Peering through the smoke and mirrors – is vaping safe?

Vaping is not the latest fashion trend or diet fad. Vaping refers to the use of electronic cigarettes, also known as e-cigarettes or e-cigs. 
The use of electronic cigarettes has increased since 2008 and has become an international phenomenon. The CDC reports e-cigarette experimentation and use doubled among U.S. middle and high school students during 2011–2012, resulting in an estimated 1.78 million students having ever used e-cigarettes as of 2012. 

Is vaping safe?

There are many pros and cons to vaping, and the use of electronic cigarettes raises many questions. If your goal is to quit smoking, why would you use a device that continues to function as a psychological "crutch"? Is vaping safe? Should you practice nicotine abstinence or focus on decreasing the harmful effects of nicotine?
I had to consider these issues following a discussion with a patient about her desire to quit smoking. She asked me what I thought about e-cigarettes. I didn't have an informed position at the time, but I’ve been doing my homework. Here’s what I’ve learned. 
What are e-cigs? 
Electronic cigarettes are battery-operated products designed to deliver nicotine, flavor and other chemicals. They turn chemicals, including various levels of highly addictive nicotine, into an aerosol inhaled by the user. Most e-cigarettes look like conventional cigarettes, cigars or pipes. Some resemble everyday items such as pens or USB memory sticks.
Some communities have banned the sale of electronic cigarettes to those under the age of 18 and limited use of the products to the same venues that currently allow tobacco use.
Simulated smoking
E-cigarettes deliver nicotine in an aerosolized manner that simulates an authentic smoking experience without the real smoke. The ingredients found in e-cigarette cartridges and solutions are relatively few. For the most part, they are non-toxic and non-carcinogenic, especially in low quantities. They include nicotine, propylene glycol, glycerin and tobacco flavoring1.
What we know about conventional cigarettes is that they contain thousands of compounds – such as cadmium, arsenic, chromium, nickel and lead – many of which have been shown to induce or promote cancer. The e-cigarette cartridge may or may not contain tobacco. Some cartridges are nicotine-free. Most often, only a miniscule quantity of nicotine is found in the tobacco flavoring2. However, some manufacturers provide a range of strengths. Some brands can be comparable to a conventional cigarette. 
The cartridges should never be left within the reach of children. A 5 ml refill can contain nicotine concentrations of 20 mg/ml or even 100 mg/ml per vial. A lethal dose of nicotine for children is 10 mg, and between 30 and 60 mg for adults. It is important to prevent skin contact or consumption by children or pets in order to avoid very tragic consequences3.
Economic impact
One way to look at the public acceptance of a new product is to consider the economic impact. In regards to e-cigarettes, the revenue has doubled annually since 20084. Many people find that vaping represents a safer, cheaper alternative to conventional cigarettes. However, e-cigarettes come in a range of prices, depending on the manufacturer, model and style. The starter kit typically contains the e-cigarette device, a battery and several cartridges. The cost can range from $60 to $1505. The difference in price seems to be related to how long an e-cigarette lasts. For example, an e-cigarette is good for 150 ─ 300 puffs, while a single conventional cigarette is good for about 10-15 puffs.
Is vaping safe?
Puff for puff, vaping an e-cigarette has been shown to deliver less nicotine into the bloodstream than conventional cigarettes. However, increased heart rate and blood pressures have been recorded in vapers as well as in smokers.
Although vaping can be seen as a way to reduce the harm caused by conventional cigarettes and as a bridge to smoking cessation, I would urge caution in the use of e-cigarettes. Additional research is required to determine whether e-cigarettes will decrease or increase nicotine addiction, and whether the long-term effects of vaping on the heart and lungs will be as dangerous as those of conventional cigarettes.
For more information on smoking cessation, visit or 
1, 2, 3 Palazzolo, D. Electronic cigarettes and vaping: a new challenge in clinical medicine and public health; Frontiers in Public Health. November 2013; vol 1, article 56 Pages 1-20
Abrams, D. Promise and peril of e-cigarettes: can disruptive technology make cigarettes obsolete? JAMA January 8, 2014 Vol. 311, No. 2 ppgs135-136

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