Electronic Cigarettes – a Panacea or Option?
Dr K K Aggarwal, Dr S S Agarwal
Electronic cigarettes (e-cigarettes) have been touted as a sure fire way to reduce the negative health impacts of smoking, while still delivering nicotine to people accustomed to daily doses. Still, in comparison with available US FDA approved pharmaceutical therapeutics, the safety and efficacy of e-cigarettes as tools to quit smoking are unknown.
E-cigarettes, invented in China in 2003, has seen a marked increase in global usage since 2010, typically targeting younger, high income, and more educated brackets of society. These e-cigarettes mimic the size and shape of cigarettes and contain a cartridge containing liquid, which includes nicotine (up to 36 mg/ML) amongst other chemicals (usually propylene glycol or glycerol).
Metals such as chromium, nickel, tin, and lead have been found in e-cigarette liquids/vapors amongst other compounds such as phenolic compounds, and volatile organic compounds. Still, constituents of cigarette smoke (carbon monoxide, oxidant gases, and tars for example) are absent in e-cigarettes.
While believed overall to be likely less harmful than cigarette smoke, evidence is not definitive. When heated and aerosolized, the overall safety of propylene glycol (producing the toxin, acrolein) or glycerol is unknown, with fears that propylene glycol may decompose at high temperatures producing propylene oxide. Both of these agents decompose to form carcinogens acetaldehyde and formaldehyde, depending of the batter voltage used in the e-cigarette. Further fluid ingestion could lead to consumption of a dosage of 20-100 mg/ml (in a typical 5 mL vial), against a lethal dose of nicotine of 10 mg in children. While less toxic, second hand smoke also includes serum cotinine, in comparable amounts to cigarette smoke exposure.
E-cigarettes have been banned in Uruguay, Brazil, Singapore, and Canada – all fairly progressive countries. A WHO report suggested that regulations were needed to stop promotion to non-smokers, and the US FDA refuses to regulate e-cigarettes. These points should be noted by physicians when suggesting alternatives to their patients.