Electronic Cigarettes: What They Are & Health Risks

July 2022

Electronic cigarettes are a nicotine delivery device shaped like a conventional cigarette or pen that contains an ion-lithium battery and a concentrated liquid nicotine. This nicotine is heated up and then inhaled, or "vaped". In addition to nicotine, this liquid contains other solvents like water, propylene glycol, glycerin and flavoring. 

Also known as vape pens, it was initially introduced to the commercial market as a great way to replace conventional cigarettes. Companies claimed that e-cigarettes contained less carcinogenic substances and were associated with a lower risk of developing acute long problems. Some even promoted e-cigarettes as a great alternative for those wishing to quit smoking. 

However, due to a lack of scientific data to prove their efficacy and safety, vape pens have been banned in many parts of the world. Many national public health agencies, like the CDC and Health Canada, do not recommend the use of e-cigarettes as many contain harmful products and the long-term impact on health is still unknown. 

Are electronic cigarettes bad for you?

Just like a conventional cigarette, electronic cigarettes are harmful due to the nicotine in their composition. Nicotine is one of the most addictive substances known, making it hard to quit vaping or smoking. 

In addition, nicotine is released in the smoke blown away after inhaling, which puts people around smokers at risk. This is very risky for pregnant women, as nicotine exposure can increase the risk of neurological malformation in the fetus. 

Although there are less toxic substances in e-cigarettes than regular cigarettes,  e-cigs still contain carcinogenic substances. The CDC reports that when a nicotine cartridge is heated to over 150ºC (over 300ºF), ten times more formaldehyde is released in comparison to a regular cigarette. This is a known carcinogen. Other harmful metals are released and inhaled from the liquid cartridge as well as from the device itself. 

In addition, the chemical substances used to add flavor to electronic cigarettes are not proven to be safe for longterm use. 

EVALI: the vaping disease 

An EVALI (E-cigarette or Vaping product use-Associated Lung Injury) is a lung condition caused by e-cigarettes or vaping. It was identified for the first time in 2019.

This disease is related to the presence of vitamin E acetate, which is a harmful type of oil used in electronic cigarette cartridges. Some additionally contain THC, the psychoactive substance from cannabis, which also interferes with normal lung function.

An EVALI can cause symptoms that are similar to other lung diseases, like pneumonia or a flu, and can include: 

  • Shortness of breath
  • Fever
  • Coughing
  • Nausea and vomiting
  • Stomach pain
  • Diarrhea
  • Dizziness 
  • Palpitations
  • Chest pain 
  • Fatigue 

These symptoms can emerge within a few days or over several weeks. If you notice any of these symptoms, you should see your doctor for assessment and treatment as necessary. Treatment often requires hospital admission for oxygen use and medication, like steroids, antibiotics or antivirals. 

Do e-cigarettes increase risk for COVID-19? 

A literature review published in the American Journal of Respiratory and Critical Care Medicine reported that electronic cigarette use may increase susceptibility to COVID-19 [1]. The presence of nicotine in the liquid can damage the lungs, making them more vulnerable to infection. 

In ad​​dition, the smoke exhaled can increase transmission rates of coronavirus within the environments they are being used [1]

Why Juul products are banned in the USA

Juul products are banned for sale and distribution in the United States in 2022. In addition to playing a "disproportionate role in the rise in youth vaping," the FDA states that Juul products contain insufficient and conflicting data regarding its toxicological profile [2]

Although the FDA confirmed that it does not contain enough information to declare Juul products an immediate public health hazard, the agency did express concerns about the health risks associated with vaping [2]

Can electronic cigarettes be used to help quit smoking? 

The American Thoracic Society reports that studies on vaping to replace cigarette use have had conflicting results, and therefore this topic remains inconclusive. Some studies do show a positive relationship between vaping and smoking cessation success, but many other show that smokers are incapable of replacing traditional cigarettes indefinitely with e-cigarettes. Therefore, electronic cigarettes should not be used the same as other smoking cessation, like nicotine patches or gum. 

Nicotine patches, for example, work because the nicotine dose gradually decreases overtime, which helps the body to be less dependent on it. Cigarettes release the same amount of nicotine each time, giving smokers the same "hit" or feelings each time they are inhaled. This makes it more difficult to quit smoking. It is also important to note that there is no legal nicotine limit for smoking products in the USA. 

The WHO agrees with the ATS’s position and highlights that there are better, proven products available to help with smoking cessation. 

Additionally, electronic cigarettes can also lead to a higher addiction to nicotine, as the flavors used in these devices make them more palatable (especially to young users who may use e-cigarettes as a gateway to traditional tobacco products). 

Was this information helpful?

Edited by Tua Saude editing team in July 2022. Clinical review completed by Manuel Reis - Registered Nurse in July 2022.

References

  • U.S. FOOD AND DRUG ADMINISTRATION. FDA Denies Authorization to Market JUUL Products. 2022. Available on: <https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products>. Access in 28 Jun 2022
  • HEALTH CANADA. Consider the consequences of vaping. Available on: <https://www.canada.ca/en/services/health/campaigns/vaping.html>. Access in 28 Jun 2022
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  • COOKE, A.; et al. The Electronic Cigarette: The Good, the Bad, and the Ugly. J Allergy Clin Immunol Pract. 3. 4; 498-505, 2015
  • BBC. A misteriosa doença ligada a cigarros eletrônicos que já matou seis pessoas nos EUA. Available on: <https://www.bbc.com/portuguese/geral-49670309>. Access in 23 Sep 2019
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  • AMB. Posição da AMB quanto aos dispositivos eletrônicos para entrega de nicotina (cigarros eletrônicos e cigarros aquecidos). 2017. Available on: <http://portal.anvisa.gov.br/documents/219201/2782895/28.07.2017+Carta+-+AMB++-++Cigarros+Eletr%C3%B4nicos.pdf/eef5af78-5d90-4502-908c-b37b4355dccc>. Access in 03 Jun 2019
  • MCALINDEN, K. D.; et al. The rise of electronic nicotine delivery systems and the emergence of electronic-cigarette-driven disease. Am J Physiol Lung Cell Mol Physiol. 319. 4; L585-L595, 2020
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Clinical review:
Manuel Reis
Registered Nurse
Manuel graduated in 2013 and is licensed to practice under the Ordem dos Enfermeiros de Portugal, with license #79026. He specializes in Advanced Clinical Phytotherapy.