Vaping vs Smoking: The Verdict
Here's your evidence based update!
I’m currently completing my rotation on obstetrics and gynaecology and I’m regularly required to give post c-section advice.
On advising patients not to smoke, a reply I commonly receive is “I don’t smoke but I vape. That should be okay right?”
The truth is that vaping is what cigarettes used to be. Trendy.
The largest uptake of vaping has been from teenage, non smokers because it is seen as something stylish. 2010 had seen the introduction of wild and wacky flavours with menthol, strawberry and tutti-frutti. I sometimes do wonder how these taste? …. I’m kidding!
In 2015, the government sanctioned a report on e-cigarettes and concluded that it was 95% less harmful than smoking. Since then the claim has come under dispute and it is accepted that it is too early to conclude the exact impact of vaping.
However, there are some studies that have taken place and they provide some useful information. A useful review from the BMJ takes some of these findings which I’ve summarised below:
Vape solutions are typically composed of a combination of a flavorant, nicotine, and a carrier, commonly propylene glycol or vegetable glycerin, that generates the characteristic smoke appearance of vape aerosols. There is no tobacco.
Therefore, people who vape should expect the effects of nicotine including withdrawal symptoms. These include palpitations, suppressed appetite, headaches and more.
Damage to the lungs cannot be excluded. Aerosols contain substances including benzene, acrolein, volatile organic compounds, and propylene oxide. These pro-inflammatory substances have been found to increase airway resistance, reduce mucociliary clearance and damage the DNA of lung epithelial cells. This raises concerns about infection, airway hypersensitivity and even cancer.
There is also concern about substances contained within vaping liquids. For example, THC or cannabis contained liquids raise automatic concerns but those which have been infused with vitamin E have resulted in significant cases of severe lung injury. This is termed EVALI (e-cigarette or vaping use-associated lung injury).
However, there are some more detailed studies that have found vaping to be a safer alternative to cigarettes. A 2010 Cochrane review found it to be more effective than placebo in helping patients to stop smoking. This is why charities around the UK have come out in condemnation about the government’s new proposals concerning e-cigarettes.
How Does This Impact Our Practice?
The government has recently announced changes to restrict the use and access to vapes by children. There is a blanket restriction of single use vapes, restriction of fruity flavours as well as a change in packaging to something less attractive. This leads to the following practice approaches
Children/teenagers should be discouraged with vaping. We should inform them that the long term effects are unknown but nicotine withdrawal can result in trouble concentrating, headaches and anxiety.
In adults, it is ultimately up to them. We are effective bridging vapes in smoking cessation programmes so it certainly has some utility. There are a number of charities that can also advise including Action on Smoking and Health who have some helpful articles.
If there are any further updates in this space, we will be sure to let you know!
Until next time..
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