Electronic Cigarettes

Electronic cigarettes were introduced to the US market in 2007. Though much of the initial marketing was aimed toward smoking cessation, these devices have quickly become a popular source of nicotine for many individuals, both teens and adults.

An e-cigarette is made to deliver nicotine to its user by aerosolizing a nicotine-containing solution. The device has four parts: the battery, the heating element, the vaporizing chamber, and the solution cartridge. Some devices are manually activated by pressing a button. The solution is heated, aerosolized, and the vapor is then inhaled. Other machines automatically activate when the user draws on it like a traditional cigarette.

The solution cartridge contains flavored nicotine solution (e-juice) for aerosolization. The composition of e-cigarette solutions varies significantly from manufacturer to manufacturer and the choices of flavors and concentrations are increasing. The liquid includes a vehicle solution (propylene glycol, low molecular propylene glycol, or vegetable glycerin), artificial flavorings, and nicotine in varying concentrations.

Since electronic nicotine delivery systems are not currently regulated by the FDA, there is no standardization of nicotine dosage. Some e-cigarette concentrations have been tested as high as 100 mg/ml and the lethal dose of nicotine varies from 10 to 60 mg. One study of e-cigarette users showed that their salivary nicotine levels were three times higher than that of a conventional cigarette smoker.

The link between cigarette smoking and increased risk of developing lung cancer has been well established. The question that has yet to be answered is: are e-cigarettes a safer alternative in regard to lung cancer risk and the other toxic effects seen with tobacco cigarette smoking?

Several substances have been identified in e-cigarette solutions including nitrosamines, tobacco alkaloids, aldehydes, metals, and hydrocarbons. Since each brand of solution is different, it is difficult to generalize about the potential toxic effects of these devices. Limited controlled studies are available on the overall safety and long-term health effects of these devices.

What we do know is that nicotine-containing e-cigarettes affect the heart and lungs by elevating the diastolic blood pressure, increasing the heart rate; and increasing lung airway resistance. Too, many individuals smoke conventional cigarettes while also using e-cigarettes. This so-called “dual use” is associated with higher levels of nicotine in the bloodstream. This leads researchers to believe that these people may become even more nicotine dependent.

Since their introduction, manufacturers have promoted these devices for smoking cessation. However, the FDA has not approved them for this purpose. So far the small number of studies and surveys done on e-cigarettes for smoking reduction or cessation has given us conflicting results. The bottom line, there is insufficient evidence to use e-cigarettes for smoking cessation.

Major health associations around the world, such as the World Health Organization, the American Heart Association, and the American Thoracic Society, are concerned because these devices contain the drug, nicotine. And as such, health groups feel they should be regulated like other tobacco products.

Finally, much of the marketing of these products has been toward the youth market and recent surveys have shown an increase in teen use. Many of the teen users erroneously believe e-cigs are a “healthier alternative” to cigarettes. Also, electronic nicotine delivery devices and e-juice are easier for teens to buy; however, laws have been passed by the Virginia General Assembly making it illegal to sell to a minor.

The content in this column is for informational purposes only. Consult your physician for appropriate individual treatment. Dr. Reynolds practices Family Medicine in Chesterfield.