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Vaping to quit smoking

What vaping is, its origin, how it works and is used for quitting, as well as recent health concerns

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The dangers of smoking are hard to overstate. Nearly 500,000 people die of tobacco-related disease each year in the US, adding to 1 in 5 deaths. Over the next decade, estimates are that around eight million people will die prematurely worldwide each year due to tobacco use. The list of tobacco-related diseases and conditions is long and growing.  It includes these and others not listed below:

  • cardiovascular disease (narrowing or blocking of blood vessels that can lead to a heart attack, chest pain (angina) or stroke);
  • emphysema (shortness of breath), bronchitis (infection of the main airways of the lungs or bronchi), and asthma
  • lung and other types of cancer
  • tooth decay
  • weathering of the skin
  • having a low-birthweight baby
  • diabetes
  • eye damage (including cataracts and macular degeneration).

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The point is, if you smoke, you should try hard to quit; and if you don’t smoke, don’t start!

While the dangers of smoking cigarettes are clear, the best way to quit is not. In fact, there is no single best way.  Most people who quit for good have to try more than once before they succeed. Over the years, vaping has become one of the most popular ways to quit smoking.  So, to help you decide whether vaping is right for you, let’s take a look at what you should know about it.

 

What is vaping?

Electronic cigarettes or e-cigarettes, also known as e-cigs are battery-powered smoking devices. They come in different shapes, but the way they work is generally the same.  Some have a removable transparent piece or tank, which the user can refill with a liquid (commonly known as “juice”) that usually contains nicotine, flavorings, and chemicals.  When inhaled through the mouthpiece, a sensor triggers a vaporizer (heater) to heat a small amount of liquid flavoring. The liquid turns to vapor and is drawn into and out from the user’s mouth, resembling smoke.  That’s why e-cigarettes are called “vapes” - because they turn liquid to vapor (shortened to “vape”). So, the use of e-cigs by inhaling and exhaling vapor or vape is called “vaping”.

 

Origins of “vaping”

There is nothing new in the use of a device to make vapor for inhaling and exhaling, as a leisure activity or “vaping” as we now know it.  Water-pipe tobacco smoking is an ancient smoking tradition that has been around for centuries in different cultures, with roots in India, Africa, and the Middle East. It is known by various names, including shisha, hookah, nargile, etc; reflecting the variety of its origin.  The water-pipe device includes an indirect heat source (such as lit charcoal) to slowly burn tobacco leaves while users draw smoke down through a water chamber and into their mouths through hoses. It is sometimes flavored with fruit, vanilla and other tastes.

However, the modern vaping is not the same as smoking a water-pipe.  In a water-pipe, a burned mixture of tobacco and molasses is drawn through water to cool the smoke.  Burning creates cancer-causing chemicals that are inhaled by the smoker.

The vaping technology of e-cigarettes does not burn anything and the liquid mixture is simply vaporized (heated to vapour). The vapor does not contain the harmful compounds found in smoke from water-pipes or cigarettes.

 

Who invented e-cigarettes?

Unknown to many, in 1927 Joseph Robinson came up with the idea of an electronic cigarette.

In 1963, Herbert A. Gilbert invented a “smokeless non-tobacco cigarette” and patented it 1965, but it was never commercialized.  In the 1980s, Phil Ray and Normal Jacobson worked more towards commercializing the idea of e-cigarettes. However, in the 1990s, Food and Drug Administration (FDA) didn’t allow tobacco companies to introduce e-cigarettes to the market.

The Chinese firm, Hon Lik invented and patented the modern e-cigarette in 2003.  Vaping,” or smoking electronic cigarettes, first became widely popular in China, where 60 percent of men are smokers.

 

Is vaping safe?

Since users of e-cigarettes inhale vapour created by heating, not burning nicotine, flavorings and other substances, there seems to be general agreement that vaping is safer than smoking cigarettes. That said, although it is assumed by some that vaping can cause mouth or throat irritation, nausea, and coughing; these conditions can also relate to the common healing effects of the body when people quit smoking and may not be caused by vaping itself.  The effects of vaping are not yet known completely and more studies are needed to understand how vaping affects the body.   

Companies that make or sell e-cigarettes must follow certain FDA regulations. For example, only people aged 18 and over are allowed to buy e-cigarettes. Researchers are working hard to gather more information about e-cigarettes and how they are used. This information may lead to additional regulations and could be helpful for informing the public about what’s in e-cigarettes and the potential health risks of using them.

A 2013 study in the journal, Tobacco Control found that the harmful chemicals in e-cigarettes occurred at levels 9 to 450 times lower than in regular cigarette smoke.

A 2009 study by the FDA found that the e-cigarettes studied “contained detectable levels of known carcinogens (substances capable of causing cancer) and toxic chemicals to which users could potentially be exposed.”

E-cigarettes have been in the news a lot lately for many reasons.  The initial concerns were that they are being marketed to kids, with flavor options such as cotton candy, cupcake, and tutti-frutti. One survey found that about 80% of middle school students had seen ads for e-cigarettes. Since we know that nicotine is highly addictive and the long-term risks to kids of vaping are not known, the rising popularity of vaping among young people might create a host of unforeseen health problems in the future.

