MANILA — A health expert is sounding the alarm as more people are supposedly getting e-cigarette or vape-associated lung injury (EVALI), especially among the youth.

Dr. Maricar Limpin, a pulmonologist and Smoking Cessation Program director at the Philippine Heart Center, said the patients usually complain of getting tired easily and having difficulty in breathing, even in the absence of asthma, infection, or cough.

READ: Controversial bill lowering the age for vape access lapses into law: Palace

"Dito sa atin, may nakikita na rin tayong EVALI... Ngayon, unti-unti, kaming mga espesyalista sa baga, nakakakita na kami sa aming mga clinics ng mga pasyente na ang pinakareklamo ay nahihirapan makahinga. Pag tinatanong namin siya (patient) - na mukha namang hindi infection - wala talaga kaming makitang dahilan para mahirapan siyang huminga. Ang nakita lang namin, marami sa kanila, dating naninigarilyo tapos nag-shift sa e-cigarette," she told ABS-CBN News.

"May pasyente ako na six months pagkalipas na makapag-umpisa ng paggamit ng e-cigarette [nagkasakit]. After na huminto ng sigarilyo, nag-shift sa e-cigarette," she added.

Limpin said vaping and smoking are equally harmful, adding that the claim that vaping is "less harmful" is just a "marketing strategy", along with releasing cute designs and enticing flavors.

She said vaping is like putting cancer-causing elements right into your body, and it "obviously" has nicotine, which can be "addictive".

"Ang lagi pa nilang sinasabi, vapor daw ito, which is actually misinformation. Kasi ang vapor, ang ibig lang sabihin, iyong liquid - so kunwari, tubig - you turn it into a gas. Wala ng ibang kasama... But dito sa e-cigarette at saka even sa sigarilyo, it is not transformed into gas. Kahit iyong mga e-liquid na iyan, hindi siya nata-transform just into gas," she said.

"Doon sa kasama na nakikita natin doon sa usok, kahit doon sa medyo walang usok - napaka-kaunting usok - meron kang makikita doong ibang chemicals kasama ang mga metallic compounds, katulad ng lead, na kasama sa usok. And therefore, it is not vapor; it is an aerosol... Ang isa sa gusto sana natin, magkaroon ng disclosure doon sa ingredients," she added.

The health expert also expressed alarm on the "flavors" being used in vapes - including strawberry, sweet corn, green apple, among others - saying these were made for ingestion and not for inhalation, as the latter can build up "irritating" chemicals.

READ: Vapes are not a safer, better option: Leachon

She said what's even tricky about e-cigarettes and vapes is that they are hard to quantify, unlike cigarette smoking which can be counted per stick or per pack.

"Mas mahirap nga iyong paghinto ng vape kesa doon sa cigarette. Bakit? Kasi ang hirap mo i-quantify iyong addiction na meron iyong isang tao. Sasabihin niya, ang isang pod gagamitin niya for how many days. But pag tinanong mo... ilan ba iyong concentration ng nicotine na naroroon sa hinihithit niya, kailangan alam mo kung ilang puff. Kasi ngayon thousands of puff na ang pwede mong gawin sa isang pod. Merong pod na 10,000 puff, merong pods ngayon na up to 12,000... And they are now becoming more affordable kasi marami sa kanila disposable. Iyong device [naman], pwede mong i-charge tapos palitan mo lang iyong pod," she said.

Still, Limpin believes it is not too late for people to quit vaping or smoking.

"Cold turkey (abrupt and sudden quitting) is the best sa paghinto ng sigarilyo - iyon din ang the best sa paghinto ng vape. Definitely, maaaring tumaba kayo kasi mas gaganda iyong panlasa mo saka iyong pang-amoy mo so medyo gaganahan ka kumain. So kailangan lang i-control natin iyong ating pagkain. Pag busog na tayo, huminto na tayo. Kahit masarap iyong pagkain, tigilan na natin iyong pagkain pa. And, of course, let us do our regular exercise," she said.

