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EDITORIAL
Year : 2014  |  Volume : 41  |  Issue : 2  |  Page : 71-72

Electronic cigarette: A boon or bane!!


Department of Pulmonary Medicine, KLE University, J. N. Medical College, Belgaum, Karnataka, India

Date of Web Publication20-May-2014

Correspondence Address:
Vinay Mahishale
Department of Pulmonary Medicine, KLE University, J. N. Medical College, Belgaum, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.132809

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How to cite this article:
Mahishale V. Electronic cigarette: A boon or bane!!. J Sci Soc 2014;41:71-2

How to cite this URL:
Mahishale V. Electronic cigarette: A boon or bane!!. J Sci Soc [serial online] 2014 [cited 2020 Aug 12];41:71-2. Available from: http://www.jscisociety.com/text.asp?2014/41/2/71/132809

Everyone should be aware of the undeniable facts that cigarette smoking is a leading cause of several serious medical diseases; that nicotine is a powerfully addictive substance; and despite the availability of several therapies that are approved by the various health agencies, the vast majority of smokers who try to quit have incredible difficulty maintaining abstinence. Although, alternate forms of nicotine delivery, such as nicotine patches nicotine nasal spray and chewing gums have been around for many years, electronic cigarettes (e-cigarettes) have achieved remarkable popularity in a very short period.

The principal addictive component of tobacco smoke is nicotine. The mechanisms of nicotine addiction are highly complex, but include at least two important reward pathways: One mediated directly and immediately by stimulation of dopamine release in the shell of the nucleus accumbens, secondly indirectly after more sustained use through release of dopamine in the nucleus accumbens core in response to stimuli associated with nicotine administration. [1] Nicotine is an addictive substance which leads to the establishment of tolerance of dopamine release. Abstinence from smoking induces intense withdrawal symptoms and craving to smoke that can be reduced by administering medicinal nicotine. Conventional nicotine replacement therapy (NRT) products typically provide relief from withdrawal symptoms but do not modify behavioral changes in smokers. E-cigarettes have the potential to provide nicotine by inhalation in a formulation that mimics smoking, and serves both (medicinal and behavioral).

Electronic nicotine delivery systems or e-cigarettes look like cigarettes, but do not contain raw or burn tobacco. Instead, they comprise a battery-powered atomizer that produces a vapor for inhalation from cartridges containing humectants (propylene glycol or glycerol), flavors (e.g., tobacco, mint, or fruit), and nicotine. Many smokers report using e-cigarette to quit smoking or to substitute for tobacco in smoke-free places. E-cigarette do attenuate craving for tobacco, but appear to deliver little nicotine to the blood. [2],[3],[4]

Since their launch in 2004 in China, e-cigarettes, a diverse range of battery operated devices that vaporize nicotine for inhalation, have been purchased by millions of people. Many smokers use e-cigarettes to help them quit. Sales are increasing so rapidly that some analysts predict that they will surpass cigarette sales within a decade. [5] The place of e-cigarettes in tobacco control is controversial and there is a paucity of reliable data. Available research suggests that e-cigarettes have the potential to assist smokers to quit or reduce smoking. Studies show that e-cigarettes are capable of delivering nicotine into the bloodstream and attenuating tobacco withdrawal as effectively as NRT. Use of e-cigarettes also simulates behavioral and sensory dimensions of smoking. However, this argument has many fundamental flaws!

