The E-Cigarette – Friend or Foe?

By Brian L. Tiep, MD
Director of Pulmonary Rehabilitation
City of Hope National Medical Center

The modern Electronic Cigarette (E-Cigarette) was developed by Hon Lik, a Chinese pharmacist. He was a 3 pack/day smoker, whose father died of lung cancer. He decided to develop a safer alternative to cigarettes to help himself and others to smoke more safely or quit altogether. E-Cigarettes are now a multibillion-dollar industry with more than 800 brands and 200 manufacturers, with the tobacco industry becoming a major player. E-cigarettes come in many shapes, sizes, and options. Using E-cigarettes is called “vaping.” They are hi-tech devices that vaporize a liquid upon taking a puff.

E-cigarettes contain a variety of chemicals including propylene glycol, glycerine, nicotine, and flavorants. This bath of chemicals is heated to high temperatures in an atomizer chamber, creating a vapor that is inhaled. Vaping is touted as a safer alternative to tobacco cigarettes. The actual safety is the subject of considerable research complicated by a number of factors including the wide variability in the chemical composition of liquid and temperature at the atomizer tip. Heating these chemicals to high temperatures creates some toxic chemicals such as diactyl, acetaldehyde, diethylene glycol (antifreeze), and acrolein. Toxicology studies have demonstrated components of E-cigarettes to be respiratory irritants and some of the chemicals can cause bronchiolitis and cancer.

A couple of studies indicate vaping to be a viable method for quitting smoking. However, most other studies have come to the opposite conclusion.  It is also known that some smokers who quit via E-cigarettes now use both – including Hon Lik. A major concern is their attractiveness to children. Nicotine is powerfully addicting and some children who never smoked cigarettes have tried vaping – some have gone on to smoking tobacco cigarettes. Also, young people are using E-cigarettes as a drug delivery system for marijuana and other drugs. Thus, the E-cigarette may be a gateway to tobacco smoking and other drugs.

There are experts who regard E-cigarettes to be harm reduction devices as compared to tobacco cigarettes. If they are less harmful, they are not harmless; we have safe medication to help in quitting. Several countries and many localities in the USA have significantly restricted their use as well as their advertising. Last month the FDA announced that they’re going to regulate them – not a moment too soon.