Electronic Cigarettes

Electronic cigarettes, or e-cigarettes, are designed to facilitate ‘smoking,’ without the physical combustion of tobacco. Despite the novel method of delivery, electronic cigarettes allow an arterial bolus of nicotine to be transmitted through the lungs in much the same way as cigarettes, creating an arterial nicotine concentration similar to that of a smoker.

Such is the recent increase in popularity of electronic cigarettes that Google recorded a 5000% increase in searches for them between 2008-2010.

It has also been shown that non-nicotine containing e-cigarettes can help improve the success of quitting attempts showing they are effective in maintaining the aspect of psychological addiction, whilst weaning off the physical addiction.

The recent Cochrane review by Hartmann-Boyce showed that nicotine containing e-cigarettes are better than nicotine free e-cigarettes for promoting cessation. Their use can increase the likelihood of quitting, but often simply leads to a reduction of cigarette use opposed to complete cessation.

Unfortunately, there may be some negative aspects to electronic cigarette use due to the constituents of the liquid which is ‘vaped’ during e-cigarette use. The glycerol and nicotine mix which is inhaled does contain toxic substances which are also found in cigarette smoke. These toxic substances are at a significantly lower concentration than in traditional cigarette smoke, meaning it: may be acceptable to view e-cigarettes as a ‘harm reduction’ device.

We feel that, based on current evidence, individuals that use an e-cigarette exclusively reduce health risks compared to smoking tobacco, but their use still carries risks to the user. Their use should therefore not be advised.

At this stage, the mechanism of action and safety of conventional NRT is better understood and should be recommended as the gold standard cessation aid by practitioners. It should be noted that electronic cigarettes may be of some benefit to smokers who are unwilling to quit.

Ultimately, more research is needed into these as a possible adjunct to cessation; however, until this point, electronic cigarettes have not been shown to invoke any serious adverse events.

To ensure we are giving patients gold-standard advice, e-cigarettes should not be viewed as a safe NRT, and only be advised as a risk reduction strategy. Users of electronic cigarettes should therefore be encouraged to eventually stop using them, but their use is (currently) believed to be preferable when compared to smoking conventional cigarettes.

Bibliography & Further Reading
Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet. 2013 Nov 22;382(9905):1629-37.
Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?. Journal of public health policy. 2011 Feb 1;32(1):16-31.
Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011 Nov 1;106(11):2017-28.
Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A, Jablonska-Czapla M, Rosik-Dulewska C, Havel C, Jacob P. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco control. 2014 Mar 1;23(2):133-9.
Hajek, P.; Etter, J.; Benowitz, N.; Eissenberg, T.; McRobbie, H. Electronic cigarettes: Review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction 2014, 109, 1801–1810.
Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub3
Vansickel AR, Eissenberg T. Electronic cigarettes: effective nico- tine delivery after acute administration. Nicotine Tob Res. 2013;15: 267–270.
Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PloS one. 2013 Mar 20;8(3):e57987.
Yamin C. K., Bitton A., Bates D. W. E-cigarettes: a rapidly growing Internet phenomenon. Ann Intern Med 2010; 153: 607–9.
Smoke by mbiler. Available at https://www.flickr.com/photos/vrysxy69/3230278405/in/photolist-5Vs2eg-as78JQ-9B3nw7-fvzLK-54ZZaz-6guoSz-8yjLA1-4ryAMR-6guh7K-RPomjn-4rCJNW-ck3kML-6LzREQ-63AA71-dhCnr4-3eU4bb-8UrGVs-yKb5VL-8GyRBh-2A2YF-6gumXt-6gyCcs-8GvDi8-3oVgZE-SRbCxR-8GyQes-9duYKv-8UoCt4-hPbyX-8GvCLc-6PCCsr-ddmwGF-6guohB-ytJ4q-akT89g-8reUa-S54qbv-54HydT-nLgBA-6gu7Xg-6fPK5d-5NPUHN-6gywjA-6DGTTf-5H5qGb-6gujwV-aZ4iWx-geg1kN-eyT4Ki-7fCtVz/ licensed under CC BY-SA 2.0

Did you Know

Studies have shown that people who smoke up to 4 cigarettes a day are about 50 per cent more likely to die prematurely than non-smokers.