E-Cigarettes are marketed as “safer” than a conventional cigarette. There is a growing misconception that they are harmless. The US Food & Drug Administration (FDA), however, has indicated that they contain a number of toxins and carcinogens, including tobacco specific Nitrosanines Diethylene Glycol, and other components harmful to humans.
In January 2013 the BMA published a paper calling for stronger regulation of E-Cigarettes, expressing concern that there was no peer-reviewed evidence that they are either safer or effective in helping smokers to cut down or quit smoking.
In a number of countries, including Denmark, Canada, and Australia, the sale, import or marketing of E-Cigarettes are either banned or regulated, and in others (e.g. New Zealand) E-Cigarettes are regulated as medicines, and can only be purchased in pharmacies. In the UK, however, there are few restrictions on the sale and use of these Cigarettes. They are governed by the General Product Safety Regulations 2005, and the Chemicals (Hazard, Information & Packaging for Supply) Regulations 2009, and by Trading Standards. They are, however, not restricted by age, and can be sold to children.
An E-Cigarette is a battery powered product designed to replicate smoking behaviour, without the use of tobacco. They consist of a cartridge containing liquid nicotine, an atomiser (heating element), a rechargeable battery, and electronics. They turn nicotine, flavour and other chemicals into a vapour that is inhaled by the user. In February 2014, a paper by Constantine Vardavas & Others featured in Chest Magazine entitled “Short Term Pulmonary Effects of Using an Electronic Cigarette”. They claimed that theirs was the first study to find a physiologic response after inhaling from an E-Cigarette. Within 5 minutes of use, the study showed an increase in the lung flow resistance over a range of frequencies, and was related to a decrease in the fraction of exhaled nitric oxide concentrations. Whilst recognising its own limitations, the paper called for the American FDA to pursue the regulation of E-Cigarettes until the manufacturers provide scientific evidence to support their claims.
There is clearly a need for a continued discussion about the promise and perils of E-Cigarettes, and a pressing need for scientific clarity as to their safety or otherwise. Whilst there is an undoubted reduction in the health risk to a smoker of a tobacco Cigarette and, therefore, provide an opportunity for deaths from smoking to reduce from nearly 6 million deaths annually, from a predicted death toll of 1 billion within the 21st century (World Health Organisation 2013).The uncertainty as to the risk resulting from inhalation of the vapour produced, particularly to workers and others who inhale the vapours indirectly from close proximity of E-Cigarette smokers should not be under estimated at this time.
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