E-cigarettes: Not a healthy alternative to smoking

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Caveat emptor – or "buyer beware" holds true when it comes to the unknown health effects of e-cigarettes. An article in the June issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), examines risks, including the ongoing dependence on nicotine and the dual use of e-cigarettes and regular cigarettes.

The article examines the idea that one of the initial "health benefits" proposed by makers was that it would help those who smoke cut back. The authors say that theory hasn't been proven, and there's no evidence to support the claims.

"Despite the apparent optimism surrounding e-cigarettes and their purported therapeutic role in smoking cessation, there just simply is not enough evidence to suggest that consumers should use e-cigarettes for this purpose." said allergist Andrew Nickels, MD, lead author, ACAAI member, Mayo Clinic Division of Allergy and Immunology.

Another cause for concern is that when people use e-cigarettes in public and still smoke regular cigarettes at home, they continue to expose children and asthma sufferers in the household to dangerous second hand smoke.

"Dual use of both e-cigarettes and regular cigarettes carries the risk of secondhand smoke exposure, causing worsening respiratory effects on children and asthma sufferers. It also promotes ongoing nicotine dependence," said Chitra Dinakar, MD, co-author, ACAAI fellow and Professor of Pediatrics, Children's Mercy Hospitals.

Because e-cigarettes are fairly new, there could be other long-term health complications that have yet to be discovered. Results of long-term exposure to such substances are unknown. Due to the lack of production oversight, most consumers don't know what's in the e-cigarettes they buy. The US Food and Drug Administration admits that the safety and efficacy of e-cigarettes hasn't been fully studied, and consumers have no way of knowing if e-cigarettes are safe for their intended use.

Organizations like ACAAI are advocating for enhanced scrutiny and regulation by the FDA. The ACAAI's position statement on e-cigarettes recognizes that nicotine delivered by any mechanism represents a drug exposure, and that vaporization instruments are a drug delivery system, both of which are within the Federal Drug Agency's scope of regulation.

Inhaling irritants such as smoke and vapors has an impact on the lungs, whether it is mild or severe. And irritants can cause asthma attacks in some individuals. These attacks are responsible for some of the 4,000 -related deaths per year.

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Study documents secondhand exposure to vapors from electronic cigarettes

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May 27, 2014
Abstract: Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR), asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline) and at two consecutive visits (Follow-up/1 at 6 (±1) and Follow-up/2 at 12 (±2) months). Eighteen smoking asthmatics (10 single users, eight dual users) were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods.
Keywords: smoking cessation; electronic cigarette; asthma; lung function; methacholine challenge; harm reduction

May 27, 2014
Burstyn I. Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health 2014, 14:18 doi:10.1186/1471-2458-14-18

Current state of knowledge about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces. However, the aerosol generated during vaping as a whole (contaminants plus declared ingredients) creates personal exposures that would justify surveillance of health among exposed persons in conjunction with investigation of means to keep any adverse health effects as low as reasonably achievable. Exposures of bystanders are likely to be orders of magnitude less, and thus pose no apparent concern.

May 27, 2014
Brown, Beard, Kotz, Michie & West. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction, May 2014


The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only (n=464), NRT bought over-the-counter only (n=1922) or no aid in their most recent quit attempt (n=3477).

E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter (odds ratio 2.23, 95% confidence interval 1.70 to 2.93, 20.0% vs. 10.1%) or no aid (odds ratio 1.38, 95% confidence interval 1.08 to 1.76, 20.0% vs. 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% confidence interval 1.17 to 2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% confidence interval 1.19 to 2.18) times higher compared with those using no aid.

May 27, 2014
Dr. Nickels appears to be under the impression that if smokers can just be convinced not to try e-cigarettes, they will magically stop smoking. It hasn't happened yet, and isn't likely to happen any time soon. In most cases, the choices are not "e-cigarettes" or "stop smoking". The choices are "e-cigarettes" or "continue smoking." The majority of people who have switched to e-cigarettes have already tried to stop smoking (on average at least 4 times) and kept relapsing. Some had almost given up all hope of ever being able to quit. Dr. Nickels needs to recognize that whenever he convinces a smoker, or the doctor of a smoker, that e-cigarettes are hazardous, he is convincing them it is safer to continue smoking. If Dr. Nickels would take the time to read the research, he would discover that those who switch begin to experience nearly immediate improvements in their health including reduction or elimination of coughing, improved breathing, and less need for asthma medication.

May 31, 2014
I and a lot of people that I know have switched to and only use ecigs now. It seems like these "breaking news" reports about ecigs keep coming out and they are nothing except some guy going on about the fear of unknowns or rolling in a lot of confounding info about people that use cigs and ecigs or the few people that buy these vapor hookas that smoke like a fog maker.

There is some good research out there but some people have an agenda for stoking fear rather than researching and good reporting. Ecigs are magnitudes better than cigs and we should be encouraging smokers to switch rather than fear mongering!!!!

Jun 01, 2014
I'm guessing most smokers who use e-cigarettes wish to wean themselves off nicotine, not just smoking. It would be not just foolish, but bizarre to think that manufacturers of e-cigarettes share that hope. Anything I read touting the virtues of e-cigarettes, I view with ambivalence.

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