e-Cigarettes. What advice should we give our patients?

With the increase in people using e-cigarettes, either as an adjunct to help them cease smoking tobacco, or as a recreational activity in itself, we are likely to encounter patients using e-cigarettes (or vaping) in the hospital setting.

So should patients be permitted to use these devices in hospital?
What is the evidence around any adverse health effects?
And as nurses, should we support our patients using them to assist with smoking cessation?

There remains little evidence around the safety of vaping.
There is some evidence that it may assist with smoking cessation.
Vaping should be discouraged as a recreational activity or adjunct to traditional cigarette smoking.
Pregnant women should avoid vaping.

What are e-cigarettes?

E-cigarettes are marketed as a toxin free alternative to traditional cigarettes. They consist of a battery powered device that heats and aerosols a nicotine liquid. The liquid is combined with a flavouring agent (and there are currently around 7764 different flavours available) to provide a pleasant vaping experience for the user.

vaping device

What is in them?

The liquid refills for e-cigarretes contains a nicotine solution as well as water, propylene glycol, glycerol, and vegetable glycerin.

It is widely accepted by the general public (and effectively marketed) that vaping is much safer than using tobacco cigarettes. The flavouring agents are said to be ‘food grade’ and many of the toxins found in cigarettes are absent.

Are they safe?

There is little control in the manufacture of vaping devices resulting in wide variance in the amount and dosages of the vaping solution.

There is no evidence that the so called food-grade flavourings are benign when delivered directly to the circulation via the aerosol route.

Diacetyl and acetyl propionyl has been isolated in some vaping solutions. These chemicals have been associated with Bronchiolitis Obliterans.

Mercury, lead and cadmium have also been found.

There is emerging evidence that the heated vapours trigger an inflammatory response in lung tissue epithelial cells and in some cases cell death.

In laboratory tests on mice, exposure to e-cigarrete vapours for 1 hr a day for one month resulted in decreased local immune response.

Effects of passive inhalation or second-hand exposure remain unknown.

Can e-cigarretes help our patients to stop smoking?

Tobacco cigarettes are associated with a huge mortality rate from cardiac disease, cancer and respiratory disease. They also directly produce chronic debilitating conditions that produce a very poor life quality.
Any strategy that can reduce tobacco consumption will therefore have positive health outcomes.

There is evidence (although limited) that the use of e-cigarettes can assist with traditional cigarette smoking cessation.

They provide a nicotine replacement therapy combined with the physical action (and enjoyment) of smoking.

There is some evidence that vaping amongst non-smokers may lead to the use of traditional cigarettes.

So what should we advise our patients?

You should first check to see if your hospital has a policy on the use of e-cigarettes.

The authors of the article that I have summarised here conclude:

[We should] recommend e-cigarettes are not the first choice [for smoking cessation]. However, if available drug therapies are not effective, and the patient desires to try e-cigarettes after education, then support of patient cessation efforts is key while the research continues.

Recreational use and concomitant use with smoking tobacco should be strongly discouraged. Pregnant women should be counseled to avoid e-cigarettes because risks to the fetus are unknown. (O’Malley 2016)


Reference:

O’Malley, Patricia Anne. 2016. “Safety And Efficacy Of Electronic Cigarettes”. Available: http://journals.lww.com/cns-journal/Citation/2017/01000/Safety_and_Efficacy_of_Electronic_Cigarettes_.5.aspx

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