Cigarettes and E-Cigarettes

Introduction

A new year has begun. It is time to set goals for a healthier and better year. Recently, the medical community has focused on "vaping" cigarettes, or e-cigarettes, which are linked to lung disease and premature death. This column reviews guidelines set by the CDC and offers new information beneficial to smokers and those considering e-cigarettes.

What Are the General Risks of Cigarettes?

Cigarettes can negatively impact all major organ systems and are a primary risk factor and cause of premature death among American adults. Particularly for women, smoking can lead to reproductive health issues, increase risks of various cancers (such as lung, bladder, and cervical malignancies), exacerbate coronary and vascular diseases, and raise the likelihood of obstructive pulmonary disease and osteoporosis. Pregnant smokers risk harmful effects on fetal development, including growth restriction. In recent years, various tobacco products have emerged with added flavors, including cigarettes, cigars, and e-cigarettes. Changes in cigarette form and design, such as low-tar and light versions, do not make them safer.

What Are the Differences Between Cigarettes and E-Cigarettes?

E-cigarettes electrically deliver nicotine. By heating a liquid to create vapor, which the smoker inhales into the lungs, they are generally used as an alternative to cigarettes but are not safer. They represent another mechanism of delivering nicotine to the body. The heated liquid contains nicotine, tetrahydrocannabinol (THC), and cannabinoid (CBD) oils. THC is a substance also found in marijuana.

Are You Aware of Recent Deaths Related to "Vaping"?

Investigations into lung injuries associated with e-cigarette, or "vaping," product use (EVALI) are ongoing. The CDC has identified Vitamin E acetate as a potentially harmful chemical that can be inhaled via e-cigarettes, potentially causing the reported lung damage. While Vitamin E is safe as a supplement, inhaling Vitamin E acetate can harm the lungs. Therefore, the CDC advises against adding Vitamin E acetate to e-cigarettes. Since THC is found in certain e-cigarettes, it should be avoided when possible. As of November 13, 2019, 2,172 cases of vaping-related lung illness have been reported in 49 states, with 42 fatalities in 24 states. The deceased ranged from 17 to 75 years old, with an average age of 52, indicating it affects all age groups.

What Are the Current CDC Guidelines on "Vaping" or E-Cigarettes?

The CDC advises against using THC-containing e-cigarettes or "vaping" products, especially those that are unofficial. Those who quit e-cigarettes should not return to conventional smoking and should consider quitting altogether. If difficult, FDA-approved nicotine replacement therapies, such as gum or patches, can be used. Regardless of current research findings, children, young adults, pregnant women, or those planning to become pregnant should not use e-cigarettes. Cigarettes and e-cigarettes pose health risks and should be avoided if possible. E-cigarette users with related lung symptoms or concerns should seek medical attention and cease use. Health topics should always be discussed with a doctor, and e-cigarette users with respiratory symptoms should consult a physician. For more information, please refer to the CDC webpage.

Jennifer E. Cho, MD, FACOG

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