Recent findings underscore the connection between e-cigarette use and serious respiratory conditions, casting new light on vaping’s safety.
The Surge in Vaping
In recent years, e-cigarettes and vaping have gained popularity globally, largely due to marketing campaigns touting them as a healthier and safer alternative to conventional smoking. Globally in 2021, the reported lifetime prevalence of vaping were 24%, 26%, 16%, and 25% in the Americas, Europe, Asia, and Oceania, respectively. This large percentage shift in nicotine consumption resulted in public health discussions about its long-term effects, necessitating a detailed investigation to understand the benefits and drawbacks of e-cigarettes.
Past and Present Research
The health implications of vaping remain a topic of debate. Initial studies introduced e-cigarettes as a means to mitigate some of the severe health risks associated with conventional smoking. However, subsequent research revealed a more complex picture of e-cigarette use. While there are benefits compared to conventional smoking, the more recent narrative surrounding e-cigarettes implicates vaping as having other long-term health drawbacks.
Comparing e-cigarettes and nicotine replacement therapies (NRT) for smoking cessation, a systematic review found no significant differences in reduction or harms between users of e-cigarettes and NRT. However, the researchers warned that these studies may contain biases. In one study reviewed, participants used first-generation e-cigarettes, which deliver only about 20% of the nicotine that cigarette smoking does. In the study, e-cigarette users received their supplies via courier, while NRT users had to redeem vouchers at community pharmacies to get their patches. The differences in nicotine delivery and ease of access between e-cigarettes and NRT could limit the applicability of results, making evaluating the true impact of vaping difficult.
Uncovering the Risks of Vaping
There are many hidden health dangers in e-cigarette consumption. The e-cigarette device sheds harmful metal and silicate particles into the vapour. In addition, the e-liquid contains ingredients like propylene glycol and glycerol, which produces toxic chemicals like acetaldehyde and formaldehyde when heated. These chemicals can cause respiratory irritation and cardiovascular impairment and have potential carcinogenic effects. The amount of nicotine in e-liquids adds another layer of risk, with nicotine poisoning incidents on the rise due to increased vaping.
New Insights into Vaping’s Health Impact
Further, research also highlighted concerning trends, including the emergence of respiratory and cardiovascular issues from e-cigarette use. A recently published cohort study from Hebei province, China, provides pivotal evidence linking chronic obstructive pulmonary disease (COPD) and vaping. The study tracked over 10,000 healthy participants without prior respiratory conditions from 2015 to 2020. At the end of the study, the researchers found a 28% increase in the risk of respiratory symptoms. It also found a 8% increase in the risk of COPD in e-cigarette users. Additionally, dual users who use both e-cigarettes and conventional cigarettes had a 41% and 18% increased risk in respiratory symptoms and COPD risks. These findings contribute to the growing body of evidence cautioning against the use of e-cigarettes and highlight the need for healthcare professionals and policymakers to reassess the role of vaping in smoking cessation strategies.
E-Cigarettes and COVID-19: An Added Concern
There are further concerns regarding the susceptibility of SARS-CoV-2 infection in e-cigarette users. Angiotensin-converting enzyme 2 (ACE2) is an enzyme that facilitates the virus’ entry into the lungs. Evidence suggests that vaping and smoking increases the expression of ACE2 in the lungs which may increase one’s susceptibility to SARS-CoV-2 infection and worsen COVID-19 outcomes. In addition, vaping-induced lung inflammation and oxidative stress could exacerbate COVID-19 complications, making e-cigarette use a potential risk factor for severe illness.
Vaping as a Means to Quit Smoking
Currently, according to the World Health Organisation (WHO), 88 countries have no minimum age for e-cigarette purchase and 74 countries have no regulations in place for these harmful products. In countries like Malaysia, a significant portion of the smoking population has turned to vaping in an attempt to reduce or eliminate their smoking habits. There is a similar trend in other countries. For instance, the European Parliament endorses vaping as a smoking cessation tool. Some of these success stories provide compelling arguments for the potential benefits of vaping as part of a comprehensive smoking cessation strategy. However, these successes do not erase the need for caution, as the long-term health impacts of e-cigarette use remain largely unknown.