Limpin also debunked claims of those who say they "feel more sick" if they quit smoking.

She explained that releasing more phlegm when one has already quit is a good sign that respiratory airways are normalizing, which were damaged by vaping and smoking.

The doctor appealed to the Department of Trade and Industry (DTI) to strictly implement regulations on e-cigarettes and vapes, especially to minors and the youth.

She also asked policymakers to grant regulatory powers of vapes to the Department of Health (DOH).

"Hopefully, iyong policymakers natin, lalo na dyan sa Kongreso, sana po ay isipin ninyo ang kapakanan ng ating mamamayang Pilipino, lalong-lalo na iyong mga kabataan. Ang vape issue ay hindi lamang about trade, hindi lang ito ordinary product, ito po ay may health implication. Sana magawan niyo ng paraan na kung saan maisama ninyo sa pag-regulate ang Department of Health (DOH), through the Food and Drug Administration," Limpin said.

In 2022, the controversial "Vape Bill" or the Vaporized Nicotine and Non-Nicotine Products Regulation Act (Republic Act No. 11900) lapsed into law, which the DOH opposed for "contradicting public health goals". 

Under the law, the age restriction for such products was reduced from 21 years old to 18 years old, and permitted flavorings, advertising, and sponsorship strategies. 

The regulation of the products was also transferred from the FDA to the DTI. 

'IRREVERSIBLE DAMAGE' 

In a press conference last week, Health Sec. Ted Herbosa said he wants to tap the Department of Education (DepEd) to help in the improved campaign against vaping, which he said - agreeing to other doctors - is no different from smoking. 

"Baka the approach would be more on educating the youth. Baka patulong ako sa DepEd to make sure na ma-educate iyong mga bata: 'Pag na-damage iyong lungs niyo diyan sa vape, irreversible na iyan. For life na iyan. Iyong dating nakakapag-jogging ka, nakakapag-cycling ka, baka hindi mo na magawa'... Hinihingal ka na, because the damage is permanent. Iyong EVALI, [or] e-cigarette and vape-associated lung injury," he said.

READ: WHO urges ban on flavored vapes 

"Kaya nagagalit iyong mga kaibigan kong doktor na wala raw akong ginagawa, kasi nakikita nila iyong mga pasyenteng iyan: 16 years old, 15 years old nagva-vape, wasak na iyong lungs nila, damaged nila. Sila ang gumagamot, so they want more action from me," he added. 

Herbosa has been working with the Philippine National Police (PNP) to seek help in catching those who continue to sell vapes to children, as the law states that only those aged 18 and above can use or buy vape. 

But he himself admitted, some children are still able to access vapes online. 

"Pag pumunta kayo diyan sa labas, may makikita kayong bata. Naka-uniform, high school, may nakasabit sa leeg, akala mo kwintas tapos biglang gaganunin niya, bubuga siya ng usok," he added. 

Based on the 2019 Global Youth Tobacco Survey, 14.1 percent of Filipino students aged 13 to 15 years old - 20.9 percent of which are boys and 7.5 percent are girls - currently used electronic cigarettes. 

Meantime, 24.6 percent of students have tried using electronic cigarettes. 

Ten percent of students aged 13 to 15 years old - 15.3 percent of which are boys and 5.1 percent are girls - currently smoked cigarettes. 

Data from the Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI) show, in 2022, 4.2 percent of adolescents aged 10 to 19 years old are current smokers, a jump from the 1.6 percent recorded in 2019. 

In its Technical Note on Call to Action on Electronic Cigarettes, the World Health Organization (WHO) said marketing of e-cigarettes "usually relies heavily on social media and influencers". 

"Studies illustrate the impact on adolescents; one study showed that daily use of one social media platform among middle school students was associated with a 3.8 percent increase in risk of current e-cigarette usage and an associated 6.1 percent increase among high school students," the agency said. 

"Another found that each additional hour per day spent on the platform among first-year university students was associated with a 4.6 percent in­crease in the probability of lifetime e-cigarette use," it added. 

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