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Cigarettes, Cigars, or Vapes?

How often have we come across this debate? The debate that the health risks of smoking combined with people’s neglect have created far more detrimental effects for our health system than we are prepared to admit. E-cigarettes have significantly replaced cigarettes and cigars but are they a better choice? E-smoking has acquired a good prognosis as an ultimate nicotine maintenance device via NRT (Nicotine Replacement Therapy) for people wanting to quit smoking. A CDC study showed a decrease from 21% to 12.5% among the smoking population in a recent study.

NICOTINE – Why is it everywhere?

Be it cigars, cigarettes, or anything smokeable; nicotine is common to most. What really accounts for its abundance? We know that nicotine is a psychostimulant that is easily absorbed from body surfaces i.e., skin, mucus membrane, and respiratory epithelia alike. It acts as a neurotransmitter that in turn stimulates the release of dopamine, which contributes to the feeling of pleasure and satisfaction as part of the reward pathway. It is this property that makes it addictive. Nicotine has long been used clinically to treat various conditions like obstructive sleep apnoea, anxiety, neurodegenerative, and neuromuscular disorders. Nonetheless, it has derived its reputation as an element of recreational use.

E-Smoking VS Cigarettes

Vaping was initially considered safe because its mechanism does NOT involve actual combustion. Rather, super-heated fluids form a ‘mist’ that is inhaled. This widely spread assumption has been nullified multiple times by scientific studies and statistics.

Conventional cigarettes however rely on a combustible tobacco residue that releases smoke along with several intoxicants ready for consumption. While this is a serious drawback, we must compare the long-term detrimental effects of both on a person’s health. These disastrous effects of smoking develop slowly and become evident and concerning only later in life. A phenomenon referred to as ‘the smoking time bomb’.

Cigars, on the other hand, are harmful yet relatively safer. Cigars are purified stimulants that are absorbed in doses much larger than a cigarette in one use. Fortunately, there is a discontinuity in successive doses. This means that cigars have more immediate adverse effects upon usage than long-term side effects in chronic states of health. However, some studies show that cigar smoking can cause cancers of the lung, oral cavity, larynx, and esophagus as well as cardiovascular disease. Those who smoke cigars heavily or inhale deeply also increase their risk of developing chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema.

A Case Study in E-Cigarettes

McCauley et al. presented a case study of a 42-year-old woman diagnosed with exogenous lipoid pneumonia due to vaping. She had a history of 7 months of productive cough, fevers, and dyspnoea which occurred at the same time as her use of e-cigarettes. After several laboratory tests, glycerine, which is a component added to e-cigarette liquid to produce visible smoke to simulate the cigarette smoking experience, was found to be the causative agent. The symptoms improved by vaping cessation.

This example is anecdotal at the least and all consumers should educate themselves about the potential harm they are putting themselves under.

Why ENDS are abortive.

Electronic nicotine dispensing systems (ENDS) were formulated back in 1963 when conventional smoking posed serious threats to an individual’s health. The aim was to invent a socially acceptable alternative to smoking.

However, a countercyclical approach towards this would be a societal bias associated with its safety. We know that ‘NO SMOKING’ zones hold invalid for e-cigarettes. This means that people can vape anywhere and anytime. This eventually will result in a larger than normal dosage intake for nicotine. The vapors from e-cigarettes contain, besides nicotine and the respiratory irritant propylene glycol, toxic substances also seen in cigarette smoke, such as acrolein, acetaldehyde, formaldehyde, and reactive oxygen species. These toxic substances may well cause oxidative stress and negative effects on cardiovascular and respiratory function after vaping, casting doubt on the idea that e-cigarettes are a suitable ‘healthy’ alternative to normal cigarettes.

ENDS are thus rejected by FDA for their narrow safety window.

Weighing Your Choices– A comparison

It’s time for us to take one last good look at the ongoing debate. Cigarette packages contain warning labels like ‘Smoking kills’ and ‘Smoking clogs the arteries and causes heart attacks and stroke’. Statistically, it causes more than 7 million deaths per year globally and is a major healthcare concern worldwide. Long-term detrimental effects are due to low concentration, frequent exposure, and increased dependency. One can expect lung, mouth, and oropharyngeal cancers, emphysema, chronic bronchitis, drug dependency, sterility, insomnia, anxiety, etc.

Vaping is an unrestricted zone and almost all age groups now have access to e-cigarettes. Typically, a 5ml bottle of e-cigarette refill solution consists of 20 mg/ml nicotine which is 100 mg/bottle (a life-threatening dose of nicotine is around 30 to 40 mg in adults). Prolonged and repeated exposure to propylene glycol vapor has been reported to cause cough, irritation of the eyes and lungs, and an increased risk of getting asthma. High concentrations of inhaled nicotine or skin contact may cause nausea, vomiting, or dizziness. Such risks are even higher in vaping than in smoking, where such poisonous nicotine levels rarely occur.

The Wrap-Up

Dr. Cireddu of Harvard said: “The question becomes how prepared are e-cigarette users to act as guinea pigs for the ill effects of a plethora of superheated chemicals on their hearts and lungs that we may not fully grasp until decades into the future?” From the above arguments, we can conclude that neither smoking nor vaping is beneficial to human health. Researchers know more about the long-term effects of smoking than those of vaping. Based on the available evidence, smoking appears more harmful than vaping. However, this does not mean that vaping should be considered safe.