have to be a doctor to say this doesn’t make sense. Smoking is truly bad for you. You are not going to want to smoke to stop yourself from getting coronavirus, you are just going to increase your chances of getting COPD, cancer, and emphysema. It’s still counterintuitive to smoke a cigarette.
Smoking increases the receptors for you to get the virus. So, when you get the coronavirus it binds to your ACE2 receptors, you have ton of those receptors and when you smoke that’s why people who get coronavirus get it worse. So, it’s counterintuitive. While they show nicotine is actively binding against those receptors and you don’t get the infection like other people do but when you get it the disease process is much worse. If your viral load is very high, your disease is much worse.
That’s hard to say, we don’t know if you get the same increase in the ACE2 receptors through vaping as you do from smoking. Smoking tobacco has a lot of different additives. We know enough about smoking that if you smoke your lungs are going to get bad. With vaping we don’t know as much. And vaping has a lot of things it can cause too, we just don’t know whether the severity is the same, worse or better. Right now, it doesn’t look nearly as severe but there are other things you can get.
Are vaping and smoking the same as far as the effects on your lungs?
They are definitely each their own thing. When you smoke cigarettes you basically know you are getting nicotine, tar and carcinogens but when you vape, you don’t really know everything that’s in there. There are things like the flavorings, there could be nicotine or not, there’s glycerol, and propylene glycol. We know glycol is bad for your body, it can affect your kidneys and it can be real toxic. Propylene glycol is the same thing they use to preserve food. The concept of smoking is universal but the concept of what you are smoking is completely different.
What alternatives would you recommend for a smoker or vape user if they still wanted to continue to imbibe? Vaping is hard because as with smoking, its habit forming. Some people just like to do it because they are used to putting something in their mouth and used to lighting something up, that is pretty hard to replace. So sometimes you need to take a medicine to fight that stimulation. People do things like a nicotine replacement for smoking, or just chewing gum may help to take away that oral fixation. You just have to break the habit.
But with marijuana and getting THC, there’s alternatives like eating it or trying things like cooking with it is probably a lot safer than smoking. If you just want the pure effects of the euphoria there are so many other options. There are sublingual things, or you can rub it on. When vaping was new people would ask me if they should vape or smoke…I know how bad smoking is, we still don’t know how bad vaping is but right now it still tends to be the lesser of the two evils. I do not promote either one.
For those who do not smoke or vape but who are taking in secondhand smoke are they in a compromised category or more susceptible to getting Covid-19? The big selling point when vaping came out is it is just air or mist that you are breathing out. But when they did further studies on it, while there may not be as many toxins or carcinogens as you can see with tobacco and smoking cigarettes, there are still active carcinogens in the vape. So that is an urban myth. In terms of secondhand smoke, it is a lot less likely for that person to get a severity of illness with secondhand smoke or secondhand vape than the person who is actively doing it. There is some study information suggesting you may be more prone to getting sick from the virus than somebody who is completely away from the environment. Secondhand smoke or vape is bad in general. Specific with regard to the Covid-19 virus, there is not enough data to tell you that for sure. I am sure it is the same concept. For example, if there is a house next door to you that is burning, you can still smell the ash and are ingesting the smoke and, in turn, are still getting effected just not as bad.
In general, is there a difference between inhaling nicotine versus marijuana as far as damage to the lungs? Smoking in general, whether you are smoking marijuana or tobacco, has shown to worsen your lung function. No matter what you are smoking by introducing something into your lungs you get inhalation injuries, you get these obstructive diseases. How much worse do your lungs get? Such as can you develop emphysema from marijuana? There is not that much information on that yet. We don’t know all the aftereffects of marijuana but when you use marijuana to vape that has been shown to be bad because of vitamin E or the oil they mix it with to preserve it. Nicotine in vape doesn’t seem to show the same effects. Now smoking a cigarette versus marijuana, you still get lung damage universally because you are introducing smoke and carcinogens into your body. Whether you are smoking as true a marijuana as possible is irrelevant because it will still damage your lungs for sure.
In terms of vaping, its different because nicotine is not preserved. Nicotine and cigarettes are known to cause diseases like COPD, emphysema and they make it difficult for you to exchange air. Researchers don’t know if it is the tar and carcinogens in the smoking that does it because the nicotine has its own different effects. As for studying marijuana, we don’t have the same data as far as causing airways to be blocked.
If someone quits smoking/vaping, how quickly can that have a positive effect on their lungs?
Instantaneously. The minute you stop introducing anything bad into your lungs, you are going to give them time to heal. But at some point, if you keep introducing stuff, it just takes a little bit longer to heal than if you weren’t doing it for so long. Most of our body tries to regenerate. The most notorious organ for regenerating, of course, is the liver. You can regenerate your lung, but you may not get back to your 100%, but maybe 85%. The minute you stop smoking your body will try to regenerate and get rid of toxins immediately.