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Dr.Sajjan Madappady

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Published On: Friday April 28, 2017

Are electronic cigarettes safe?

Defined as inhaling or exhaling the vapour produced by an electronic cigarette;  Vaping,  has become increasingly  popular worldwide. Google trends indicate that the popularity search interest for keyword “vaping”  seems  to have  nearly doubled in the last 2  years.  As markets are being  flooded with these products,  there is a growing  concern to understand and scientifically  evaluate the risks and benefits of this global phenomenon.

What is an e-cigarette?

Electronic cigarettes are broadly categorised as  Electronic Nicotine Delivery Systems (ENDS) and are of three major types namely, Cigalikes (look like conventional cigarettes), eGos (larger in size with a tank that can be refilled)  and Modular E-cigarettes (larger than eGos  and customisable). These were conceptualised in early 1930s,  researched  through  the decades,  but  only entered  the mass market  after their commercialisation in 2003 from  Beijing, China. Recent  surveys indicate that electronic cigarettes  are being used by nearly 9 million adult consumers in US alone with figures  estimated to  increase with time. Today, though readily  available in most urban countries as well as the internet, this product  remains  shrouded with  controversy.

What was the purpose?

WHO  reports that up to  6 million deaths per year  can be attributed to tobacco usage.  A traditional cigarette (aka Analog cigarette) contains tobacco that on combustion releases smoke containing tar. Nicotine, is the primary psychoactive component of tobacco and is addictive while tar causes the damage. Fumes produced from a combustible cigarette contain numerous toxic substances that are proven to cause cancer.  ENDS are believed to have been introduced into the market  to reduce the harmful effects of tobacco in smokers.  In an electronic cigarette, instead of tobacco, nicotine (which in itself is largely benign) is mixed with a base of propylene glycol and flavourings.  The absence of tobacco is believed to reduce the harmful effects of smoking.

How does it work?

An E-cigarette  consists of  a tube shaped device  that heats  a  nicotine- containing liquid  and delivers  vapour when inhaled.  There are 4 major components of this liquid – Nicotine, Propylene Glycol, Vegetable Glycerol(VG)  and flavourings.  A battery powered coil heats the bases (PG and VG) converting them into an inhalable  vapour . The amount of nicotine present can range from  0 – 42 mg/ml, depending on the manufacturer.  Flavours  used  are certified as edible but may be a cause of concern as  discussed further.

What does research have to say?

An  initial report  by WHO  in 2014 condemned the use of E-cigarettes, while raising the concern that it encourages  the younger  generation towards the act of smoking rather than against it. Due to lack of evidence,  ENDS were to be placed alongside combustible cigarettes in the anti-tobacco campaign. But recent studies have shown that ENDS are 95% safer than analog cigarettes due to absence of tobacco.  Another  cross-sectional study states that the level  of toxicants in vapour from an END is  9-450  times less than that of smoke, making them relatively safer.  This data, though accurate,  has been misinterpreted and deliberately sold as “harmless” to the public.  Scientists  warn  that  just because  ENDS  are comparatively “safer” , does not mean they are entirely “safe”.

Cause for concern?

A 2016  study of the flavourings used in ENDS revealed that the concentrations of these chemicals, certified as edible, were high enough in the vapour  to be of toxicological concern.  It is known that chemicals in liquid form may not be as damaging as that of a combustible cigarette, but the study found that chemicals released from flavourings in the form of vapour were, in fact,  a mucosal irritant.

Is passive vaping even possible? Manufacturers  of  ENDS claim that vaping causes little or no threat to a passive bystander but  it has been found that despite  the reassurances, vapour from an ENDS is not emission-free.  The pollutants present in the vapour are  a cause of concern for both,  direct user and passive user.


Despite their drawbacks, ENDS have shown to result in considerable harm reduction for smokers.  If used exclusively  in place of combustible cigarettes, the exposure to carcinogens is found to be much less than smoke.  Researchers claim that when used in decreasing concentrations of  nicotine, ENDS can  help  smokers  quit the habit entirely  by providing a tobacco free alternative.  Exhaustive  research  is  required to further  understand long term effects of  vaping.  Till such data  is made available, we suggest that ENDS be used solely for the purpose of de-addiction from smoking and not as an additional method of the same.

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  1. Goniewicz ML, Knysak J, Gawron M, et al Levels of selected carcinogens and toxicants in vapour from electronic cigarettes Tobacco Control 2014;23:133-139.
  2. Tierney PA, Karpinski CD, Brown JE, et al Flavour chemicals in electronic cigarette fluids Tobacco Control 2016;25:e10-e15.
  3. Schober W, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int J Hyg Environ Health 217(6):628–637 (2013); doi: 10.1016/j.ijheh.2013.11.003.
  4. Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill A, Alwis KU, et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med. 2017;166:390-400. doi: 10.7326/M16-1107
  5. Picture Credit :

Content Credit: Dr.Nikita Pandey, Pune


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Dr Madhura

Well written n good content. ….

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