Position on E-cigarettes

CATS Position on E-cigarettes

Background

The major reason people will use e-cigarettes, or vape as it is commonly known, is for nicotine intake. The e-cigarette devices and the available products for vaporization have been sold by companies as an alternative to combustible tobacco cigarettes and their known harmful effects. Other substances for recreational use, marijuana and illicit drugs, along with flavoured non-nicotine vapours are also known uses of the devices. The health effects of these substances is even less well studied compared to nicotine vaporization

The positions and recommendations herein should be regarded as the product of a non-systematic literature review. They are however in accordance (with some specific societal variations) with the positions advocated by the American Lung Association and the World Health Organization. Our hope is that this recommendation is of utility to CATS members and other stakeholders including our patient community.

Recommendations

• At present the e-cigarettes and nicotine substances for vaporization can cause lung and heart disease with a still unknown concern for carcinogenesis. The recently reported deaths and serious respiratory illnesses worldwide associated with e-cigarettes raises serious concerns regarding their safety. We strongly recommend against their use until adequate regulation is in place.
• Lung health advocacy groups are concerned with respect to the safety of these products as a means for nicotine intake. More extensive and long-term studies to any potentially harmful effects are needed.
• Their use by young people has been shown to increase the use of combustible tobacco products and therefore is a concern and is strongly discouraged.

Evidence

The review of evidence to date suggests the following with respect to e-cigarettes:

1. No randomized trials of traditional cigarettes versus e-cigarettes to compare health or disease outcomes.
2. No long-term observational trials examining health risks of e-cigarettes presently.
3. A number of societies have published position papers on their concerns for patient health related to e-cigarettes as they are a tobacco related product.
4. Most studies of e-cigarettes are related to the analysis of the vapour and identification of lung and cardio-toxic by-products along with identification of known carcinogens.
   • Key findings:
     • Cytotoxic agents propylene glycol and vegetable glycerin are the main ingredients of e-cigarettes.
     • Acetaldehyde, acrolein and formaldehyde are present in e-cigarette vapours and are both lung and cardio-toxins.
     • Second hand vapours include nicotine, diacetyl, benzene, nickel, tin and lead.
     • Vapours from e-cigarettes have been shown to contain known carcinogens such as: tobacco specific nitrosamines, nickel and toluene.
5. Though a safer alternative to combustible tobacco products use of e-cigarettes increases the use by youth and young adults of combustible tobacco products.