Have we done enough to educate patients about e-cigarettes?

Electronic cigarettes (e-cigarettes) have become popular in the United States over the past decade.¹ They have been widely marketed as an alternative to tobacco and as a way to quit smoking.

While the negative effects of smoking tobacco are well known (having as few as one to 4 cigarettes a day triples the risk of coronary artery disease and pulmonary neoplasia²), the potential risks of e-cigarettes are not as well known. There has been limited regulation and insufficient research into the harmful effects of inhaling their vapor.

The potentially harmful compounds within e-cigarette vapors include both organic and inorganic toxins.³ A study of the contents of numerous e-cigarette refills found formaldehyde and acrolein, along with several hydrocarbons.³ Lead, cadmium, and nickel were also found in e-cigarette refills and their inhaled vapors.¹ Lead causes severe neurotoxicity,⁴ cadmium can cause organ damage,⁵ and inhaled nickel causes an inflammatory reaction in the lungs.⁶

The risk-to-benefit ratio of e-cigarettes as a means of tobacco cessation and the health consequences of breathing their vapors cannot be established until research is completed. What we do know is that the nicotine in e-cigarette vapors maintains continued addiction.

It’s up to us as physicians to educate our patients about the potential harm of e-cigarette chemical toxicity and encourage cessation of both tobacco products and e-cigarettes.

Kavitha Srinivasan, MD
Lee Smith, BA
Manasa Enja, MD
Steven Lippmann, MD
Louisville, Ky