Vaping – A public health concern.

I was recently watching a podcast where a year six student asked whether vaping was healthier than cigarettes. It is a topic which I was planning to look into as have been asked by some youngsters in the Surgery as well.

Vaping or e-cigarettes are one of the commonest tools currently used for quitting smoking. (1)

Considering smoking is one of the leading causes of death globally, one would presume that vaping is a better alternative. E-cigarettes are being sold as healthier options, sadly without the evidence. (2)

Let’s have look at what the research actually says!

• Studies show the electronic nicotine delivery systems (ENDs) when combined with behavioural therapy seem to be better than other nicotine replacement therapies. (3)

• The e-cigarettes have aerosol components which include propylene glycol, glycerol, flavourings, nicotine, various heavy metals and newer chemicals like acetaldehyde and formaldehyde. On heating these chemicals, they emit many toxic fumes which behave as irritants for the lungs. (2)

• Short term impact of vaping has been seen mainly as respiratory symptoms which included cough, phlegm and nasal or sinus congestion. Common neurological symptoms were seen to be headache, dizziness, sleep disorders as well as anxiety. Some positive effects, even though limited, of improved mood and stamina have been reported as well. (4)

• The long term effects of vaping may not fully be evident till 2050 as even with cigarettes the lung damage takes 25-30 years to become evident. So far the little evidence that is available shows negative impact on immunity, damage to the lining of the lungs, stiffness of the alveoli (which are air sacs at the end of each tube in the lung) and reduced oxygen in the body. These can be seen in the form of recurrent lung infections, pneumonia, sinusitis as well as altered smell and taste. (5) (11)

• One very small study showed evidence of chronic obstructive lung disease as a result of long-term vaping. (6)

• Cardiovascular effect of vaping has also been seen in the form of stiffening of the vessels as well as damage to the lining of the arteries and veins. These are amongst the leading causes of cardiovascular events like heart attack and stroke. (7)

• I found it interesting that the flavourings used for the e-cigarettes are a major reason for youngsters using them. Studies have also shown that this is resulting in addiction amongst the younger generation, which is now a public health concern. However, non-flavoured e-cigarettes have been seen to be less harmful and toxic. (8)

• Various reports have suggested that risk of Covid -19 is higher in both smokers as well as vapers, with the increased chances of adverse outcomes post infection. (5)

• The e-cigarette production is changing rapidly and higher doses of nicotine (59mg/ml) are present in ones being sold in the USA as compared to 18mgs/ml sold in the UK. (9) This limits the ability for these products to be researched properly.

There are no long term studies currently present to give clear evidence of the impact of vaping on health. Uncertainty remains in terms of efficacy and safety (3).

As a health professional I am seeing many youngsters using e-cigarettes. It is a challenge as a clinician, as patients rely on guidance, which is currently not available.

What I can say though that with the little information we have at present, e-cigarettes maybe a support for quitting smoking however they do not come without a risk. We just don’t have the information, yet.

If one is to opt for vaping, going for the non-flavoured version seems to be less harmful.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242503/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186084/
3.  https://pubmed.ncbi.nlm.nih.gov/30699054/
4. https://www.jmir.org/2013/4/e59/
5. https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01737-5
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781946/
7. https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.121.056777
8. https://www.mdpi.com/1422-0067/21/15/5513
9. https://www.bmj.com/content/366/bmj.l5275
10. https://pubmed.ncbi.nlm.nih.gov/34877438/
11. https://www.nejm.org/doi/full/10.1056/NEJMc1913069