Are E Cigarettes a Better Option? Is there really a “Free Puff?”

Since 2007, when they first appeared in the U.S. market, there have been an increasing number of advertisements that promote electronic-cigarettes (ECs) or electronic nicotine delivery systems (ENDS). Is this truly a healthy alternative to cigarettes? Could this be the Holy Grail the tobacco industry has been seeking all these years-a cancer free cigarette? What research has been done, how safe are they and basically-what do we really know about ENDS or ECs?

What is an E-Cigarette? Numerous manufacturers market ENDS, but the devices share key design features. They use a battery-operated heating device that vaporizes a nicotine-containing solution from a replaceable cartridge in a process triggered by the pressure drop that occurs when the user inhales from the device. They resemble cigarettes, and, in addition to providing nicotine in inhaled form, replicate some of the behavioral aspects of cigarette smoking. Cartridges come with various concentrations of nicotine, and refill solutions containing large amounts of nicotine are available. The most common vehicle in which the nicotine in such cartridges is contained is propylene glycol, though other chemicals may be used. Chest 

Who uses ECs and Why?: According to the Centers for Disease Control, one in five smokers have tried them. CEs are primarily used by people who are or have been smokers. It provides a way to smoke in public places and in general, are cheaper than cigarettes.

Will they help you quit smoking? In May, the journal Nicotine and Tobacco Research published a study on ECs. Researchers looked at about 2,500 people who called smoking cessation hotlines, and followed up with them seven months later. Among the participants, 30 percent reported using e-cigarettes at some point during the seven-month study, and about 9 percent were frequently using them at the time of the follow-up. ECs smokers were less likely to succeed in quitting than those who did not use e-cigarettes: About 21 percent of e-cigarette users were tobacco-free after seven months, compared with 31 percent of those who didn’t use e-cigarettes. Do E-Cigarettes Help Smokers Quit ?

The Food and Drug Administration, however, hasn’t endorsed e-cigarettes as smoking-cessation aides, and in 2010, the agency sent warning letters to companies who marketed e-cigarettes as such.

For more reading on this topic-Scientific American article Do ElectronicCigarettes Really Help Smokers Quit? 

Are they harmful?: According to a study presented at the European Respiratory Society’s (ERS) Annual in 2012, "We found an immediate rise in airway resistance in our group of participants, which suggests e-cigarettes can cause immediate harm after smoking the device. More research is needed to understand whether this harm also has lasting effects in the long-term. The ERS recommends following effective smoking cessation treatment guidelines based on clinical evidence which do not advocate the use of such products." A study in Chest2012 indicated that with long-term exposure to ENDS, it is plausible that, as with cigarette smoking, there is the potential for more permanent changes in lung function. An editorial on ENDS in this same issue of Chest  concludes In the interim, we now have enough information to state that the use of the ENDS does cause at least short-term adverse effects that are similar to those of cigarettes, and to tell our patients that there is no such thing as a free lunch…or, in the case of ENDS, a (harm-) free puff.

Are there health effects from inhaling nicotine? The short answer is there is no real body of research that has looked at nicotine separate from tobacco smoke. It is interesting to note that long term nicotine gum use has been associated with the following: hair loss; skin irritation; elevated blood pressure; irregular heartbeat; insulin resistance; and gastrointestinal issues.

Nicotine is an addictive substance, which naturally occurs in tobacco. It has powerful side effects on the cardiovascular system: it increases epinephrine (adrenaline), which raises blood pressure, heart rate and respiration and glucose levels. It acts as a vasoconstrictor, making it harder for the heart to pump blood through constricted arteries. Finally it may cause the body to release stored fat and cholesterol into the blood stream. If your a male, a 2012 study found that exposure to nicotine decreased overall sperm viability between 5-15%.

Are ECs regulated?: In the U.S. they are not regulated by the FDA. In 2009, the FDA found traces of carcinogens and a harmful substance used in anti-freeze in two brands of ENDS and blocked their shipment from China. Because of court rulings they no longer over see these products. Further, ingredients are not listed on the packaging.

Bottom Line: Carcinogen levels in EC vapor are about one thousandth that of cigarette smoke, according to a 2010 study in the Journal of Public Health Policy. While certainly better than tobacco, the research is not there yet to determine the overall safety and long term effects of ECs. Early indications are that most likely  there will be issues for long term EC users, particularly for those with pre existing conditions. Combined with other smoke ender tools, such as counseling, there may be a role for ECs. However, there is no such thing as a “free puff” or a healthy cigarette. If you want to quit the habit, call your state’s Quit line and/or talk to your medical provider. 

Note: Since this article was posted, the Journal of the American Medical Association on 7/15/13 posted a review article, which is worth reading.