August 29, 2017

Harmless Vapor? The Truth about E-Cigarettes

By Greg Campbell, MD

Many of my patients are turning to e-cigarettes in an attempt to stop smoking. Many cite that they are “better” than traditional cigarettes and are more socially acceptable given the restrictions on smoking in public places.

While I always encourage and applaud any attempts to stop smoking and become tobacco free, I will always interject and ensure people understand that e-cigarettes are not a part of a recommended path to nicotine independence.

At present, the FDA is moving to control the over 7,000 different formulations of e-cigarettes and trying to understand their effects and components. Initially, this market was uncontrolled and unregulated, with many different companies producing e-cigarettes of all sorts. The boom of this market is evident in the many “vaping” stores that have sprung up throughout the country as well as by the large tobacco companies entering the market. Regardless of the manufacture or type of e-cigarettes, the basic premise is that a small battery heats up a volatile liquid creating an aerosolized fluid that is inhaled. The liquid contains nicotine (extracted from tobacco), many carrying compounds, colors and flavors.

The problem with the e-cigarettes is that it remains addictive and is not “better” than a cigarette. The vapor that is produced contains many potential carcinogenic compounds and may expose people to even others that are not fully understood. Formaldehyde, antifreeze, heavy metals, small ultra-fine particles and other chemicals can be present, and their levels vary widely dependent on the manufacturer. Without regulation, we truly do not know what is in the e-cigarette, nor the levels of these compounds. Similarly, secondhand exposure to these chemicals is also not understood. Therefore, e-cigarettes are being prohibited in areas that prohibit smoking. We do know that nicotine is an addictive chemical that is harmful.

The fad of e-cigarettes is attractive to new smokers and teenagers. Many flavors seem targeted to kids – including cotton candy and bubble gum – often disguising the true addictive properties of the nicotine in candy-like marketing. Much work has been done to help prevent people from starting smoking and helping people quit – the current rate of tobacco use is the lowest ever with less than 20 percent of the US population smoking. However, this new marketing approach is a threat to this success and an unfortunate new entry point to the addiction of nicotine. Thankfully, the FDA did ban the sale of e-cigarettes to minors (under age 18) in 2016.

Since 2016, the FDA is working to understand e-cigarettes and control the marketplace similarly to traditional tobacco products. More work is being done to understand the risks. As of yet, no studies have shown that e-cigarettes help people stop smoking, despite initial claims that they did. These studies often show that people continue to smoke traditional cigarettes in addition to the e-cigarettes.

For now, much uncertainty remains in the future of e-cigarettes, but like traditional tobacco products they are likely here to stay. I would urge everyone looking to stop smoking to talk to their doctors and review the many resources that are available and that have been proven to help.

Greg Campbell, MD, is a board certified pulmonologist with Asheville Pulmonary and Critical Care Associates, an affiliate of Mission Health.

Mission Health partners with you to find personalized ways to end dependence on nicotine. For more information to make your best life now or to make an appointment, call 828-213-3222 or visit