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
Department of Pulmonary Medicine, KLE University, J. N. Medical College, Belgaum, Karnataka
|How to cite this article:|
Mahishale V. Electronic cigarette: A boon or bane!!.J Sci Soc 2014;41:71-72
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Mahishale V. Electronic cigarette: A boon or bane!!. J Sci Soc [serial online] 2014 [cited 2021 May 18 ];41:71-72
Available from: https://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.  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. ,,
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.  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." ,, It crosses the placenta and alters fetal gene expression and tissue development in a variety of organs.  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.  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. 
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.
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