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Published On: Friday April 28, 2017
Are electronic cigarettes safe?
Defined as inhaling or exhaling the vapour produced by an electronic cigarette; Vaping, has become increasingly popular worldwide. Google trends indicate that the popularity search interest for keyword “vaping” seems to have nearly doubled in the last 2 years. As markets are being flooded with these products, there is a growing concern to understand and scientifically evaluate the risks and benefits of this global phenomenon.
What is an e-cigarette?
Electronic cigarettes are broadly categorised as Electronic Nicotine Delivery Systems (ENDS) and are of three major types namely, Cigalikes (look like conventional cigarettes), eGos (larger in size with a tank that can be refilled) and Modular E-cigarettes (larger than eGos and customisable). These were conceptualised in early 1930s, researched through the decades, but only entered the mass market after their commercialisation in 2003 from Beijing, China. Recent surveys indicate that electronic cigarettes are being used by nearly 9 million adult consumers in US alone with figures estimated to increase with time. Today, though readily available in most urban countries as well as the internet, this product remains shrouded with controversy.
What was the purpose?
WHO reports that up to 6 million deaths per year can be attributed to tobacco usage. A traditional cigarette (aka Analog cigarette) contains tobacco that on combustion releases smoke containing tar. Nicotine, is the primary psychoactive component of tobacco and is addictive while tar causes the damage. Fumes produced from a combustible cigarette contain numerous toxic substances that are proven to cause cancer. ENDS are believed to have been introduced into the market to reduce the harmful effects of tobacco in smokers. In an electronic cigarette, instead of tobacco, nicotine (which in itself is largely benign) is mixed with a base of propylene glycol and flavourings. The absence of tobacco is believed to reduce the harmful effects of smoking.
How does it work?
An E-cigarette consists of a tube shaped device that heats a nicotine- containing liquid and delivers vapour when inhaled. There are 4 major components of this liquid – Nicotine, Propylene Glycol, Vegetable Glycerol(VG) and flavourings. A battery powered coil heats the bases (PG and VG) converting them into an inhalable vapour . The amount of nicotine present can range from 0 – 42 mg/ml, depending on the manufacturer. Flavours used are certified as edible but may be a cause of concern as discussed further.
What does research have to say?
An initial report by WHO in 2014 condemned the use of E-cigarettes, while raising the concern that it encourages the younger generation towards the act of smoking rather than against it. Due to lack of evidence, ENDS were to be placed alongside combustible cigarettes in the anti-tobacco campaign. But recent studies have shown that ENDS are 95% safer than analog cigarettes due to absence of tobacco. Another cross-sectional study states that the level of toxicants in vapour from an END is 9-450 times less than that of smoke, making them relatively safer. This data, though accurate, has been misinterpreted and deliberately sold as “harmless” to the public. Scientists warn that just because ENDS are comparatively “safer” , does not mean they are entirely “safe”.
Cause for concern?
A 2016 study of the flavourings used in ENDS revealed that the concentrations of these chemicals, certified as edible, were high enough in the vapour to be of toxicological concern. It is known that chemicals in liquid form may not be as damaging as that of a combustible cigarette, but the study found that chemicals released from flavourings in the form of vapour were, in fact, a mucosal irritant.
Is passive vaping even possible? Manufacturers of ENDS claim that vaping causes little or no threat to a passive bystander but it has been found that despite the reassurances, vapour from an ENDS is not emission-free. The pollutants present in the vapour are a cause of concern for both, direct user and passive user.
Despite their drawbacks, ENDS have shown to result in considerable harm reduction for smokers. If used exclusively in place of combustible cigarettes, the exposure to carcinogens is found to be much less than smoke. Researchers claim that when used in decreasing concentrations of nicotine, ENDS can help smokers quit the habit entirely by providing a tobacco free alternative. Exhaustive research is required to further understand long term effects of vaping. Till such data is made available, we suggest that ENDS be used solely for the purpose of de-addiction from smoking and not as an additional method of the same.
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- Goniewicz ML, Knysak J, Gawron M, et al Levels of selected carcinogens and toxicants in vapour from electronic cigarettes Tobacco Control 2014;23:133-139.
- Tierney PA, Karpinski CD, Brown JE, et al Flavour chemicals in electronic cigarette fluids Tobacco Control 2016;25:e10-e15.
- Schober W, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int J Hyg Environ Health 217(6):628–637 (2013); doi: 10.1016/j.ijheh.2013.11.003.
- Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill A, Alwis KU, et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med. 2017;166:390-400. doi: 10.7326/M16-1107
Content Credit: Dr.Nikita Pandey, Pune