Researchers say e-cigarettes may not be a safe alternative to smoking

The growing popularity of vaping is the focus of scientific research on its risks. [Photo © Avery Zingel]

By Justin Reeson, Avery Zingel, Tom Hall

We’ve all seen it by now: someone puffing on something that at first looks like a cigarette but, well, isn’t.

Generally longer than a cigarette and often made of exposed metal, it’s reminiscent of the Terminator’s finger.

Electronic cigarettes are everywhere.

Heralded as a safer, tastier alternative to tobacco cigarettes and as a gateway to quitting smoking altogether, e-cigarette use has grown dramatically in Canada since about 2006, the same year smoking in public places was banned in most of the country.

The battery powered e-cigarettes have a coil that vaporizes liquid from a cartridge, which is then inhaled. Some of the replaceable liquid cartridges contain nicotine, some don’t.

Lenient regulation on contents

But despite their popularity and health claims, e-cigarettes remain largely unregulated, which makes some researchers and doctors nervous.

“Thus far, being not regulated, every e-cig is found to have different quantities of contaminants, additives and nicotine,” says Dr. Smita Pakhale, an associate scientist with the Ottawa Hospital’s Clinical Epidemiology Program Research Institute.

Pakhale says she wouldn’t recommend a patient switch from tobacco cigarettes to e-cigarettes because there is still too much that is not understood about their health consequences.

Furthermore, despite anecdotal claims about how much e-cigarettes have helped people quit smoking a pack a day, Pakhale says there is not enough data to prove that e-cigarettes help people quit conventional cigarette smoking.

And even the simple act of smoking an e-cigarette may be normalizing the use of cigarettes.

But what is more troubling for doctors and lawmakers is that the flavoured e-cigarette juice may in fact be attracting people who would otherwise not smoke, such as teens. And even the simple act of smoking an e-cigarette may be normalizing the use of cigarettes.

E-cigarettes can look remarkably similar to conventional cigarettes. Photo Credit © Wiki Commons public domain

E-cigarettes can look remarkably similar to conventional cigarettes. Photo Credit © Wiki Commons public domain

Something Pakhale says is dangerous because most major e-cigarette producers are owned by traditional tobacco cigarette producers.

“We do have some data that more youths are trying e-cigarettes,” she says. “So, if more youths try the nicotine containing e-cigarettes, there is a danger of it acting as a gateway to conventional cigarette smoking.”

But there is evidence that e-cigarettes can help people quit smoking. The Cochrane Collaboration, an international research organization, conducted a review of studies on e-cigarettes to determine if there is any truth to the health claims.

The Cochrane Review looked at 13 studies published by July 2014. They compared the results of two of the best studies which involved more than 600 people from New Zealand and Italy, and found that there was evidence that people who used e-cigarettes that contained nicotine were more likely to reduce the amount they smoked by at least half, compared to those who used a patch.

Though it wasn’t clear that e-cigarettes were any more effective in helping people quit smoking than nicotine patches.

In Canada, researchers at Carleton University have been examining the effects of secondhand e-cigarette vapour.

Christopher Scherf is graduate student in Carleton’s school of health sciences. He says none of the potentially dangerous chemicals detected in the exhaled vapour are above the normal levels found in the air we breathe everyday.

The concern, says Scherf, is the particulate matter in the vapour.

Scherf says that as tools to help people quit smoking, e-cigarettes are probably a good thing, but they need to be better regulated.

“In terms of chemicals the second hand e-smoke may not be that harmful,” Scherf says. “In terms of particulate matter, there was a significant spike. Ultrafine particulate matter can get deep down into a person’s lungs.”

And, Scherf says, that’s fine if the particulate matter is water or something generally recognized as being safe. But they are finding that there are some things (like metal particles) that may be present in the vapour can cause some problems, though the work is still in its early stages.

“Some people will say that particulate matter is dangerous,” he says. “And I can certainly agree with that, but it’s also very important to look at what that particulate matter is composed of. More data and research is needed before any hard conclusions can be drawn on the safety of e-cigarettes.”

Scherf says that as tools to help people quit smoking, e-cigarettes are probably a good thing, but they need to be better regulated.

“I don’t think they should be sold to minors, and I don’t think they should be able to have unregulated levels of nicotine,” he says.

There is nothing necessarily more dangerous in e-cigarettes than nicotine. In place of normal cigarettes carcinogenic ingredients, e-cigarettes typically contain just three things: nicotine, a flavouring and propylene glycol, a chemical that has been considered safe for consumption in the U.S. since 1997. (However, despite being safe to eat, there are concerns that inhaling vaporized propylene glycol could be harmful.)

“In review of the literature it seems that a lot of the metals coming out in e-cigarette vapour are a result of poor manufacturing processes, such as faulty wiring and bad soldering jobs,” Scherf says. “The liquid itself doesn’t have any metals.”

Photo credit © Horsten, Wiki Commons

Components of an E-Cigarette. A: LED light cover B: battery (also houses circuitry) C: atomizer (heating element) D: cartridge (mouthpiece) Photo credit © Horsten, Wiki Commons

The concern according to a report published in Scientific American is that the coil in the e-cigarette that heats the vapour also heats the surrounding metals, which could result in nano-particles being inhaled deeply into the lung. In theory, this process could damage the lungs resulting in diseases such as emphysema.

However, clinical trials have yet to draw any firm conclusions.

In the meantime, the unregulated e-cigarette market has been called a wild west. A recent U.S. study by the National Institute of Health found that while traditional smoking has been dropping among eighth graders for years, there has been an increase in those trying e-cigarettes in the same age group.

The Ontario government has proposed a new law, which would come into effect in 2016 that would ban the sale of all flavoured tobacco products and treat e-cigarettes like traditional cigarettes.



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