VAPING, or e-cigarettes, has made the headlines over the past year. There has been a lot of talk and debates about its safety and benefits.
E-cigarette users, known as vapers, have lobbied it as a safer alternative to smoking conventional cigarettes. However, this has been refuted by medical experts in many countries, including Malaysia.
Let’s take a look at some of the questions and the available evidence on e-cigarettes.
Is vaping really safe, or it is just safer in comparison to smoking conventional cigarettes?
There are more than 7,000 harmful chemicals in cigarette smoke. These chemicals have been proven to cause many deadly and chronic diseases. Previous lab studies on the content of e-cigarette juices and “vapour” have shown the presence of these chemicals, but in lower or trace concentrations.
These chemicals include formaldehyde (embalmment agent), acetaldehyde (used to make acetic acid), acrolein (herbicide agent), toluene (paint thinner), tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, and metals such as cadmium (used to make batteries), nickel, lead, tin, chromium (used to make steel), and mercury.
These chemicals are irritants, toxic to living cells, cancer causing agents, as well as destructive to nerve tissues and blood cells.
More than 4,000 chemicals found in cigarettes have not been found in e-cigarettes, including tar.
Although most of the chemicals in the conventional cigarettes are absent in e-cigarettes, there is still propylene glycol and glycerin, the main ingredients of e-juices.
Importantly, the effects of inhaling propylene glycol and glycerin, which is a humectant, are still unknown. They are commonly considered safe as they can be consumed orally and have been widely used in food and pharmaceutical preparation.
However, the harmful effects of inhaling propylene glycol in industrial studies (using propylene glycol as a de-icing agent or theatre fog) have been demonstrated.
Heating these chemicals at high temperatures, which occurs when vaping at >3V, could also produce a very high concentration of formaldehyde, way above the level found in conventional cigarettes.
In addition, the effects of inhaling various flavouring agents has not been determined. Agents that are safe to be ingested are not necessarily safe to be inhaled, too. For example, when you accidentally aspirate particles of food, whereby inflammation of the air pipe linings may occur which can lead to pneumonia.
There is also evidence to show higher concentrations of nicotine in e-juices than stated on the label. This unregulated concentration of nicotine in e-juices is worrying as it may lead to toxicity at a high concentration. Furthermore, it may cause death if it is ingested accidentally or purposely, in suicide attempts.
Based on the available evidence, it can be concluded that e-cigarettes contain fewer harmful chemicals compared to conventional cigarettes. However, its safety is uncertain as e-cigarettes still contain toxicants and carcinogens. Inhalation of perceived harmless humectants and flavouring agents could be dangerous, too.
Are the harms from e-cigarette use less than smoking conventional cigarettes?
At this moment, its safety in comparison with conventional cigarettes cannot be established due to the lack of evidence showing its long-term and acute effects on health.
There are studies that show an improvement in breathing, taste, smell and physical endurance reported by vapers. However, the findings on the acute effects of vaping on cardiovascular and respiratory systems are rather inconsistent.
Can e-cigarettes help smokers to stop smoking?
E-cigarettes have been marketed as a tool that can help smokers to quit smoking. However, this claim has not been supported by strong evidence as the studies with the promising outcome contain flaws, limiting the interpretation of the findings.
Furthermore, a recent review by Kalkhoran and Glantz (2016) [http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2815%2900521-4/abstract] shows that smokers are less likely to quit cigarette smoking when they use e-cigarettes.
Thus, it is not surprising to find a majority of vapers are dual-users who also smoke conventional cigarettes. They usually smoke fewer cigarettes than they used to, hoping to reduce its harmful effects. This harm reduction approach has unfortunately unconfirmed benefits even when they smoke less than 50% of their usual cigarette consumption.
Substituting conventional cigarettes with e-cigarettes shows that vapers realise smoking cigarettes is dangerous and harmful to their health, as well as the health of their loved ones. Since a majority of them are unable to stop this risky behaviour, they opt for a perceived “safer” alternative that can provide them comfort and less guilt.
Even though there are uncertainties in the safety of e-cigarette use, they want to believe its benefits as they believe vaping is the best option with the least discomfort in their struggle to break free from smoking cigarettes. Successful smoking cessation by continuing vaping may give them a false sense of achievement, ignoring the core problem of nicotine addiction.
To date, there are still some unanswered questions about e-cigarettes due to the lack of evidence. The available studies are imperfect, requiring careful interpretation of their findings. Many studies on e-cigarettes are still ongoing and the evidence may be evolving and subject to debates.
However, the most important message for smokers is that vaping is harmful. It is not the answer to their cigarette addiction. They cannot free themselves from the addiction through vaping. They need to stop smoking and stop vaping. Seek professional help and never stop trying.
Dr Hizlinda Tohid is a family medicine specialist and lecturer at University Kebangsaan Malaysia Medical Centre.