Vaping and E-Cigarettes – What We (Don’t) Know

The so-called ‘e-cigarette’ was designed to help smokers quit their deadly habit – but it has developed a life (and a fast growing market) of its own.

Don’t be fooled: What was launched and promoted a few years ago as a pseudo-medical device called Electronic Nicotine Delivery System (ENDS) has turned into a lifestyle accessory. The market for vaping, the ‘smoking’ of electronic cigarettes, is expected to grow at a rate just shy of 20% per year, reaching a worth of almost $50 billion by 2025. Designated vaping stores pop up in cities, selling fashionable e-cigarettes and vaping liquid for all tastes. And we can widely see people practising it.

Vaping and E-Cigarette Shop in Tel Aviv: Large selection of Liquids and E-Cigarettes on sale …

But what is Vaping and what do we know about it?

The term ‘vaping’ was added to the Oxford English Dictionary only in 2014 and describes ‘the action or practice of inhaling and exhaling the vapour produced by an electronic cigarette or similar device’. Though vaping may seem new and original, it is actually something that has been around for a while in different guises. In ancient Egypt (around 5000 years BCE), the people were described as have using hot stones to vaporize oils and herbs. Later came the invention of ‘shisha’ in around 1500 CE, in Asia. Some sources say it originates in India, where an emperor invented it in order to mingle with other nobleman, before it was later adapted to make it more ‘healthful’ by an Indian physician, who used water to try and filter out more harmful ingredients. This then gave way to the creation of ‘Hookah’- the system through which a glass vase containing water is used to inhale tobacco or other substances.

These systems, though similar in the way they use heat to vaporize tobacco, are different to the e-cigarette, which is usually battery operated. Attached to a heating element, the atomizer, the act of puffing on the e-cigarette usually activates the heating of a liquid (the ‘e-liquid’) contained in a cartridge. This liquid is then vaporized, allowing inhalation. A new trend has also been reported in relation to these products, especially in teens in the US, termed ‘dripping’. This involves putting drops of e-liquid onto heated atomizer cells and then inhaling directly. Many reasons have been cited for this, for example creating a thicker vapour, a stronger flavour and a more pleasurable sensation on the back of the throat. Worryingly, approximately 25% of US teens now engage in this practice and we don’t know the risks that may be involved.

So what’s in this vaping e-liquid and what’s the problem?

There are thousands of different e-liquids available all over the world. And regulation is only in the making. The European Parliament passed a law requiring e-cigarettes to become more regulated in 2014, with the same happening with the FDA in the US who extended their regulatory powers to include e-cigarettes. These requirements included disclosure of the ingredients of the e-liquid, and from early 2018 this will include a requirement in the US to carry a health warning.

The reason for regulation in many countries is because of the nicotine content of some e-cigarettes, which in many countries is classified as a poison. Not all e-liquids, however, contain nicotine, but do contain various other substances. It is important to note that studies have shown that the labelling on whether a liquid contains nicotine is not reliable. Many liquids labelled as being ‘nicotine free’ may contain (even high levels of) nicotine. Studies also showed that the nicotine content varied by brand, and also by the country where it was from.

And how does it compare to cigarette smoking?

Many studies comparing vaping to traditional cigarette smoking confirm that e-cigarettes do in fact contain much lower levels of certain toxic compounds. Also Nicotine levels were significantly lower than found in cigarette smoke. But this of course does not make them without risk. Several other compounds found in e-liquids have been of particular interest to scientists (this list is by no means exhaustive):

  • Diacetyl- used in flavouring e-liquids and linked with the severe respiratory (lung) disease bronchiolitis obliterans was found in 75% of e-liquids tested by researchers at the Harvard TH Chan School of Public Health.
  • Metals such as lead, cadmium, arsenic, aluminium, copper. Levels of nickel in vapour were up to 100 times higher compared to conventional cigarettes, and levels of lead and chromium were at least comparable.
  • The flavouring component of e-liquids have been the subject of considerable study. E-liquids are flavoured to make them more palatable, but studies show that many chemicals that are used as flavouring are potentially harmful to the body, in particularly the cells of the lungs when inhaled. They are often used elsewhere in the food industry, and for this reason manufacturers may advertise the chemicals used in these products as ‘generally recognised as safe’ or ‘food grade’ because they are deemed safe to use when ingested. However, when they are inhaled they are considered potentially more unsafe (possibly because they are heated to a high temperature in an e-cigarette).

Current opinion on the safety of e-cigarettes

There is much argument regarding the safety of e-cigarettes, and even large bodies have differing opinions. The Royal College of Physicians (RCP) of London released a report in 2016 which seemed to have quite a favourable view on e-cigarette smoking, focusing on their positive role in helping some smokers to quit and a lack of evidence that it promotes smoking in previous non-smokers. However, even if vaping may be preferable over smoking cigarettes: we do not know the long term effects, and the RCP have been clear on this.

For those who already vape, watch this space – definitive answers will hopefully arrive in the next few years. Epidemiological evidence will either provide conclusive evidence that it is either terrible for your health, or actually not as bad as we feared. For now, the jury is out, so if you need to do it, best do it in moderation.