The Asian Perspective on Vaping
In Asia, there are various regulatory approaches to vaping, reflecting the diverse perspectives towards e-cigarettes. Singapore, for instance, adopts a strict stance against vaping, It is categorised as illegal. However, support is still provided to those who wish to quit smoking through professional help. This nuanced approach emphasises the need to balance public health priorities with the realities of nicotine addiction and cessation efforts. Vaping is also banned in Thailand, Bhutan, India, Sri Lanka and Timor Leste. In Malaysia, excise tax is implemented on vape devices and e-liquids. However, a survey of Malaysians revealed that 87% agreed on heavier taxes to be imposed on vaping products. This suggests that the general public may show large concerns about the safety of e-cigarettes. The varied regulatory landscapes across Asia highlight the complexities involved in managing e-cigarette usage, necessitating careful evaluation of both the potential benefits and risks.
Conclusion
In conclusion, driven by claims of a safer smoking alternative, the need for a comprehensive understanding of the impact of vaping becomes increasingly critical. The evidence to date reveals that, despite potential short-term benefits, the safety and efficacy of e-cigarettes as a cessation tool remain contentious, and its long-term effects should be further investigated.
Nevertheless, the recent study performed in Hebei, China, adds to the growing body of evidence linking vaping and increased risks of respiratory problems and COPD. It highlights why policymakers and healthcare professionals should be careful about recommending e-cigarettes as a smoking cessation tool. As we grapple with these issues, it is clear that the journey towards understanding and addressing the impact of e-cigarettes on public health is far from over. There is a strong need for robust, unbiased research as the world seeks to balance the potential benefits of vaping as a smoking cessation aid and the importance of keeping the public healthy and safe in the long-term.
References
- Pound, C. M., Zhang, J. Z., Kodua, A. T., & Sampson, M. (2021). Smoking cessation in individuals who use vaping as compared with traditional nicotine replacement therapies: A systematic review and meta-analysis. BMJ Open, 11(2), e044222. https://doi.org/10.1136/bmjopen-2020-044222
- Marques, P., Piqueras, L., & Sanz, M. J. (2021). An updated overview of e-cigarette impact on human health. Respiratory Research, 22(1), 151. https://doi.org/10.1186/s12931-021-01737-5
- Medical Channel Asia. (2023, April 10). Vaping in Southeast Asia: Uncovering hidden health dangers and implications. https://medicalchannelasia.com/vaping-in-southeast-asia-uncovering-hidden-health-dangers-and-implications/
- Medical Channel Asia. (2023, November 28). The rise of nicotine poisoning in Malaysia: A new challenge. https://medicalchannelasia.com/the-rise-of-nicotine-poisoning-in-malaysia-a-new-challenge/
- Song, B., Li, H., Zhang, H., et al. (2024). Impact of electronic cigarette usage on the onset of respiratory symptoms and COPD among Chinese adults. Scientific Reports, 14, 5598. https://doi.org/10.1038/s41598-024-56368-9
- World Health Organization. (2024, January 19). Tobacco: E-cigarettes. https://www.who.int/news-room/questions-and-answers/item/tobacco-e-cigarettes
- Vapor Voice Staff. (2021, May 18). Market watch: Malaysia’s vapor segment keeps growing. Vapor Voice. https://vaporvoice.net/2021/05/18/market-watch-malaysias-vapor-segment-keeps-growing/
- Global Center for Good Governance in Tobacco Control. (2024). E-Cigarette Ban & Regulation: Global Status as of February 2021. https://ggtc.world/knowledge/who-fctc-article-53/e-cigarette-ban-regulation-global-status-as-of-february-2021
