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E-cigarettes, battery powered devices which are also known as Electronic Nicotine Delivery System (ENDS) by the World Health Organization (WHO), were first invented in the 1960s, but didn’t really take off until a decade ago when it was brought to life by a Chinese pharmacist, Hon Lik, who himself is a heavy smoker.2, 3
Despite the presence of multiple manufacturers of e-cigarettes, the basic design of the device is similar, consisting of a plastic tube, an electronic heating element, a liquid nicotine cartridge, and a lithium battery and atomization chamber with a membrane to suspend ingredients.3
The act of puffing on an e-cigarette is called “vaping”.4 An e-cigarette converts nicotine containing liquid (e-liquid or e-juice) into vapour that can be inhaled. E-juice contains additives including propylene glycol giving various aromas and flavours, such as tobacco, coffee, mint and fruits, and in more colours than iPhone 5C! 3, 4 Besides, the nicotine content in e-juice cartridges may vary between brands and manufacturers and so, various concentrations of nicotine can be delivered through “vaping”.5 This device mimics tobacco cigarette by vaporising nicotine so that it is readily entrained into airway system and then enters the bloodstream, leading to a near instantaneous nicotine reward in the central nervous system.3
What is the cost of e-cigarettes?
There are more than 250 brands of e-cigarettes in the market. The Tobacco Vapour Electronic Cigarette Association estimates the device starter kit costs between US$30-100 (~ MYR104-347).6 In the U.S, a current research study revealed that there has been rapid expansion in ever and current e-cigarette consumption over the past 4 years. Major population of users are young adults and current cigarette smokers. Even though smokers are most possible users of these products, nearly one third of current users are non-smokers.7 E-cigarettes will contribute a booming sales in the industry if the trend continues. According Wells Fargo securities analysts, e-cigarettes were about to hit US$1 billion sales in 3 years since 2010.5
Are e-cigarettes safe?
Burning of tobacco produces smoke which is known as the biggest danger to smokers and second-hand smokers whereas e-cigarettes don’t burn. Therefore, e-cigarettes are widely believed and marketed as less harmful alternatives to conventional tobacco cigarettes. Most significantly, scientists showed that e-cigarettes can help smokers cut down their cigarette intake and eventually to smoking cessation.5, 8 However, the lack of studies and reviews means the failure to establish the claim of e-cigarette as a safer substitution to regular cigarettes.
In contrast, a recent report released by the U.S Food and Drug Administration (FDA) stated that vapour dispersed by e-cigarettes contains traces of the solvents in which flavourings and nicotine can be dissolved. Those tested solvents are known cause lung irritation.9 In addition, some new studies showed that vaping not only delivers a cocktail of toxic chemicals including carcinogens to the lungs but also leads to bacterial infections resistant to antibiotics. Furthermore, “vapers” can inhale substantial amount of tiny aerosols which in turn can deposit in the lung’s smallest and deepest airways.10 There have been reports of e-cigarettes battery explosions caused either by prolonged charging and use of improper chargers or by design defects, suggesting e-cigarettes may be the cause of fire accidents.11 For instance, a mid-aged man was reported dead following an explosion of his e-cigarette “gun”.
So far, introduction of e-cigarettes has triggered a fierce debate among researchers and health experts who ultimately aim to reduce the prevalence of tobacco-related diseases and deaths. Regardless of e-cigarettes make the problem better or worse, many countries and global health organizations such as WHO and FDA urge to ban its use indoors due to concerns on potential harm caused by inhalation of vapour.10, 11
Even though existing evidences show that e-cigarettes are by far less harmful than smoking tobacco, more researches should be conducted to strengthen and/or elaborate current findings related to the use of e-cigarettes as well as implementation of lawful regulations. Lastly, all healthcare professionals play a major role in counselling their patients on the FDA-approved quit smoking approaches if they wish to stop smoking, rather than switching to another form of puffing.
- McGill N. Research on e-cigarettes examining health effects: Regulations due. The Nation’s Health; 2013; 43 (5): 1-10.
- Consumer Advocates for Smoke-free Alternative Association (CASAA). E-cigarette History [internet]. [cited 2014 Dec 1]. Available from:http://casaa.org/E-cigarette_History.html
- Kuschner WG, Reddy S, Mehrota N, Paintal HS. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider. Int J Gen Med. 2011; 4: 115–120.
- Action on Smoking and Health. ASH briefing: Electronic Cigarettes; Nov 2014.
- Henley J. E-cigarettes: miracle or health risk? [internet]. The Guardian; 2014. Available from:
- Neporent L. 5 Things You Need to Know About E-cigarettes [internet]. ABC News; 2013 [cited 2014 Dec 2]. Available from:
- McMillen RC et al. Trend in Electronic Cigarette Use Among U.S Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine Tob Res; 2014; doi: 10.1093/ntr/ntu213
- Morgan Griffin R. E-Cigarettes 101 [internet]. WebMD; 2014. Available from:
- Shute N. Health Organizations Call for a Ban On E-cigarettes Indoors [internet]. National Public Radio; 2014. Available from: http://www.npr.org/blogs/health/2014/08/26/343382661/health-organizations-call-for-a-ban-on-e-cigarettes-indoors
- Raloff J. Health risks of e-cigarettes emerge [internet]. Science News Vol. 185 No. 13; 2014. Available from:https://www.sciencenews.org/article/health-risks-e-cigarettes-emerge
- Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf. ; 2014; 5(2): 67–86.