General Health

Effect of E-cigarettes on lung function

Studies show that the vapors from electronic cigarettes (e-cigarettes) have slight amounts of nicotine and potential harmful toxins (at levels lower than conventional cigarettes). The long-term carcinogenic and lung function effects of electronic cigarettes are not known. 

The 1964 landmark report by the Advisory Committee to the U.S. Surgeon General was one of the first reports to identify the detrimental effects of cigarette smoking on health. Despite  the advances in diagnosis and treatment of smoking-related diseases, cigarette smoking continues to create a massive burden of avoidable diseases and premature mortality even into the 21st century. 

The e-cigarette is a new class of electronic nicotine delivery system (ENDS) that was introduced in 2004 and was popularly considered a “healthier alternative” to conventional cigarette smoking. Hence the use of e-cigarettes increased rapidly all over the world. However, there is less data available regarding the use of the device as a treatment for tobacco and smoking dependence and even less is known about its overall impact on population health. Unlike FDA-approved nicotine inhalers, which deliver non combustible aerosolized nicotine, e-cigarettes use a power source, electronic heating element, and liquid nicotine cartridge. 

E-cigarettes consist of a cartridge, filled with an e-liquid, an atomiser to heat the e-liquid to create a vapour which is inhaled through a mouthpiece, and a rechargeable battery. The cartridge contains a stabilizing compound (e.g., propylene glycol or vegetable glycerin), varying amounts of nicotine, and flavoring additives. When activated by the user, the atomiser heats the liquid, resulting in aerosolized nicotine vapor and a visible plume. This vapor is inhaled into the lungs, termed “vaping,” where nicotine is absorbed. 

E-cigarettes require higher levels of suction to smoke than conventional cigarettes, and the amount and density of aerosol produced by e-cigarettes diminish progressively as puffs are taken. Conventional cigarette smoke contains more than 7,000 compounds with at least 70 recognized carcinogens including carbonyl compounds such as formaldehyde, organic compounds such as benzene, tobacco-specific nitrosamines, free radicals, toxic gases, and heavy metals. In 2009, the FDA detected low levels of tobacco-specific nitrosamines and diethylene glycol in two brands of commercially available e-cigarettes, prompting an FDA warning that e-cigarettes may pose a health risk. 

Apart from nicotine addiction, the ingredients used in flavouring agents and additive agents can also be harmful for health. When heated, these additive agents can produce various compounds, including formaldehyde and acetaldehyde, which are carcinogenic to humans. Disposal of waste from e-cigarettes and the manufacture of e-cigarettes could also pose potential environmental hazards.

Little is known about the effect of vaping on the immune system. Both traditional and e-cigarette consumption by non-smokers caused short-term effects on platelet function, increasing platelet activation and platelet aggregation as well as neutrophil activation, although to a lesser extent with e-cigarettes. Additionally, increased oxidative stress, vascular damage, and changes in vascular tone have all been reported in different human studies on vaping

Studies were conducted where the presence of toxic carbonyl and volatile organic compounds were tested in various e-cigarettes and nicotine inhalers. Among 15 carbonyl compounds tested, four were detected in e-cigarettes and trace amounts were detected in nicotine inhalers. Two of 11 volatile organic compounds were detected in e-cigarettes, and none were in the nicotine inhaler. Nearly all e-cigarettes contained tobacco-specific nitrosamines which were not found in the nicotine inhaler. The heavy metals cadmium, nickel, and lead were detected in the e-cigarettes, with trace levels also in the nicotine inhaler.

In a study conducted in 2011, scientists determined the effects of e-cigarette vapor on lung function in 30 healthy smokers. They found out that smoking e-cigarettes for 5 minutes resulted in increased total respiratory impedance, respiratory flow resistance, and overall peripheral airway resistance indicating a difficulty in breathing. In addition, e-cigarette use was associated with increasing oxidative stress as indicated by lower levels of exhaled nitric oxide. Serum levels of nicotine detected are heterogeneous and depend on the user and the device. 

Another study detected the urine levels of metabolites of acrylonitrile, acrolein, propylene oxide, acrylamide and crotonaldehyde, all of which are detrimental for human health, were significantly higher in e-cigarette-only users than in non-smoker controls, reaching up to twice the registered values of those from non-smoker subjects. 

In the interest of public health, electronic cigarettes (e-cigarettes) were banned in September, 2019, by the Indian Government. The decision was taken to protect the country’s youth following news from the US about an alarming rise in teen use as there was a high number of deaths there due to e-cigarettes. 

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