Electronic Cigarettes: Are they really as safe as we think?

(Cianna Jolie, Unsplash)

This article was exclusively written for The European Sting by Ms. Nour Nassour, a 2nd year of medical school student from LeMSIC, one of the NMO associated with IFMSA. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The WHO defines electronic cigarettes as devices that do not burn tobacco leaves but
instead vaporize a solution inhaled by the user [2]. Electronic cigarettes, or e-cigarettes aim to provide a similar sensation to inhaling tobacco smokes for the user; they are used
worldwide by millions of people as alternatives to real cigarettes and some studies shows
that they are effective in helping to quit smoking. The Centers for Disease Control and
Prevention (CDC) concluded that e-cigarettes can benefit adult smokers who are not
pregnant, as long as they completely replace any other nicotine or tobacco products. [1] However, are they really as safe as we think?

It has been found that the vapor contained in e-cigarettes is made out mainly of glycols,
nicotine and flavoring agents but also of particles, metals and Tobacco-specific nitrosamines (TSNAs), seeing as some of these ingredients are toxic when present at high dose, it is important to closely monitor their concentrations when inhaled. However, studies show that sometimes the product labels did not show the ingredients (e.g. flavors, solvent, nicotine) nor their concentrations (e.g. of nicotine) [3].

Let’s take a closer look at one of the major component of e-cigarettes: the Glycols (propylene glycol and glycerin); they are mostly considered safe for oral intake, but there is a major debate as to if a product is safe when ingested orally meaning it is safe to inhale it. In fact, it has been shown that exposure of glycols via smoke can easily reach threshold safety limits thus warranting some concern [3].

Furthermore, several brands often replace glycerol/propylene glycol by ethylene glycol [3, 5], a chemical associated with pronounced toxicological risks (3, 6). And diethylene glycol, a glycol also associated with pronounced toxicological risks, has been detected in small quantities in very few studies [3].

Unexpectedly, one of the major concerns of e-cigarettes has to do with the flavorings. Researchers have stated that that the chemicals that make up different flavors also produce different levels of free radicals, toxins that are often associated with cancer and other diseases [4]. In fact, workers who frequently inhaled diacetyl, a food sweetener also used as a flavoring agent in some e-cigarettes often developed airway obstruction caused by bronchiolitis obliterans, or “popcorn lung”, a rare obstructive lung disease [3]. However the danger of the flavoring agents varies with the one used and its concentration in the vapor; we should also mention that different brands, models and batch use various flavorings/concentrations [3], so it is quite hard to establish a concrete general assumption on the matter.

It is worthwhile noting that the research on the safety of e-cigarettes is relatively new and thus very challenging; one major problem is that any research applies only to the specific product brand, model and batch, with no certainty that the findings can be reproducible with different products. [3]

In conclusion, the only thing we know for sure is that the risks associated with smoking ecigarettes depend heavily on the specific situation of the consumer seeing as ex-smokers, non smokers, dual smoking, different brands and consumption rate all produce different outcome. Of course the safest way is always the smoke free way.

References
1. https://www.medicalnewstoday.com/articles/216550.php
2. https://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/
3.https://www.who.int/tobacco/industry/product_regulation/BackgroundPapersENDS3_4November-.pdf
4. https://www.hindustantimes.com/fitness/you-thought-e-cigarette-flavours-are-harmless-it-affects-a-lot-more-than-just-taste-buds/story-3NKiygOOfECEcwyVJK7muM.html
5. Hutzler C, Paschke M, Kruschinski S, Henkler F, Hahn J, Luch A. Chemical hazards present in liquids and vapors of electronic cigarettes. Archives of Toxicology. 2014;88(7):1295–308.
6. Hess R, Bartels MJ, Pottenger LH. Ethylene glycol: an estimate of tolerable levels of
exposure based on a review of animal and human data. Archives of Toxicology.
2004;78(12):671–80

About the author

My name is Nour Nassour from LeMSIC, one of the NMO associated with IFMSA. I am
currently serving as LeMSIC local director at the University of Balamand and executive board member for the term 2018/2019; I am also in my 2nd year of medical school studies at the University of Balamand in Lebanon. Thank you for this opportunity, it was a pleasure to research and write about e-cigarettes, their safety and risks as compared to tobacco leaves cigarettes.