E-cigarettes: Not a healthy alternative to smoking
Gerald Hurowitz, M.D.·Published 27 May 2014·7 min read
Key points
Caveat emptor - or "buyer beware" holds true when it comes to the unknown health effects of e-cigarettes.
No list of e-cigarette pros and cons would be complete without discussing the drawbacks of e-smoking.
You may have seen stories about e-cigarette battery explosions and wondered about their truthfulness.
The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill.
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 e-cigarettes makers was that it would help those who smoke cigarettes 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.
E-Cigarettes and Health Risks
No list of e-cigarette pros and cons would be complete without discussing the drawbacks of e-smoking. In fact, it turns out that health can potentially be either a benefit or a drawback. There are some potential side effects associated with e-cigarettes and it’s important to be aware of those before you get started. For example, some e-cigarette owners have reported dehydration, perhaps because of propylene glycol’s ability to absorb and trap water. It’s a good idea to drink a little extra water while e-smoking to counter this. In addition, some e-smokers have discovered that they are sensitive or allergic to propylene glycol. Using e-liquids made entirely from vegetable glycerin can help you avoid this if you suffer any ill effects from propylene glycol-based e-liquids. Nicotine overdose is also a possibility if someone were to drink e-liquid from a bottle, although I have not heard of this ever happening.
Written and revised by
Gerald Hurowitz, M.D.
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So, those are the short-term health risks of e-cigarettes. The long-term risks are still unknown. Propylene glycol and vegetable glycerin are two common additives in products such as food and cosmetics, but no one knows the long-term effects of inhaling them. In addition, there seems to be conflicting information regarding whether or not nicotine on its own is a carcinogen. We do know, however, that nicotine can have unwanted effects on the circulatory system and blood sugar. Nicotine is also dangerous during pregnancy and can interfere with breastfeeding. So, it is important to consider all of these factors and consult a doctor before using e-cigarettes. It’s best for your health if you don’t use any product containing nicotine at all. If that isn’t an option, consider the e-cigarette pros and cons and decide for yourself whether using e-cigarettes might be better than continuing to smoke.
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 asthma-related deaths per year.
E-Cigarettes and Battery Explosions
You may have seen stories about e-cigarette battery explosions and wondered about their truthfulness. In 2012, services such as CBS News reported that a Florida man had been injured by a battery explosion while he was using an e-cigarette, resulting in severe damage to his mouth, tongue and teeth. I have seen other reports of e-cigarette battery explosions as well, but these have come from unreliable sources such as forums and blogs. When you use any battery, you’re taking certain risks. Battery explosions have happened in cars, computers and mobile phones, and there’s a slight risk of the same thing happening with an e-cigarette battery. So, when you consider the list of e-cigarette pros and cons, this drawback seems mild compared to the massive potential drawbacks of smoking. Although the incident in Florida was horrible, you’re taking the same risk every day with your other battery-powered devices. E-Cigarettes and Real Taste
I’ve put the taste of e-cigarettes into the “drawbacks” area of this list of e-cigarette pros and cons because first-time e-smokers who hope that e-cigarettes will taste like real cigarettes may initially be put off. E-cigarette vendors who claim their products taste like real cigarettes are to blame for this; if they were honest about the taste of e-cigarettes, there’d be no risk of disappointment. The simple fact is that while some e-liquids do taste very much like real tobacco, smoke is what gives real cigarettes their taste. Unless your e-cigarette contains burning tobacco, it won’t taste like a real cigarette. Regardless, e-cigarettes can taste incredible. As soon as your sense of taste starts to return, you’ll wonder how you ever managed to enjoy those filthy cigarettes.
For more information about asthma, visit AllergyandAsthmaRelief.org.
About ACAAI
The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes.
A Historical Timeline of Electronic Cigarettes
2003: The electronic cigarette is first developed in Beijing, China by Hon Lik, a 52 year old pharmacist, inventor and smoker. He reportedly invents the device after his father, also a heavy smoker, dies of lung cancer. The company Lik worked for, Golden Dragon Holdings, developed the device and changed their name to Ruyan, which means "like smoke."
April 2006: Electronic cigarettes introduced to Europe.
2006-2007: Electronic cigarettes introduced to the U.S.
March 2008: Turkey's Health Ministry bans the sale and importation of e-cigarettes. Health Ministry Drugs and Pharmacy Director, Mahmut Tokac,, claims electronic cigarettes are just as harmful as regular cigarettes. The vice president of the Foundation Combating Smoking in Turkey, K?yas Gu"ngo"r, claims that "nicotine is the most dangerous element among 4,800 poisonous chemicals in cigarettes."
September 2008: The World Health Organization (WHO) proclaims that it does not consider the electronic cigarette to be a legitimate smoking cessation aid and demands that marketers immediately remove from their materials any suggestions that the WHO considers electronic cigarettes safe and effective.
October 2008: In a study funded by Ruyan, Health New Zealand conducts a detailed quantitative analysis and concludes that carcinogens and toxicants are present only below harmful levels. On the basis of the findings, the e-cigarette is rated several orders of magnitude (100 to 1000 times) less dangerous than smoking tobacco cigarettes. The nicotine dose is comparable to that of a medicinal nicotine inhaler. Overall, the product tested was deemed a "safe alternative to smoking." http:// healthnz.co.nz/ecigarette.htm
January 2009: Australia bans the possession and sale of electronic cigarettes which contain nicotine, citing that "every form of nicotine except for replacement therapies and cigarettes are classified as a form of poison."
January 2009: Jordan's Ministry of Health bans the import of the electronic cigarettes, citing World Health Organization's health concerns. In a February 2012 review of the ban, Malek Habashneh, director of the ministry's awareness and communication directorate, claims that "e-cigarettes contain toxic chemicals that cause more health problems than the nicotine in normal cigarettes."
March 2009: FDA adds electronic cigarettes to Import Alert 66-41 and directs the U.S. Customs and Border Protection to reject the entry of electronic cigarettes into the United States.
March 2009: Canada bans the sale, advertising and import of electronic cigarettes. Health Canada advises Canadians not to purchase or use them, claiming they contain a "known irritant" (propylene glycol.)
March 2009: Hong Kong Department of Health bans electronic cigarettes. The maximum penalty for possessing or selling e-cigarettes is a HK$100,000 fine and two years' imprisonment. Since smoke-free tobacco is prohibited in Hong Kong, the ban on e-cigarettes continues to leave high-risk cigarettes as the only legal tobacco product available.
March 2009: FDA notifies electronic cigarette company "Smoking Everywhere" that its shipments have been refused entry into the U.S. The FDA maintains that electronic cigarettes "appears to be a combination drug-device product" that requires preapproval, registration and listing with the FDA.
May 2009: Action on Smoking and Health (ASH) files a petition to the FDA, calling for FDA regulation of electronic cigarettes.
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Hollis Heavenrich-Jones hollisheavenrich-jones@acaai.org 847-427-1200 American College of Allergy, Asthma, and Immunology
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