Electronic Cigarettes (E-Cigarettes): Good, Bad, or Indifferent?

                 

      An electronic cigarette (or e-cigarette),electronic vaping device, personal vaporizer (PV), or electronic nicotine delivery system (ENDS) is an electronic inhaler meant to simulate and substitute for tobacco smoking. It generally employs a heating element that vaporizes a liquid solution. Some release nicotine, while some merely release flavored vapor. Although they are often designed to mimic traditional cigarettes in their appearance, more devices are not trying to imitate them. The benefits and risks of these products are, as of 2013, uncertain, but they are likely safer than smoking tobacco. Laws vary widely concerning their use and sale, and are the subject of pending and ongoing debate.

    E-cigarettes are the latest fad sweeping this country. Their sales increased from 50,000 in 2008 to 3.5 million in 2012.  As of 2011, in the United States, one in five adults who smoke has tried electronic cigarettes.  Hon Lik, a Chinese pharmacist, is widely credited with the invention of the first generation electronic cigarette. In 2003, he came up with the idea of using an ultrasound-emitting element to vaporize a pressurized jet of liquid containing nicotine diluted in a propylene glycol solution. This design produces a smoke-like vapor that can be inhaled and provides a vehicle for nicotine delivery into the bloodstream via the lungs. The device was first introduced to the Chinese domestic market in May 2004 as an aid for smoking cessation and replacement. The company that Hon Lik worked for started exporting its products in 2005–2006. Several e-cigarette models marketed by tobacco companies were launched or are set to launch in 2013, including the Vuse, MarkTen, and Vype. Blu, a prominent e-cigarette producer, was also acquired by Lorillard Inc., a tobacco industry leader, in 2012.

   Smokers have access to these products and, unless bad effects surface, they are unlikely to be banned in the near future. Since non-smoking children occasionally try them, they should be prevented from access to these products without parental consent.

   So are these “cigarettes” effective in aiding smokers in their attempts to quit? To answer this, a clinical trial in 2013 (Lancet, Sept 9) evaluated the comparative efficacy of 16 mg. nicotine e-cigarettes, nicotine patches (21-mg patch, one daily), or placebo e-cigarettes (no nicotine). All were adult smokers and wanted to stop smoking.  This study lasted for 13 weeks and smoking abstinence was assessed after 6 months. Although not dramatic, the e-cigarettes did show a modest rate (7.3%) of abstinence versus a 5.8% rate with the patches and 4.1% rate with the placebo.

   But are e-cigarettes safe? Unfortunately we have no long-term safety data on the impact of repeated inhalation of propylene glycol or vegetable glycerin on lung tissue. Some short-term data suggest that they may cause airway (bronchial) irritation, but to what extent and how that compares to standard cigarettes are unknowns.

   Currently, e-cigarette manufacturers are devoting attention toward manufacturing and marketing rather than creating reliable scientific data about these products. Theoretically, if these products contain only nicotine and no other known carcinogens, they should at least reduce the risk of cancer.

   So where do we stand regarding whether we should recommend use of these products? I conclude with points below:

   1. At present, e-cigarettes are not clearly superior to Food and Drug Administration-approved medications for smoking cessation.

   2. They are not yet FDA approved for treatment.

   3. Short-term safety data suggest they may cause lung irritation.

   4. Long-term safety data do not exist. Until recommending these products, we need more data.

    Thus at present we are largely in uncharted waters!

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A FEW TIPS ABOUT PAIN-KILLERS

             The nonsteroidal anti–inflammatory drugs (NSAIDs) are used to treat mild and moderate pain due to many non-serious conditions, including osteoarthritis (degenerative arthritis of aging), headaches and migraines, menstrual periods and muscle soreness. With 70 million prescriptions each year in the U.S., NSAIDs are one of the most commonly used types of medications.

Let’s focus here on osteoarthritis, which affects about 27 million Americans, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Although it occurs in younger people, it’s seen most commonly in adults age 65 and older.

A good way to treat osteoarthritis, if medication is needed, is with an NSAID. These drugs block the production of substances in the body called prostaglandins, which play a role in pain, inflammation, fever, and muscle cramps and aches. At low doses, NSAIDs work essentially as pain relievers. At higher doses, though, they not only relieve pain but can actually reduce the body’s inflammatory response and may minimize tissue damage.

Most oral forms of NSAIDs are now available as less expensive generic forms. And three are available in lower-dose formulations as nonprescription over–the–counter drugs: acetylated salicylates (Aspirin, Bufferin, and generic), ibuprofen (Advil, Motrin, and generic), and naproxen (Aleve and generic). Although their costs vary from about $4 to more than $300 a month, sticking to those noted below will save lots of money, but first discuss with your doctor about the medicine and dose that is right for you, along with possible risks.

All NSAIDs should be used with caution, for they can cause serious side effects, including stomach ulcers, gastrointestinal bleeding, heart attack, and stroke. Most NSAIDs (except for low–dose aspirin) may not be appropriate for people at risk of heart disease or stroke. In any event don’t take them for long periods of time without consulting a doctor.

   My two favorite choices are noted below (both available over-the-counter)

           1) Ibuprofen – (Advil, Motrin and generic)

           2) Naproxen – (Aleve and generic)

These two medicines are inexpensive and are as effective and safe as other NSAIDs when used appropriately. Following are some of the points to take into account:

1) If you have had a stomach ulcer or bleeding, or are at high risk of either, avoid using NSAIDs. The risk of bleeding from NSAID use increases with age. Even if you’re not having such problems, try to avoid taking any of this class of drugs on an empty stomach.

2) If you have heart disease or are at risk of heart attack or stroke, talk with your doctor about the potential risks of taking any NSAID regularly for long periods, especially at high dosage levels. Of all the members of this category, naproxen appears to be free of these cardiovascular risks.

3) Take the lowest dose of an NSAID that brings relief and do not take any longer than necessary.

4) If you have kidney disease or high blood pressure, talk with your doctor about the risks of taking NSAIDs for long periods of time.

 5) NSAIDs can interact with other medicines to cause serious side effects. If your doctor prescribes an NSAID, tell him or her about any other medicines or dietary supplements you are taking.