You can smoke them virtually anywhere. Many say they will help you quit smoking, a plus for people with COPD who often struggle with smoking cessation. Others are skeptical and afraid to try them. The FDA would like to regulate them as medical products. The e-cigarette industry feels that the FDA has no substantiated reason to do so. There's a lot of talk going on about e-cigarettes, so before making a decision to use them, learn the facts about their pros and cons.
What are E-Cigarettes?
Electronic cigarettes, or e-cigarettes for short, are battery-powered devices filled with liquid nicotine (a highly addictive chemical) that is dissolved in a solution of water and propylene glycol. Many of them look like real cigarettes, with a white cylindrical tube, brown filter, and red-glowing tip. Others come in less conspicuous, darker colors.
How Do They Work?
Often termed "vaping," when you take a puff on the end of the e-cigarette tube, a battery heats up the nicotine, which creates a vapor that is then inhaled into the lungs. The end result is a sensation of smoke in the mouth and lungs without really smoking.
The Upside to E-Cigarettes
Unlike tobacco products, there are no current laws in effect prohibiting the use of e-cigarettes in public places. Case in point, I work in a hospital and a fellow nurse smokes them right there in the nursing station.
Here's what current research says about the positive aspects of this product:
- In a study of 40 tobacco-dependent smokers, researchers concluded that smoking e-cigarettes alleviated the desire to smoke (after abstaining from smoking overnight), was well-tolerated, and pharmacologically more like a Nicorette inhaler than tobacco.
- Another study of 50 smokers who wanted to reduce the health risks associated with smoking, but not quit completely, concluded that the Eclipse brand of e-cigarettes dramatically decreased the consumption of cigarettes without causing withdrawal symptoms. In addition, when participants smoked Eclipse, the nicotine concentrations in their blood remained fairly stable and their desire to quit altogether remained intact. However, the study concluded that because the Eclipse increased carbon monoxide concentrations in the blood, it may not be a safer choice of cigarette. On the other hand, it caused few, significant adverse events.
- In a case study series, the e-cigarette was found to help three study participants -- who all had a documented history of repeated failed attempts at smoking cessation using professional smoking cessation assistance methods -- quit smoking and remain abstinent for at least 6 months.
- During an online survey conducted in 2010, researchers polled visitors of websites and discussion forums dedicated to the use of the e-cigarette and smoking cessation. Of the 3,587 participants, 70% were former smokers, 61% were men, and the median age was 41 years. On average, participants used the e-cigarette for approximately 3 months, drew 120 puffs/day, and used 5 cartridges/day. Almost all of them used cartridges that contained nicotine. Ninety-six percent said that the e-cigarette helped them quit smoking, while 92% said that it made them smoke less. A majority of the participants said the e-cigarette helped them fight cravings, cope with withdrawal symptoms, and avoid relapsing on cigarettes.
The Downside of E-Cigarettes
If you are a savvy consumer, both positive and negative aspects of the the product you are considering should be scrutinized before you purchase it. The e-cigarette is no exception. Take a look at what some of the research says about the negative aspects of the e-cigarette:
- A 2010 research paper published in Tobacco Control suggests that the e-cigarette lacks important regulatory factors, such as essential health warnings, proper labeling, clear instructions on how to use them, and safe disposal methods. The authors of the study also found that some of the e-cigarette cartridges leaked, which could cause toxic exposure to nicotine.
- A study published in the December 2011 issue of CHEST found that the e-cigarette caused acute pulmonary effects after smoking it for only five minutes, although study authors pointed out that these effects may not be of clinical significance. During the study, 40 healthy non-smokers (30 experimental/10 control) were asked to smoke the e-cigarette ad lib for five minutes. The experimental group used the e-cigarette with the nicotine cartridge in place, while the control group smoked it with the nicotine cartridge removed.
After five minutes, lung function was assessed using a variety of tests. Results showed that smoking the device for just five minutes caused an increase in impedance, peripheral airway flow resistance, and oxidative stress in the lungs of healthy smokers (smokers who are not diagnosed with lung disease or chronic health conditions.) They also pointed out that the study only measured results from smoking the e-cigarette for five minutes -- because the average consumer is likely to smoke the e-cigarette many times a day, this might increase the risks. However, the authors suggested that it is possible that if the e-cigarette were used as a short-term bridge to smoking cessation, the benefits might outweigh the risks.
- On their website, the FDA states that states that "E-cigarettes may contain ingredients that are known to be toxic to humans, and may contain other ingredients that may not be safe." They also suggest that because e-cigarette manufacturers are not required to submit clinical study data to them, the public has no way of knowing "whether e-cigarettes are safe for their intended use, what types or concentrations of potentially harmful chemicals are found in these products, or how much nicotine they are inhaling when they use these products." The FDA is also concerned that the marketing efforts of e-cigarettes may increase addiction to nicotine, especially in young people, encouraging them to experiment with real tobacco products.
The Best Way To Quit Smoking
How you choose to quit smoking is a matter of personal choice. The best method is the one that works for you. With this in mind, doing whatever it takes to be successful -- and safe -- is how many people ultimately approach it.
Consult your health care provider about different stop smoking aids, including nicotine replacement therapy, quit smoking medications such as Clonidine and Wellbutrin, quit smoking support groups, and educational materials.
If you decide to try the e-cigarette, be sure to discuss this with your doctor and do your homework. Understand the pros, cons, and safety concerns, and then make an informed decision. The most important thing to remember is, no matter how you do it, you are making the best decision of your life when you finally decide to quit smoking, especially if you have COPD.
Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011 Nov;106(11):2017-28. Epub 2011 Jul 27.
Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control. 2010 Apr;19(2):98-103.
Caponnetto P, Polosa R, Russo C, Leotta C, Campagna D. J. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. Med Case Reports. 2011 Dec 20;5(1):585.
Evangelopoulou, Gregory N. Connolly and Panagiotis K. Behrakis Constantine I. Vardavas, Nektarios Anagnostopoulos, Marios Kougias, Vassiliki. Acute pulmonary effects of using an e-cigarette: impact on respiratory flow resistance, impedance and exhaled nitric oxide. Chest; Prepublished online December 22, 2011.
Fagerström KO, Hughes JR, Rasmussen T, Callas PW. Randomized trial investigating effect of a novel nicotine delivery device (Eclipse) and a nicotine oral inhaler on smoking behavior, nicotine and carbon monoxide exposure, and motivation to quit. Tob Control. 2000 Sep;9(3):327-33.
Fagerström KO, Hughes JR, Callas PW. Long-term effects of the Eclipse cigarette substitute and the nicotine inhaler in smokers not interested in quitting. Nicotine Tob Res. 2002;4 Suppl 2:S141-5.
Food and Drug Administration News and Events: Public Health Focus. http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm. Accessed 1/24/2011.
Anna Trtchounian and Prue Talbot. Electronic nicotine delivery systems: is there a need for regulation? Tob Control published online December 7, 2010.