E-cigarettes

E-cigarettes are battery-powered devices that provide inhaled doses of nicotine vapors and flavorings. E- cigarettes have the same shape and size as regular cigarettes, but they are nonflammable, so you don’t smoke them. images-2“Vaping” use has been rapidly growing, with about one in five cigarette smokers in the U.S. trying them (1). Usage has doubled since 2010.

E- cigarettes contain polyethylene glycol, the chemical used for theatrical smoke, and  an additive in toothpastes, deodorants, and moisturizers. The FDA’s analysis also reveals detectable levels of known carcinogens and toxic chemicals, including diethylene glycol and tobacco-specific nitrosamines (2). In a recently published study (3), although numerous brands of e- cigarettes contained some toxic substances, the levels were 9-450 times lower than regular cigarettes, thus implying vaping may be safer.

According to the CDC, it is not clear that e-cigarettes help people quit smoking or even decreased cigarette usage. In a study from Italy, published two years ago, researchers provided e-cigarettes to pack-a-day smokers who had no interest in quitting smoking (4). After 6 months, 22.5% were abstinent from smoking, 55% had cut their daily consumption by at least half, and overall the participants smoked 88% fewer cigarettes. In a very recently published study in The Lancet (5), researchers found that e-cigarettes (with or without nicotine) were modestly effective at helping smokers to quit, with similar results to nicotine patches, and with few adverse events. In my practice, I have seen some patients quit smoking with the use of e- cigarettes and reduction in episodes of bronchitis, presumably from diminished exposure to the heat and combustion products of cigarettes. Many e-cigarettes contain nicotine, so they might be addictive. There is also concern that e-cigarettes might be a gateway to new smokers, particularly teenagers.

Currently, e-cigarettes that are marketed for “therapeutic purposes” are regulated by the FDA Center for Drug Evaluation and Research (CDER), but otherwise are unregulated and there is little research available on their safety or efficacy as smoking cessation tools. There are significant differences between brands and nicotine levels may vary widely.

Switching to e- cigarettes could help smokers avoid thousands of chemicals found in regular cigarettes, some of which have been shown to cause cancer in humans. There is no proof, however, that e- cigarettes are risk-free, even though they are being marketed by the tobacco companies as the “safe cigarette.” More research is needed.

References:

1. Centers for Disease Control and Prevention. About one in five U.S. adult cigarette smokers have tried an electronic cigarette. February 28, 2013. http://www.cdc.gov/media/releases/2013/p0228_electronic_cigarettes.html

2. Reference Committee D. Use of Electronic Cigarettes in Smoking Cessation Programs. Report of the Council on Science and Public Health. CSAPH Report 6-A-10. http://www.ama-assn.org//resources/doc/csaph/a10csaph6ft.pdf

3. Goniewicz ML, Knysak J, Gawron M, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2013 Mar 6. [Epub ahead of print]

4. Polosa R, et al Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: a prospective 6-month study. BMC Pub Health 2011; 11: 786.

5. Bullen C, et al. Electronic cigarettes for smoking cessation: a randomised controlled study. Lancet. Published online September 7, 2013. http://dx.doi.org/10.1016/S0140-6736(13)61842-5