Is Vaping Safe?

Is Vaping Safe

Introduction

After little over a decade on the market, e-cigarettes are fast becoming an established alternative to smoking. But, like any new technology, there is still only very little research on the use of e-cigarettes and their safety. Clinical trials and definitive scientific research is now being published on e-cigarettes. Anecdotal evidence from the world over suggests that vaping is quickly becoming one of the most popular ways to quit smoking. So what health concerns should you consider when you vape? How safe is vaping, and how much better is vaping than smoking?

Is Vaping Safe

In this article, we aim to provide you with a clear, up-to-date analysis of research on the health effects of vaping. So if you are considering vaping, you can make your decision an informed one.

What are e-cigarettes, and how do they work?

Electronic cigarettes (e-cigarettes for short) are small devices that vaporise ‘e-liquid’ or ‘e-juice’ for the user to inhale. They are designed to provide an adjustable dose of vaporised nicotine when inhaled, that closely mimics the act of smoking. E-cigarettes provide nicotine without the carcinogenic compounds that are associated with tobacco smoke.

Is Vaping Safe

E-cigarettes work by activating a heating element, known as an atomiser, to vaporise a liquid solution that the user can inhale. There is no smoke, no combustion, only vapor. Users control their nicotine intake by purchasing e-juice or pre-filled e-cigarettes that contain their required nicotine content. In some more advanced e-cigarettes, you can also control the density of the vapour you inhale in each drag.

Is Vaping Safe

What is e-juice, and how safe are its components?

E-juice is the fluid used in e-cigarettes to create the inhaled vapour. It comes in a variety of flavours and nicotine concentrations. E-juice is composed of a propylene glycol or glycerol base, food grade flavourings (the same as those used in ice-cream, for example), water, and nicotine. The propylene glycol or glycerol are used to dilute the flavourings and nicotine to the correct level, and create the visible vapour.

Is Vaping Safe

How safe does current research consider e-juice and it’s vapour, compared to tobacco? Many of the toxic components found in tobacco smoke are generated specifically through combustion, the burning of tobacco. The potential damaging effects of vaping has been a relatively simple task to research due to the basic composition of e-cigarette vapour, compared to the thousands of compounds found in tobacco smoke. The other good news is that vaping doesn’t require combustion, dramatically reducing the volume of carcinogenic substances. Unlike tobacco smoke, where more harmful components are being characterised every day, current research suggests the individual components of e-juice have a limited potential to cause harm [1, 2, 3].

Is Vaping Safe

E-cigarette flavourings are generally considered the singular component of e-juice that could have potential health risks. Flavourings need only be approved as safe for humans to eat – a very different process to the inhalation of their vapour. E-cigarettes introduce a long-term, daily exposure of these compounds through inhalation, a type of ingestion that there is currently very limited research on [1, 2]. Almost all new e-juice flavours will not have any supporting evidence to demonstrate their safety, asides from the knowledge that they are harmless when eaten. Published research on the effects of e-juice flavourings in general is limited; it is down to the user to decide if the potential risks of e-juice flavourings are of more concern than the proven and widely established dangers of tobacco.

A recent study has shown that super-sweet e-juices can damage your teeth, reducing enamel hardness up to 27% more than unflavoured e-juices. Researchers concluded that highly sweetened e-juices can have a similar effect to consuming high-sugar drinks and candy [4], suggesting it is worth considering the impact of your e-juice flavour on your oral health.

A note on diacetyl flavouring

The use of diacetyl as a buttery-tasting flavouring in e-juice has been highly controversial. Inhaling large volumes of diacetyl powder is damaging to the lungs [5]. Health concerns based on this fact have led to the unfounded association of vaping diacetyl flavoured e-juice with an irreversible disease known as ‘popcorn lung’. This compound is considered an avoidable risk, and because of this, diacetyl is rarely used in e-juice anymore.

Is Vaping Safe

The Dangers of Smoking Vs. Vaping

Vapers have generally chosen to make the switch due to the proven risks of smoking. Over 20 components found in tobacco smoke have been associated with cancer, heart disease and lung diseases such as COPD [6. Smoking will cause 15% of all cancers in the UK [7], and studies have shown that 20-30% of smokers will develop COPD symptoms [8]. Simply put, we know smoking has terrible effects on your health. The primary addictive substance found in tobacco, nicotine, is not itself associated with cancer or lung disease, suggesting vaping as a nicotine delivery system has huge potential to be a safe alternative to tobacco.

The UK government and Public Health England (PHE) has published advice on e-cigarette use [3]. Their general consensus is that e-cigarettes are to be encouraged as a tool to aid smoking cessation, with some devices even licensed for medical use. In fact, PHE supports an independent review that vaping is around 95% less harmful than tobacco [9]. E-cigarette usage is governed similarly to smoking in the UK – advertising is controlled, and use is banned in confined public spaces and for those under 18 [10]. The U.S. government has a similar stance – e-cigarette sale and use is legal.

