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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[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]


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

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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

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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”.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]


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[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]


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.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]


  1. McGill N. Research on e-cigarettes examining health effects: Regulations due. The Nation’s Health; 2013; 43 (5): 1-10.
  2. 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
  3. 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.
  4. Action on Smoking and Health. ASH briefing: Electronic Cigarettes; Nov 2014.
  5. Henley J. E-cigarettes: miracle or health risk? [internet]. The Guardian; 2014. Available from:
  6. Neporent L. 5 Things You Need to Know About E-cigarettes [internet]. ABC News; 2013 [cited 2014 Dec 2]. Available from:
  7. 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
  8. Morgan Griffin R. E-Cigarettes 101 [internet]. WebMD; 2014. Available from:
  9. 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
  10. 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
  11. 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.

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Erectile Dysfunction


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Erectile Dysfunction (ED) is a common problem in Malaysia affecting 16% to 47% of men. That is about 1.68 million Malaysian men above 40 years of age whom experience some degree of ED.1

ED is defined as the persistent or recurrent inability to achieve and/or maintain sufficient erection for satisfactory sexual performance, for at least 3 months duration.2[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Risk Factors and Causes of ED

ED can be due to a range of causes, which may involve both physical and physiological factors.

Table 1: Causes and risk factors of ED

Psychological processes Mental disorder Neurological disorder
Performance anxiety Anxiety disorders Trauma
Loss of attraction Depression Myelodysplasia (spinal bifida)
Relationship difficulties Intervertebral disc lesions
Stress Drugs and substance abuse Diabetes mellitus
Narcotics Alcohol abuse
Antihypertensives (thiazides, beta blocker, methyldopa, spironolactone) Pelvis surgery
Hormonal abnormalities Antidepressants and transquilisers
Hyperprolactinaemia NSAID Arterial disorder
Hypogonadism leading to testosterone deficiency Miscellaneous drugs (ketoconazole, hyoscine, anticancer agents) Hypertension
Hypo- or hyperthyroidism H2 antagonists Smoking
Diabetes mellitus
Peripheral vascular disease

Smoking – a good reason to stop! Adapted from CPG in erectile dysfunction (Malaysia Urological Association and MEDACT 2009)

Cigarette smoke contains about 41,000 chemicals eg, acetone, ammonia, arsenic, carbon monoxide, lead and tar. These chemicals causes damage to the blood vessels, which hinders proper blood flow to the penis.3

According to a report from the American Heart Association (data from 4,764 Chinese men with average age of 47), those who smoked more than 20 cigarettes a day had a 60% higher risk of ED, compared to those who never smoked. What was important to note from the study was the fact that as long as you smoked at some point in your life, you are 30% more likely to suffer from ED.4

Similar to smoking, drug of alcohol abuse can also reduce blood flow to the penis causing ED. A sedentary lifestyle and being overweight are other contributing factors of ED.5[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Laboratory Tests for Diagnosis of ED

There are several laboratory tests that may help in identifying clues to diagnosis of ED. These may include:

  • Urine Analysis
  • Fasting Blood Glucose
  • Testosterone Level
  • Serum Prolactin
  • Luteinizing Hormone (LH)
  • Thyroid Function
  • Liver Profile
  • Prostate-Specific Antigen (PSA).

Your doctor may also recommend you to do an Ultrasound.6

While these are specific tests that could help with the diagnosis of ED, it is important to do a complete health check annually (e.g: Head-To-Toe), since the factors causing ED is multi-faceted.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Treating underlying conditions

If you suffer from diabetes and heart disease, treating these underlying causes may resolve ED. Talk to your doctor if you are taking any hypertensive medication. Certain medications may have the effect of restricting blood flow to the penis, thus causing ED. Alternatively, you may also consult with a qualified pharmacist for Medication Check Up service in order to identify such medications. Do not stop taking any medications without consulting your healthcare provider.

For conditions due to hormonal abnormalities (e.g: hypogonadism, androgen deficiency or hyperprolactinemia), you may consult an Urologist who will perform certain tests and suggest appropriate therapy to treat these underlying cause.2[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Altering Modifiable Risk Factors and Causes

If you are a smoker, consider quitting now! You may enrol yourself in a quit smoking program with a professional body that offers professional help, advise and support. Lovy Pharmacy Quit Smoking Program are available nationwide and managed by qualified pharmacists who can provide an intensive and comprehensive program that includes one-to-one counselling for behavioural modification using stop-smoking aids and other relevant materials.

Besides quit smoking, you may also need to:

  • Work with your doctor or pharmacist to manage diabetes, heart disease or other underlying health conditions.
  • Do regular check-ups and health screening test annually.
  • Limit or avoid alcohol use.
  • Exercise and reduce weight if you are overweight or obese.
  • Get help for stress and other mental or psychological problems.2-4

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Nutritional supplements such as the following may help to improve the symptoms of ED:

  • Amino Acid Arginine.
  • Bioflavonoids.
  • Zinc.
  • Vitamin C.
  • Vitamin E.

Other herbal supplements such as Asian ginseng and ginkgo biloba can improve blood circulation, thus may have the effect in inducing proper blood flow to the penis, improving conditions of ED.3[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row]