Dr. Shyam P Lohani

As a tobacco cessation device, e-cigarette was first developed in 2003 in China. Since then, it has grown rapidly to reach millions of users. The sales of this product are growing rapidly worldwide, especially among youths. It is not a simple habit but an addiction to use any forms of smoking or smokeless tobacco. Like other addictions, it can be difficult to quit. The nicotine present in those products fuels the addiction.
Unlike conventional tobacco smoking in which nicotine is inhaled by burning the tobacco, whereas, in an e-cigarette, nicotine is inhaled by heating the liquid that may or may not contain nicotine. In addition to nicotine, many other chemicals such as propylene glycol, glycerin, and flavoring agents are present in an e-cigarette. Besides, heavy metals such as lead, arsenic, nickel and tin have also been found along with regular chemicals.

Global scenario
Globally, e-cigarettes market value stood at about US$ 14.05 billion in 2018 and is expected to grow to $29.39 billion at a compound annual growth rate (CAGR) of more than 20 per cent through 2022. Growing awareness about the alternatives to tobacco smoking is driving the market for e-cigarettes (PRNewswire, 2019). The United States, the United Kingdom and France are the biggest markets and vapers in those countries alone spent more than $10 billion on smokeless tobacco and vaping products in 2018 (BBC, 2019). There has been steady, though, small decrease in smokers globally. Estimates suggest that the number of vapers has increased from about seven million in 2011 to 41 million in 2018 (WHO, 2019). However, another projection shows that the number of adults who vape will reach almost 55 million by 2021.
Many people believe that vaping is safer than smoking. But this is not necessarily the case. Growing evidence suggests that vaping is dangerous. Many researches have proved that vaping both with and without nicotine disrupt normal lung function in otherwise healthy people. E-cigarettes are smokable, refillable or replaceable cartridges or containers holding liquid that contain nicotine, solvents, and chemical flavors. Inhaling e-cigarettes put a negative pressure on the device that triggers a battery to heat the liquid solution inside the cartridge, which is then atomised into inhalable vapour.
At this time, there is limited evidence of the long-term effects of vaping, because the lung effects of vaping will take decades to develop. But based on the experience with cigarettes, similar adverse health effects including COPD, heart disease, and cancer can be anticipated. Vaping with nicotine is especially risky for young people. Those who vape with nicotine are more likely to start smoking cigarettes in the future.
Reports have shown that nicotine-free vaping can also irritate the respiratory system, cause cell death, trigger inflammation, and harm blood vessels. Vaping may be slightly less harmful than smoking as about 7,000 chemicals are inhaled with smoking, whereas vaping is likely to involve a lower number of chemicals. Damage to the lungs and increased cancer risk are two most prominent effects seen with both the habits.
Although less is known about vaping, it is less dangerous for current cigarette smokers. However, with the several cases of severe lung disease among people who vape raise serious questions about the safety of vaping. Our lungs are meant to inhale clean air and nothing else, thus vaping is destined to develop lung problem in the long-run as it takes many years to recognise the damage cigarettes can cause.

Health campaigns
We are still learning about the long-term health effects of e-cigarettes. Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavourings may be safe to eat but not to inhale since our digestive system is more efficient than the lung. There is some evidence that young people who use e-cigarettes are more likely to start smoking cigarettes in the future.
Vaping is being promoted to be a less risky choice for people who are trying to quit smoking. However, even if the vape liquid is nicotine free, there might be a long-term risk associated. E-cigarettes might have helped some conventional smokers quit smoking, smokers who use e-cigarettes are one third less likely to quit smoking than smokers who do not use e-cigarettes.
Both smoking and vaping are harmful to human health. Based on the available scientific evidence, smoking appears to be more harmful than vaping. However, this does not mean that vaping is safe. Therefore, it is best to discourage vaping as an alternative to smoking or also a means of smoking cessation.
Vaping can be discouraged but not eliminated. We have experiences with the effective anti-smoking campaigns launched decades ago. Vaping reduction efforts must primarily be targeted to the fresh starters. Public health campaigns should be geared toward people who are most likely to use and become addicted. Healthcare providers should also take a proactive role in counselling patients to reduce nicotine use.

(A Professor, Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)