The ban on e-cigarettes – a welcome step, Dr HS Bedi

I was introduced to the real-world harm by e-cigarettes when young Master Vijay (name changed) – a student of Class 9 in the Tricity - landed up in my Clinic with severe shortness of breath. The father showed me the small electronic cigarette device his son was using. An electronic cigarette (E-cigarette) is a battery-operated device that emits doses of vaporized nicotine, or non-nicotine solutions, for the user to inhale. It aims to provide a similar sensation to inhaling tobacco smoke, without the smoke. Also known as e-cigarettes, e-cigs, electronic nicotine delivery systems (ENDS), vaporizer cigarettes, and vape pens, they are marketed as a way to stop or cut down on smoking. E-cigarettes have been taken up by millions around the world since they first appeared on the Chinese market in 2004. In 2016, 3.2 percent of adults in the United States were using them. "Vaping" is now the most popular form of tobacco use among teenagers in the U.S …. and according to Vijay - very common in India too. E-cigarette use rose by 900 percent among high school students in USA from 2011 to 2015.

In 2016, over 2 million middle and high school students had tried e-cigarettes. For those aged 18 to 24 years, 40 percent of vapers had not been smokers before using the device. A growing body of research suggests that vaping is hazardous. While it may help existing smokers to give up, there is concern that young people are starting to vape for its own sake as it itself is addictive, and not to replace tobacco use. In 2016, the U.S. Food and Drug Administration (FDA) started to enforce rules about the sales, marketing, and production of these products.

Fast facts on e-cigarettes:

Here are some key points about e-cigarettes.

• Here are some key points about e-cigarettes.


• E-cigarettes aim to resemble cigarettes, but without burning tobacco.


• They are sold as aids to reduce or quit smoking, and some people find them helpful for this.


• However, research shows that they may have a negative impact on health.


• However, research shows that they may have a negative impact on health.


• Health authorities all over the world are trying to tighten up regulations to discourage young people from using e-cigarettes.

What are e-cigarettes?

An e-cigarette is a long tube that usually resembles a cigarette, a cigar, a pipe, or a pen (pic attached). Most are reusable, with replaceable and refillable cartridges, but some are disposable. The first patent for a "smokeless, non-tobacco cigarette" was requested by Herbert A. Gilbert in 1963, but the current device did not appear until 2003. Thee- cigarette as we know it was invented by Hon Lik, a Chinese pharmacist, working for Golden Dragon Holdings, now known as Ruyan. The company started exporting into major markets in 2005 to 2006. There are now over 460 different brands on the market – none are made in India.

How they work

Most e-cigarettes have a mouthpiece, or cartridge, a heating element, a rechargeable battery, and electronic circuits. As the user sucks on the mouthpiece, a sensor
activates a heating element that vaporizes a flavored, liquid solution held in the mouthpiece. The person then"vapes," or inhales, the aerosol solution. The nicotine content varies from zero to "extra-high," or 24 to 36 milligrams (mg) per milliliter (ml).

Are electronic cigarettes safe?

The e-cigarette may be less hazardous than tobacco for existing smokers, but it appears to bring dangers of its own. E-cigarettes claim to bypass many of the health
risks of tobacco smoking and to offer a more healthful alternative to cigarettes and other conventional forms of nicotine intake. Some studies have found that using e-cigarettes can help some smokers quit. Others suggest they offer "modest" benefits for those who want to quit smoking, but" good potential" for those who are cutting down.

The Centers for Disease Control and Prevention (CDC) in the USA earlier stated that cigarettes can benefit adult smokers who are not pregnant, as long as they completely replace any other nicotine or tobacco products. However, in 2015, 58.8 percent of adult users continued to smoke regular cigarettes. They did not use vaping as a complete substitute for tobacco. The CDC now adds that vaping is not at all suitable: for young people, for those who have never smoked before and during pregnancy Marketing the activity as cool and safe, and offering a variety of flavors, manufacturers are keen to attract teens and adolescents. Vijay started it to appear ‘cool’ and sophisticated. It is a big market. In 2017, market research firm Euromonitor International pegged the value of India's e-cigarette/vaping market at around $15.6 million and projected it to grow at a staggering 60% annually until 2022. According to the Association of Vapers India which promotes the use of vape for its role in reducing smoking, nearly 1.5 million people in India consume e-cigarettes. According to the Global Adult Tobacco Survey 2016-17 (GATS 2), an estimated 0.02% of Indian adults use e-cigarettes. While vaping devices are available for as cheap as Rs 150, the most popular ones cost Rs 1,200-2,000.

Risks

While e-cigarettes may help some people quit, there is growing evidence that vaping is harmful in some cases, and more harmful than avoiding smoking altogether.
Here are 10 reasons why the authorities are concerned:

1. Most e-cigarettes contain nicotine, which is addictive and triggers changes in the adolescent brain. It is hazardous during pregnancy as it can affect fetal development.

2. The aerosol contains solvents, flavorings, and toxicants, which are harmful

3. E-cigarettes expose the lungs to different substances. One of these is dicetyl, which can cause "popcorn lung," a severe and irreversible lung disease.

4. Potentially fatal poisoning has resulted from accidentally swallowing and from inhaling c-cigarette liquid.

5. People who seek to quit smoking will stop using conventional and medically monitored methods of doing so.

6. Those who use or who have used e-cigarettes are less likely to stop smoking altogether.

7. Teens who use e-cigarette products are more likely to start using regular tobacco as well.

8. Continued use of nicotine can make other drugs, such as cocaine, more pleasurable.

9. The flavorings, the marketing, and the concept that it is not harmful all tempt teenagers to start vaping. There is concern that this increases the chance that they will smoke conventional cigarettes later.

10. Second-hand smoking is not eliminated by vaping, as vaping releases carcinogenic emissions.

In addition, experimental use of vaping materials may put teens at higher risk.

Recent research

In January 2018, results were published of lab and animal studies assessing how nitrosamines, present in e-cigarettes, can damage DNA. The researchers found that the ability of lung cells to repair after exposure to e-cigarette smoke was significantly reduced. In addition, the smoke damaged the lungs, bladder, and heart in mice.
E-cigarette kits are available to purchase online. The US CDC is investigating a “cluster” of lung illnesses that it believes may be linked to e-cigarette use after such cases were reported in 14 states. US states have reported 94 possible cases of severe lung illness tied to vaping, primarily among teenagers and young adults. Patients experienced coughing, shortness of breath and fatigue as in my patient Vijay. Some had serious breathing difficulties that required ventilation. As a surgeon operating both on the heart and lungs I have a first-hand account of how smoking can damage the heart and lungs and also cause lung cancer. In fact my Chief in Australia would refuse to operate on stable non-emergency patients who did not commit to stopping smoking and I follow the same dictum. The reason is very scientific – smoking will invariably cause blockage of all the grafts I put in. We know that traditional cigarettes kill up to half of all lifetime users, according to the WHO.

I am all in support of the Government ban. In fact, I would go a step further and ban all tobacco products – period

Dr Harinder Singh Bedi, the author is MCh, FIACS (Gold Medalist) and is Director, Cardio Vascular Endovascular & Thoracic Sciences, at the Ivy Hospital, Mohali, Punjab. He was earlier at the Escorts Heart Institute, New Delhi and the St Vincent’s Hospital, Australia. Dr Bedi is also the Vice President of the Venous Association of India and the Patron & Founder President of the Association of the North Zone Cardio Thoracic & Vascular Surgeons. He is a member Editorial Board, Cardiac Sciences at Specialty Medical Dialogues.