E-cigarettes, electronic vaporisers or vapes — we’re all familiar with these shiny, portable devices that young people tote around despite being banned in Singapore as part of a blanket prohibition on imitation tobacco products. Vape pods come in a variety of sweet-tasting flavours that could get anyone hooked, and although they were originally designed as a healthier alternative to cigarettes, they may still be detrimental to lung health.
In Singapore, usage has gone up because of the ease of accessibility and the “cool factor” that comes with the product.
On the 13th October 2021, the US Food and Drug Administration (FDA) approved tobacco-flavoured e-cigarettes for the first time, on the grounds that the benefits it has on adults trying to quit smoking outweighs the risks of new users developing an addiction.
In this article, we cover everything there is to know about e-cigarettes and get valuable insight from the Senior Consultant Surgeon and Medical Director of the International Centre for Thoracic Surgery (ICTS), Dr Aneez.
The FDA said that the manufacturer’s data demonstrates how its tobacco-flavoured products are beneficial for adult smokers who switched to their products from conventional cigarettes, thus reducing exposure to harmful chemicals. In other words, FDA agrees with the manufacturer’s data that CERTAIN e-cigarette products can be a better alternative to conventional cigarettes.
That being said, only tobacco-flavoured products were approved, while sweet flavours, which are more popular with the younger crowd remain unauthorised for sale. This is because data suggest that most youths and young adults who used e-cigarettes start with flavours such as fruit, candy, or mint rather than tobacco. Most new users are drawn to these sweeter flavours and as such FDA considers them to be a higher risk.
It’s a fact that vaping isn’t safe and the risks of various lung diseases that come with vaping are considerably high. In fact, studies show that vaping is as harmful as cigarettes and may also cause cancer.
The American Lung Association expressed clear disappointment at FDA’s decision, noting that these products approved contain nicotine that is addictive and harmful to the brain’s development.
To add to this, Dr Aneez commented that even without nicotine, inhaling the mist may still damage the lungs. He recalls treating several patients who developed chronic wheezing, a symptom of an irritated respiratory system, with symptoms indicating chronic bronchitis, similar to an asthma attack. “The mist comes through a tract of warm air, which contains particulate matter”, the thoracic surgeon explains.
Additionally, ingredients in e-juices are not regulated and can contain dangerous products such as formaldehyde, acrolein and diacetyl which damage the lungs.
Other medical professionals have similar opinions, mainly due to its possible harmful effects on the youth. This is especially noting how more and more youths, children included, are using e-cigarettes.
Evidence of the benefits of e-cigs in aiding smoking cessation is at best theoretical with no definitive evidence. Both the American Lung Association and the American Thoracic Society have said that evidence is still inconclusive. Furthermore, the WHO also does not recognise e-cigs as a legitimate cessation aid.
Singapore’s Ministry Of Health (MOH) shares the same sentiments and mentioned that it is open to reviewing new evidence on vaping’s safety and efficacy for smoking cessation. However, at this current point in time, there is much more evidence showing the harms of e-cigarettes.
E-cigarette liquids contain nicotine, aerosol, and a bunch of other chemicals that can be harmful to the body. Nicotine is very addictive and there is evidence that suggests using e-cigarettes may cause a gateway effect to conventional smoking and other drugs. Research in the US, UK, Canada, and Poland all showed similar results in which those who vape were found to be more likely to become cigarette smokers as compared to non-users.
However, as mentioned earlier, nicotine is just the tip of the iceberg. Chemicals in e-cigarettes are linked to various lung diseases including collapsed lungs and chronic bronchitis. This is not only to the user but also to those who inhale the second-hand vapour. Dr Aneez has also operated on vapers who have suffered from pneumothorax.
“One of these toxic chemicals is benzene, which can cause cancer in all organs of the body and not just the lungs. Another chemical used is formaldehyde, a highly toxic chemical used in embalming dead bodies”, says Dr Aneez.
In Singapore, therapeutic products are regulated under the Health Sciences Authority (HSA) and to date, there has not been any application to register e-cigarettes as a cessation aid.
Even if there is, concerns remain high as it is practically impossible to limit e-cigarette sales to only current smokers. The risks it has on hooking new users, especially adolescents and young adults, will continue to be a huge consideration point. For now, more research needs to be done to understand both the short-term and long-term effects of e-cigarettes. When the time comes, we will have to see how HSA will evaluate the benefits of e-cigarettes as a cessation aid as compared to the risks it lays on the general population.
The truth is, vapes do contain a cocktail of harmful chemicals that can cause cancer, we just don’t know the long term risks of developing cancer and other health effects. However, it is definite that vaping can damage the lungs because of the chemicals we inhale. Additionally, flavours and perfume from vaping can trigger tracheal irritation and inflammation of the lungs and oesophagus.
From a thoracic surgeon’s standpoint, Dr Aneez believes that we should stay cigarette and vape-free to prevent damage to the lungs, and just cause something is seen as the lesser of two evils, doesn’t mean it’s any better for our health.
References:
Cohen, Marisa. “Do I Have Vaping Disease?” WebMD, 31 December 2019, https://www.webmd.com/lung/features/vaping-illness-symptoms. Accessed 20 December 2021.
“Doctors call FDA authorization of e-cigarette sale, marketing alarming.” ABC27, 20 October 2021, https://www.abc27.com/news/health/doctors-call-fda-authorization-of-e-cigarette-sale-marketing-alarming/. Accessed 20 December 2021.
“News Highlights.” MOH | News Highlights, 26 January 2018, https://www.moh.gov.sg/news-highlights/details/faqs-on-e-cigarettes-vaporisers-and-heat-not-burn-tobacco-products. Accessed 20 December 2021.
“THE STRAITS TIMES: VAPING IS HARMFUL AND NOT COOL, SAYS LUNG SURGEON - International Centre For Thoracic Surgery.” International Centre For Thoracic Surgery ICTS, 12 April 2021, https://www.icts.com.sg/the-straits-times-vaping-is-harmful-and-not-cool-says-lung-surgeon/. Accessed 20 December 2021.
“Vaping: FDA approves e-cigarette in US for first time.” BBC, 13 October 2021, https://www.bbc.com/news/world-us-canada-58897141. Accessed 20 December 2021.
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