Are Electronic Cigarettes safer then traditional Cigarettes?
At a time when the number of smokers worldwide is at its highest, and antismoking policies are proliferating, the sector for alternative smoking products is in a froth of excitement about the potential to increase its market share and revenues. In recent years several manufacturers, have produced electronic cigarettes (ecigarettes) that are distributed to various countries including Pakistan. Electronic cigarettes look and feel like cigarettes, but do not burn tobacco. Electronic Cigarettes are now being widely advertized in electronic and print media of Pakistan. Many smokers are asking the health professionals about the safety of these new devices. Existing brands vary but, in general, ecigarettes contain a battery and an electronic device that produces a warm vapour or 'mist'. The vapour usually contains nicotine and often - but not always - contains propylene glycol. The vapour is inhaled and, as the user exhales, some visible vapour is released, but no tobacco smoke. Some ecigarettes also contain a light-emitting tip that glows when the user puffs, to resemble the burning end of a cigarette. The nicotine content of the cartridge varies, and the cartridges usually contain chemical additives and flavours (such as various brands of tobacco, chocolate, coffee, mint or fruit). The cartridges can usually be refilled, and refill bottles are provided with the device.
Internationally, the legality of ecigarettes varies; they cannot be sold in Australia, Brazil, Canada, Denmark or Switzerland and some other countries. Analyses conducted by the United States Food and Drug Administration (FDA) showed that ecigarettes contain carcinogens, including nitrosamines, toxic chemicals such as diethylene glycol, and tobacco-specific components suspected of being harmful to humans . The FDA also found that ecigarette cartridges labeled as containing no nicotine did in fact contain low levels of nicotine. Some manufacturers do not disclose the ingredients in their products. In particular, the origin of the nicotine itself is uncertain, as pesticide-grade nicotine rather than pharmacological-grade nicotine may be used in ecigarettes.
Little is known about the safety of ecigarettes, as few research reports have been published. In addition, the similarities in shape, actions and inhalation between ecigarettes and tobacco cigarettes could also help smokers quit. However, as there are no data to support the manufacturers' claims that ecigarettes help smokers quit, the World Health Organization asked the companies not to make any therapeutic claims.
Ecigarettes may be dangerous because of the frequent and longterm lung inhalation of diethylene glycol, nicotine and other toxic components, and because of the sub-standard manufacturing process, relative to pharmaceutical products. Because of its rapid nicotine delivery the ecigarette also has the potential to be addictive. In addition, the refill bottles may be dangerous as they contain up to one gram of nicotine, whereas the fatal dose of nicotine is estimated to be 30 to 60 mg for adults and 10 mg for children. The ecigarette may also enable smokers to continue to 'smoke' in smoke-free environments, thus delaying or preventing cessation in people who might otherwise quit. Infact, if ecigarettes are allowed to be used in public places like restaurants or in air travel then it may act as a trigger to smoke for those who have already quit smoking. Finally, the fruit and chocolate flavours may appeal to young people, and this raises the concern that ecigarettes may facilitate initiation of nicotine dependence in young never-smokers.
Because of the huge burden of tobacco-related death and disease, there is an urgent need for research into these products in Pakistan. Our government should not allow the manufactures of ecigarette to market their products in Pakistan as an aid to smoking cessation or as a product which is less harmful then traditional cigarettes.
In conclusion, based on existing information available about ecigarettes, we the health professionals do not recommend its use.