DefinePK

Abstract

https://doi.org/10.5455/JPMA.65779

 

Madam, Since the year 2010, the use of electronic cigarettes (e-cigarettes) has increased significantly. This could be attributed to the devices being marketed among the masses as a healthier alternative and facilitator for the cessation of conventional smoking. However, there is little scientific evidence to support these claims, and therefore their efficacy as a safer choice to tobacco smoking still remains disputed.1

In Pakistan, the use of electronic cigarettes or “vaping” is highest among adolescents, mainly for recreational purposes. A study conducted in Pakistan revealed that a significant amount of population was oblivious to the detrimental effects with the use of e-cigarettes and a major proportion considered e-cigarettes safe for use in pregnancy.2

Considering the six deaths which occurred in the United States of America (USA) due to vaping, the safety and regulation of e-cigarettes are now being reconsidered. As of September 2019, Centers for Disease Control (CDC) reports 380 cases of lung illness associated with the use of e-cigarette products.3 While the Food and Drug Administration (FDA) along with the CDC is currently investigating the cause of this vaping illness, liquids which contained cannabinoid products namely tetrahydrocannabinol (THC) and vitamin E acetate are presently being considered as the main culprit.

A study conducted among adolescents in the state of Colorado found that the use of e-cigarettes is significantly associated with symptoms of wheezing, and bronchiolitis such as the daily productive cough.4 Advanced experimental studies suggest that vaping increases the susceptibility of the airway to infections such as pneumococcal.5 The results from two randomized controlled trials published in a single study showed that vaping caused injury to airway epithelium (seen by increased CC16 levels and small airway constriction). Moreover, vaping led to decreased transcutaneous oxygen tension (a measure of the level of oxygen of tissues underneath the skin) and impaired arterial oxygen tension.6 The toxicity of e-cigarettes should be gauged in relevant model systems such as bronchial or alveolar epithelium. Prospective cohort studies should be carried out that follow individuals using e-cigarettes for a significant duration of time. Preventive guidelines issued by CDC recommend that e-cigarettes should not be considered as an alternative for smoking cessation. Pregnant women and young people should refrain from using e-cigarettes. Additionally, vaping products should not be bought from unauthorized places. As the use of e-cigarettes is increasing in Pakistan, the need to address this issue is dire. Public awareness and educational messages should be broadcasted on television. Health-care professionals should be vigilant and, must advise their patients and community against the use of e-cigarettes.

 

Disclaimer: None to declare

Conflict of interest: None to declare

Funding disclosure: None to declare

 

References

 

1.      Tomashefski A. The perceived effects of electronic cigarettes on health by adult users: a state of the science systematic literature review. J Am Assoc Nurse Pract. 2016;28:510-5.

2.      Sarfraz M, Khan HAR, Urooba A, Manan Z, Irfan O, Nadeem R, et al. Awareness, use and perceptions about E-cigarettes among adult smokers in Karachi, Pakistan. J Pak Med Assoc. 2018;68:147.

3.      Centers for Disease Control and Prevention. Smoking & Tobacco Use. [Online]. [Cited 2019 Sept 10]. Available from: https://www.cdc.gov/tobacco/index.htm.

4.      McConnell R, Barrington-Trimis JL, Wang K, Urman R, Hong H, Unger J, et al. Electronic cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med. 2017;195:1043-9.

5.      Miyashita L, Suri R, Dearing E, Mudway I, Dove RE, Neill DR, et al. E-cigarette vapour enhances pneumococcal adherence to airway epithelial cells. Eur Respir J. 2018;51:1701592.

6.      Chaumont M, van de Borne P, Bernard A, Van Muylem A, Deprez G, Ullmo J, et al. Fourth generation e-cigarette vaping induces transient lung inflammation and gas exchange disturbances: results from two randomized clinical trials. Am J Physiol Lung Cell Mol Physiol. 2019;316:L705-L719.