Dr Muiris Houston agrees that e-cigarettes will ‘probably’ cause a lower disease burden than cigarettes — although no long-term data is yet available — and believes they may have a limited role to play in smoking cessation.
Have you had many requests from patients looking for advice on the safety or suitability of e-cigarettes? Some reports suggest at least one-in-five smokers has tried them out, so questions about the value of switching from real cigarettes won’t be far behind.
What strikes me is the dearth of solid evidence to indicate whether there may be some benefit to e-cigarettes or whether the risks they pose are simply too great for doctors to be even neutral in their advice to patients.
E-cigarettes do not contain tobacco. Instead, they contain a cartridge filled with nicotine and propylene glycol. Add in a battery and a heating element designed to turn the liquid into nicotine-laced vapour and the ‘vaper’ (as the consumer of e-cigarettes is known) gets a noticeable nicotine ‘hit’ with each puff. There are about 400 vapes per cartridge.
Worryingly, little research has been carried out into their long-term health effects. There is no evidence to suggest that nicotine is carcinogenic but it is an addictive substance. And in very high doses it is toxic, producing measurable effects on the cardiovascular and metabolic systems.
The World Health Organization has just published an updated report into what it calls “electronic nicotine delivery systems” (ENDS). It acknowledges the level of toxins, nicotine and particles emitted from an e-cigarette is lower than the emissions from a conventional cigarette. But it says “it is not clear if these lower levels in exhaled aerosol translate into lower exposure”.
The WHO report concludes that “since the reasonable expectation of bystanders is not a diminished risk in comparison to exposure to second-hand smoke but no risk increase from any product in the air they breathe, ENDS users should be legally requested not to use ENDS indoors”. This and one or two other conclusions in the report seem to me to be getting a little ahead of the scientific evidence. This would be a pity as it opens the organisation up to accusations of wishful thinking by tobacco companies (who have invested heavily in e-cigarette manufacturing) and other pro-smoking lobbies.
Source: Muiris Houston, Irish Medical Times, 05/09/14
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