The medical community must recognize the fact that nicotine itself is a powerfully addictive substance and is a toxin when ingested in high doses. Nicotine, the main ingredient of e-cigarettes, is addictive and has been implicated in a number of cancers and also "third hand smoke." [5],[6],[7] It crosses the placenta and alters fetal gene expression and tissue development in a variety of organs. [8] Its toxic effects have been documented in many organs, and it has been shown that nicotine binds to the airway epithelial cell nicotine receptor, producing physiological changes in airway epithelial cells that are similar to those found in cystic fibrosis. [9] There is sufficient evidence about the toxicity of nicotine and the other components that have been found in e-cigarettes. Analysis of nicotine solutions used in e-cigarettes have been carried out which have revealed a range of other constituents including formaldehyde, acetaldehyde, and derivatives of benzene and benzodiazepine, raising the question of whether these solutions are suitably pure. Most e-cigarettes deliver nicotine in conjunction with propylene glycol to enable vapor generation, and the long-term effects on the lung of inhalation of this compound are not known. The vapor produced by e-cigarettes also contains a range of toxins, including some nitrosamines, though at much lower levels than in tobacco smoke. However, it is far from clear that these compounds are safe or reliable as might reasonably be expected. On this basis, it seems clear that e-cigarettes containing nicotine should not be promoted as harmless alternatives to regular cigarettes. Other concerns about e-cigarettes should also be considered. First, use of these products could prolong actual smoking cessation period. Second, data are emerging to show that some users are not stopping cigarette use, but concurrently using e-cigarettes ("dual use") in all the places where they would otherwise have been unable to smoke (e.g., restaurants, airports, and the workplace). Finally, and perhaps most challenging, is the very real possibility that e-cigarettes may serve as an initiation device for young people, who may in due course changeover to regular cigarettes when they reach the legal age to purchase those products because they are advertised as being safe, fashionable, and good tasting, often due to the addition of pleasant flavors. [10]

The success in marketing of e-cigarettes achieved by the tobacco industry, and the rapidity with which the smoking and nonsmoking population has embraced e-cigarettes around the world and in India, demands a rapid and forceful response by the regulatory, scientific, and medical communities. Almost all tobacco companies are coming out with brands of e-cigarette which are available as online shopping options and easily accessible to youngsters due to intense marketing. This is an important time for the Ministry of Health, The Government of India, to provide information to physicians, their patients, and the public detailing concerns about the safety of e-cigarettes. The Government of India should play a leading role in advocating basic and clinical research programs related to e-cigarettes to bring about changes in the regulation of e-cigarettes, and providing information to the public about alternative smoking cessation programs.

 
  References Top

1.Tobacco Advisory Group of the Royal College of Physicians. Harm Reduction in Nicotine Addiction. London: Royal College of Physicians, 2007. http://www.rcplondon.ac.uk/sites/default/files/documents/harm-reduction-nicotine addiction.pdf . [Last accessed 2014 Feb 10].  Back to cited text no. 1
    
2.Etter JF. Electronic cigarettes: A survey of users. BMC Public Health 2010;10:231.  Back to cited text no. 2
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3.Etter JF, Bullen C. Electronic cigarette: Users profile, utilization, satisfaction and perceived efficacy. Addiction 2011;106:2017-28.  Back to cited text no. 3
    
4.Brody JS. The promise and problems of e-cigarettes. Am J Respir Crit Care Med 2014;189:379-80.  Back to cited text no. 4
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5.Purkayastha D. BAT ramps-up e-cigarette expansion as sales go up in smoke international business times (July 31, 2013). Available from: http://www.thefreelibrary.com/BATRamps-upE-cigaretteExpansionasSalesGoUpinSmoke.-a0338323170. [Last accessed on 2013 Dec 13].  Back to cited text no. 5
    
6.Kuschner WG, Reddy S, Mehrotra N, Paintal HS. Electronic cigarettes and thirdhand tobacco smoke: Two emerging health care challenges for the primary care provider. Int J Gen Med 2011;4:115-20.  Back to cited text no. 6
    
7.Brody JS. Transcriptome alterations induced by cigarette smoke. Int J Cancer 2012;131:2754-62.  Back to cited text no. 7
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8.Votavova H, Dostalova Merkerova M, Krejcik Z, Fejglova K, Vasikova A, Pastorkova A, et al. Deregulation of gene expression induced by environmental tobacco smoke exposure in pregnancy. Nicotine Tob Res 2012;14:1073-82.  Back to cited text no. 8
    
9.Maouche K, Medjber K, Zahm JM, Delavoie F, Terryn C, Coraux C, et al. Contribution of α7 nicotinic receptor to airway epithelium dysfunction under nicotine exposure. Proc Natl Acad Sci U S A 2013;110:4099-104.  Back to cited text no. 9
    
10.Britton J. Electronic cigarettes. Thorax 2013;68:904-5.  Back to cited text no. 10
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