Is Vaping Safe

Despite government approval in the U.S. and UK, vaping is not considered 100% safe in absolute terms. E-cigarette vapor particles are the correct size to penetrate the lungs and airways at very high levels (similar to tobacco smoke), potentially leading to short-term irritation, and e-juice contains potentially fatal doses of nicotine if consumed by accident. Researchers consider several factors to determine the safety of e-cigarettes, including use in smokers compared to non-smokers, and in non-smoking youth [2]. As of May 2018, the FDA has cracked down on e-juice brands whose packaging ‘resembles food or beverage products’, due to concerns about packaging that resembles sweets and other products intended to appeal to children and youth. The key concerns are that attractive packaging draws in non-smoking youth, and also the serious risk of small children consuming highly toxic e-juice [11]

RiskSmokingVaping
Addictive PotentialHighLow – High – low nicotine/nicotine free e-juices are available
CancerHigh – smoking is proven to cause at least 20 types of cancer [6]Low – although e-juice flavourings require more research
Lung DiseaseHigh – proven to cause lung diseases like emphysema and COPD [8]Low – potential for short term irritation of the airways, although more research required.
Heart DiseaseHigh – proven to cause heart disease and high blood pressure[8] – early research suggests that vaping may induce markers associated with increased cardiovascular risk [12]
Children and Young AdultsHighHigh – nicotine is damaging to the developing brain
PregnancyHighHigh – nicotine will damage the developing fetus [13]

Vaping and Pregnancy

Smoking is widely known to cause damage to the developing fetus throughout pregnancy, causing low birth weight and Sudden Infant Death Syndrome. Evidence suggests that although these issues are partially caused by tobacco smoke, it is primarily nicotine that is responsible for this damage to the unborn child. For women that cannot stop smoking, nicotine replacement through vaping or patches is suggested as a damage controlling alternative. However, this will not be enough to protect the child from the potentially fatal effects of nicotine. Ingestion of nicotine in any form, throughout the entire gestation period, is considered a risk to the developing baby [13].

Vaping and Lung Disease

People that continue to smoke, whilst experiencing lung diseases caused by smoking, could benefit from using e-cigarettes. COPD is a destructive lung disease associated with smoking. A recent study investigating if vaping can make COPD worse over a two-year period has shown that following the replacement of cigarettes with vaping, respiratory ‘exacerbations’ were halved, and improved general health and physical activity status was reported [14], suggesting vaping has great potential to benefit individuals with COPD.

Vaping and Heart Disease

Smoking is known to cause heart disease [8, 15]. The jury is still out on vaping – early research on a small cohort of 42 participants showed that habitual e-cigarette use was associated with an increase in markers associated with increased cardiovascular risk [12]. This study raises important questions, reminding us that more research needs to be done, however, it is not definitive evidence that vaping can cause heart disease. The study did not include smokers as a positive control, so we still don’t know how significant this increased risk of heart disease is compared to smoking.

Is Vaping Safe

Conclusion

In this article, we have looked at the safety of e-juice and e-cigarettes, and how the risks of vaping size up compared to smoking. Vaping is generally considered safer than smoking, particularly for people with existing lung diseases. Current research suggests that vaping is a far less damaging way to get your nicotine fix. As always, if you are looking to quit smoking, it is always best to consult your healthcare provider to see what options will best suit your lifestyle and circumstances.

References

1. Wilder, Natalie; Daley, Claire; Sugarman, Jane; Partridge, James (April 2016). “Nicotine without smoke: Tobacco harm reduction“. UK: Royal College of Physicians. p. 125.

2. Electronic cigarettes: an aid in smoking cessation, or a new health hazard?
Konstantinos Farsalinos, Therapeutic Advances in Respiratory Disease
https://doi.org/10.1177/1753465817744960 [Accessed 19 Oct 2018]

3. UK Government 2018 Summary on e-cigarettes and heated tobacco products. https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review/evidence-review-of-e-cigarettes-and-heated-tobacco-products-2018-executive-summary [Accessed 19 Oct 2018]

4. Kim, Shin Ae et al. “Cariogenic Potential of Sweet Flavors in Electronic-Cigarette Liquids.” Ed. Neal Doran. PLoS ONE 13.9 (2018): e0203717. PMC. Web. [accessed 18 Oct. 2018]

5. Diacetyl – Popcorn Lung Class Action Lawsuit. https://www.torhoermanlaw.com/personal_injury_lawsuit/toxic_tort_lawsuit/diacetyl/ [accessed 18/10/2018]

6. Cancer.org – health risks associated with smoking tobacco. https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/health-risks-of-smoking-tobacco.html?_ga=2.185122477.545438922.1539856979-53956969.1539856979 [accessed 18/10/2018]

7. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. [accessed 18/10/2018]

8. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(46):938–43 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.html [accessed 2018 October 18]

9. Public Health England E-cigarettes: an evidence update A report commissioned by Public Health England https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/733022/
Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf
[accessed 2018 October 18]

10. UK Government 2018 Policy on use of e-cigarettes in public places and workplaces. https://www.gov.uk/government/publications/use-of-e-cigarettes-in-public-places-and-workplaces [accessed 2018 October 18]

11. FDA Center for Tobacco Products Warning Letter to Breanne Warkenton. https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm605912.html [accessed 2018 October 18]

12. Moheimani RS, Bhetraratana M, Yin F, et al. Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users Implications for Cardiovascular Risk. JAMA Cardiol. 2017;2(3):278–284. doi:10.1001/jamacardio.2016.5303

13. International Child Care Practices Study: infant sleep position and parental smoking.
Nelson EA, Taylor BJ. Early Hum Dev. 2001 Aug; 64(1):7-20.

14. Polosa R, Morjaria JB, Caponnetto P, et al. Evidence for harm reduction in COPD smokers who switch to electronic cigarettes. Respir Res. 2016;17(1):166.

15. Smoking and Your Heart – national heart, lung and blood institute 2018 Statistics https://www.nhlbi.nih.gov/health-topics/smoking-and-your-heart [accessed 2018 October 18]

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