Animal studies and limited human research have shown that vaping can lead to changes in the airways that are similar to those caused by smoking. Some of the same chemicals detected in the flavorings have been removed from food products because they’ve been linked with health problems. There are also concerns that teenagers who become addicted to nicotine by vaping may be more likely to smoke cigarettes as adults or try other addictive drugs such as opiates.  Finally, “dual use” of tobacco products (vaping and smoking cigarettes) is not rare. A 2015 survey cited by The Truth Initiative (an anti-tobacco organization) found that nearly 60% of e-cigarette users also smoked cigarettes.

 

What about recent health concerns?

In recent months, there have been serious health concerns regarding the use of e-cigarettes in the US.  Currently, about 2,051 cases of vaping-related illnesses have been reported along with 39 deaths, according to the Centres for Disease Control and Prevention (CDC). The cause of the lung injuries and deaths has prompted health officials to warn against vaping altogether and for state and federal lawmakers to mull or impose vaping sale bans. 

Vitamin E acetate was found in every lung-fluid sample from afflicted patients tested by researchers and the first time such a chemical has been detected in samples from patients with the vaping-related injuries.

Vitamin E acetate is a chemical (oil) commonly found in skincare products, and it isn’t dangerous when applied to the skin or swallowed.  However, when heated and inhaled through vaping devices, the chemical can cause harm to a patient’s lungs. It will also be important to know how the chemical reacts to the skin when exposed to high temperatures.  The chemical has been recently used in black market products containing Tetrahydrocannabinol (THC), the psychoactive chemical in cannabis, as a thickening agent. THC causes temporary changes in awareness, mood, consciousness and behaviour.

The CDC’s conclusion comes from a study that examined 29 samples from patients with vaping-related lung illnesses. All 29 of them contained traces of vitamin E acetate and no other potential toxins were detected.

THC was found in 23 of 28 patients, including three who said they had not used THC products, while nicotine was detected in 16 of 26 patients.

These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs, involving samples that reflect patients from across the country, according to Anne Schuchat, the principal deputy director at the CDC.

However, officials cautioned that there could more than one toxin causing the illnesses, and more evidence is needed to establish a causal link between vitamin E acetate and the injuries.

So, until vaping is approved safe by the authorities, it’s important to heed the warnings and stay away from vaping altogether.

There are other proven, safe, and effective methods for quitting smoking. One way to start is to talk with your doctor, nurse, or a trained quitline counselor to figure out the best strategies for you.

Many people use quit smoking medication, like nicotine replacement therapy (NRT), in the form of a patch or gum, which doctors and other experts agree is one of the most helpful tools smokers can use to quit.  You can also get free good support over the phone and help with different ways of quitting, from any of the national quit-smoking organizations, such as the National Cancer Institute (NCI).  Here are their contact details, including toll-free number:

The combination of medication and support is known to increase the chance of quitting for good. Explore your options and find a quit method that’s right for you.

 

Can vaping help people quit smoking?

The use of e-cigarettes or vaping is not approved by the FDA as a quit-smoking aid.

However, supporters of vaping have promoted it as a way to help cigarette smokers to quit. Although giving up nicotine products altogether might be the ultimate goal, there may be health benefits to a smoker who becomes a long-term vaper instead, though this remains unproven; as well as health benefits of gradually reducing nicotine content of vaping liquids to zero-nicotine.

A new study compared vaping with other common nicotine replacement approaches as a way to help smokers quit. The findings support the idea that vaping may help some smokers.

Researchers recruited nearly 900 people who wanted to quit smoking, and randomly assigned half to receive e-cigarettes and the other half to receive other nicotine replacement products (such as nicotine patches and gum). All of the study participants received weekly individual counseling for four weeks. After one year, smoking cessation was confirmed by measures of exhaled carbon monoxide (which should be low if you’ve quit but high if you’re still smoking).

Here’s what they found:

  • Among those assigned to vaping, 18% had stopped smoking, while about 10% of those using nicotine replacement therapy had quit.
  • Among successful quitters, 80% of those in the e-cigarette group were still vaping; only 9% of those in the nicotine-replacement group were still using those products.
  • Reports of cough and phlegm production dropped more in the e-cigarette group.

So, while vaping was associated with nearly twice the rate of smoking cessation, more than 80% of smokers entering this study continued to smoke a year later. One other caution to note: the e-cigarettes used in this study contained much lower levels of nicotine than found in some common brands used in the US (such as Juul). The importance of this difference is unclear, but a higher nicotine level could contribute a higher rate of addiction to the e-cigarette.

 

References

  1. NCISmokefree, What We Know About Electronic Cigarettes, [website] year unknown, https://smokefree.gov/quit-smoking/ecigs-menthol-dip/ecigs, (accessed November 1, 2019).
  2. Harvard Health Publishing, What’s the best way to quit smoking? [website] 2016, https://www.health.harvard.edu/blog/whats-best-way-quit-smoking-201607089935, (accessed November 1, 2019).
  3. LIVESCIENCE, Vaping: How E-cigs Work (Infographic), [website] 2013, https://www.livescience.com/41211-how-electronic-cigarettes-work-infographic.html, (accessed November 1, 2019).
  4. VAPINGDAILY, Vaping – A Journey Through its History, [website] year unknown, https://vapingdaily.com/what-is-vaping/vaping-history/, (accessed November 1, 2019).
  5. Sandler, R. (2019) ‘Health Authorities Know What’s Potentially Causing Vaping-Related Deaths’, Forbes, November 8.  Available at: https://www.forbes.com/sites/rachelsandler/2019/11/08/health-authorities-know-whats-potentially-causing-vaping-related-deaths/#33967f951bab,  (accessed November 8, 2019).

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