The Pros and Cons of E-Cigarettes

Are they a safer alternative for people living with COPD?

Doctor informing a female patient about e-cigarette
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People with chronic obstructive pulmonary disease (COPD) are advised to stop cigarettes as a matter of course. In response, some have begun to turn to electronic cigarettes—popularly known as e-cigarettes—as either a "safer" alternative to tobacco or a means to gradually taper off.

First introduced into the market in 2003, the devices have been well received by those who feel less than confident in kicking the habit.

Others have been far less enthusiastic, insisting there is no evidence to support their use for smoking cessation programs while suggesting the devices pose serious health risks of their own.

Increasing scrutiny of e-cigarettes led the U.S. Food and Drug Administration (FDA) to formally announce the regulation of all electronic nicotine delivery systems in 2016. These include the components of e-cigarettes as well as e-liquids, cartridges, flavorings, and atomizers.

But does this necessarily mean that e-cigarettes are "dangerous," or do they have properties that make them appropriate for people with COPD?

How E-Cigarettes Work

E-cigarettes are battery-powered devices filled with a solution of liquid nicotine, water, and propylene glycol. They are cylindrical in shape and made to appear cigarette-like. When you take a puff on one, a battery will heat up the solution and create a vapor you can then inhale.

The action, which stimulates the sensation of smoking, is called "vaping.”

Nicotine is a stimulant found in tobacco which is key to cigarette addiction but is not itself considered carcinogenic (cancer-causing). It is suggested that by removing tar from the smoking experience, people who use e-cigarettes will have a "safer" alternative to tobacco.

The Pros of E-Cigarette Use

Despite greater regulation by the FDA and the enactment of state and local laws restricting their use in public, proponents ardently believe that benefits of e-cigarettes far outweigh the perceived ills. There is research to support these views.

A key study published in 2017 and funded by Cancer Research UK found that people who switched from regular cigarettes to e-cigarettes exclusively had far lower levels of carcinogens in their body than those who continued to smoke. The researchers further concluded that nicotine intake was no greater than with regular cigarettes and that "there is a very low risk" associated with the long-term use of the devices.

The same results were not achieved in people who used e-cigarettes simply as a means to taper off. In those individuals, the level of carcinogens in body fluids was the same as if they had continued to smoke tobacco exclusively.

Other studies, meanwhile, have challenged the conceit that e-cigarettes do not help people stop smoking. A 2016 analysis of six studies involving 7,551 smokers reported that e-cigarettes helped 18 percent successfully quit smoking—nearly three times the rate seen in the general U.S. population.

The Cons of E-Cigarette Use

Despite studies supporting e-cigarette use, opponents have roundly challenged the results, insisting they only provide a mere snapshot of the possible effects. Even in terms of the smoking cessation studies, few have looked farther than six months to evaluate how lasting the benefits may be.

Moreover, the same opponents suggest that the dangers of e-cigarette extend well beyond the risk of tar. According to a 2016 study from the University of Connecticut, e-smoking can cause the same level of DNA damage to the lungs as tobacco, the changes of which confer to a greater risk of cancer.

For their part, the FDA and U.S. Surgeon General have each issued warning, advising the public that:

  • E-cigarettes can increase nicotine addiction in young people and lead them to, rather than sway them from, regular cigarettes. Since 2005, e-cigarette use in young people has increased by some 900 percent.
  • Certain e-cigarettes may contain ingredients toxic to humans. In recently published cases, the FDA found anti-freeze in two leading e-cigarette brands and higher traces of formaldehyde in high-voltage e-cigarette products. The fact is we still don't even know what is in many of the e-liquid solutions being sold.
  • The prolonged inhaling of certain flavorings (such diacetyl used to imitate popcorn butter) can cause irreversible lung damage, according to the U.S. Surgeon General.
  • Nicotine itself cannot be considered safe as it can seriously affect adolescent brain development and even cause harm to a developing fetus (resulting in lower birth weight, preterm birth, and an increased risk of sudden infant death syndrome).

The Best Way to Quit Smoking

How you choose to quit smoking is purely a matter of personal choice. However, within the context of COPD, you need to consider two important factors:

  • Using e-cigarettes a means of tapering off is no less different than tapering off without e-cigarettes. The rate of failure is equally high. If you plan to quit, it is better to stop all at once and use whatever smoking aids you need to quit.
  • We don’t yet fully know how vaping (or any of the ingredients involved in vaping) impacts COPD. In the short term, it is not uncommon for some to experience a sore throat, coughing, eye irritation, and dry mouth. Others who vape have no problems at all. As for the long-term effects, we simply don’t know how vaping may or may not hurt already damaged lungs.

As such, you need to make an informed judgment before choosing one smoking aid over another. This includes the e-cigarettes or any other nicotine delivery system on the market. Speak with your doctor to find the option that is best for you.

Sources:

Rahman. A.; Hann, N.; Wilson, A.; et al. “E-Cigarettes and Smoking Cessation: Evidence from a Systematic Review and Meta-Analysis.” PLoS One. 2015.

Shahab, L.; Goniewicz, M.; Blount, B.; et al. “Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users.” Annals of Internal Medicine. 2017; 366(6):390-400.

U.S. Department of Health and Human Services. “E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.” Washington, D.C.; 2016.

U.S. Food and Drug Administration. “Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS).” Silver Spring, Maryland; April 2017.

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