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Long-term effects of vaping are still unknown

Harmful compounds are found in e-cigarettes
December 4, 2016
Vikas Batra

What is vaping?

Vaping can be defined as the act of inhaling vapor from e-liquid through a personal vaporizer. When users draw on the device, a battery within heats the liquid, which is then atomized into an inhalable vapor. The main components of e-liquid are propylene glycol and/or vegetable glycerin, artificial flavors and nicotine. Electronic cigarettes, or e-cigarettes, are a form of vaporizer.

How is vaping (e-cigarettes) different from smoking cigarettes?

Nicotine is an addictive drug that is naturally found in tobacco. The most popular way for people to take nicotine is to inhale it by smoking cigarettes. E-cigarettes also allow nicotine to be inhaled, but they work by heating a cartridge containing liquid nicotine, flavors and other chemicals to produce vapor. The key difference between the traditional cigarettes and e-cigarettes is that e-cigarettes don't contain tobacco. Traditional cigarettes contain a lot of chemicals that have been proven to be harmful. Electronic cigarettes have some of the same chemicals.

Are e-cigarettes safe?

E-cigarettes contain a mixture of propylene glycol, glycerin, nicotine and flavoring agents approved by the U. S. Food and Drug Administration as Generally Recognized As Safe. When this mixture is heated, compounds called carbonyls (like formaldehyde and acrolein) are produced. The amount of these compounds produced depends upon the ratio of glycol to glycerin in the vaping fluid and the temperature to which it is heated. What complicates the picture is there are more than 500 brands of e-cigarettes and more than 7,000 flavors of e-cigarettes in the market. Also, levels of toxins in e-cigarettes vary within and among brands.

Flavors in e-cigarettes also cause concern. Although flavoring agents are considered safe, they are safe for use in food. We don't know if they are safe to inhale. For example, diacetyl, a buttery-flavored chemical often added to food products such as popcorn, has been found in some e-cigarettes. Diacetyl can cause a serious and irreversible lung disease commonly known as popcorn lung.

The U.S. Surgeon General has found that exposure to nicotine during pregnancy harms the developing fetus, and causes lasting consequences for the developing brain and lung function in newborns. Nicotine also has a negative impact on adolescent brain development. Nicotine use during adolescence and young adulthood has been associated with lasting cognitive and behavioral impairments, including effects on working memory and attention.

What is most concerning is that the use of e-cigarettes has quadrupled in teens in the last four to five years. Many teens who reported trying e-cigarettes also reported never smoking a cigarette, which could mean that e-cigarettes may act as a gateway to regular cigarettes. Teens may start off by trying e-cigarettes out of curiosity and, with the various flavors available, get addicted to nicotine, and then move on to smoking cigarettes as they crave more nicotine.

Can e-cigarettes be used to quit smoking regular cigarettes?
The FDA has not approved e-cigarettes as a method to quit smoking. There are a few people who are able to quit smoking using e-cigarettes, but in the real world most of the people using e-cigarettes continue to smoke cigarettes. People who transition from regular cigarettes to e-cigarettes are at a high risk of returning to regular cigarettes.

Do I recommend e-cigarettes to my patients?
I wish there were a straight answer. I do not recommend e-cigarettes as a first option to patients. There are therapies that have been proven to be effective, and they should be used first (e.g. nicotine replacement therapy, Wellbutrin, Chantix). However, in particular circumstances in which someone is trying to quit and already has been unsuccessful with other options, I do not discourage e-cigarettes.

Recently, we conducted a questionnaire survey to assess knowledge, beliefs and perceptions of risk regarding electronic cigarettes. The results suggest that both consumers and healthcare providers not only believe e-cigarettes are harmful and addicting, but that they are not dependable options in helping people quit smoking. Here are some of the results:

Consumers:
· 46 percent thought that e-cigarettes were just as harmful as regular cigarettes
· 23 percent agreed with the statement, "E-cigarettes can help a person quit smoking"
· 91 percent felt that e-cigarettes were addicting
· 67 percent agreed that e-cigarettes should not be allowed in non-smoking areas.

Healthcare providers (doctors, physician assistants and nurse practitioners)
· 39 percent thought that e-cigarettes were just as harmful as cigarettes.
· 35 percent agreed with the statement, "E-cigarettes help a person quit smoking"
· 49 percent agreed that e-cigarettes can be a gateway to other tobacco use
· 12 percent recommended e-cigarettes to their patients.

There is a lot we don't know about e-cigarettes, including their long-term effect on our health and safety as there is no long-term research data. In my opinion, e-cigarettes are probably less dangerous than traditional cigarettes, but are still not safe.

Vikas Batra, MD, is a pulmonologist on the Beebe Healthcare medical staff. He is board certified in internal medicine, pulmonary medicine, and sleep and critical care medicine. He also is fellowship-trained in pulmonary, critical care and sleep medicine, and is certified to perform the bronchial thermoplasty procedure. He sees patients at Sussex Pulmonary and Endocrine Consultants in Lewes. For more information, go to www.beebehealthcare.org.

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