Have we done enough to educate patients about e-cigarettes?

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Have we done enough to educate patients about e-cigarettes?

Electronic cigarettes (e-cigarettes) have become popular in the United States over the past decade.1 They have been widely marketed as an alternative to tobacco and as a way to quit smoking.

While the negative effects of smoking tobacco are well known (having as few as one to 4 cigarettes a day triples the risk of coronary artery disease and pulmonary neoplasia2), the potential risks of e-cigarettes are not as well known. There has been limited regulation and insufficient research into the harmful effects of inhaling their vapor.

The potentially harmful compounds within e-cigarette vapors include both organic and inorganic toxins.3 A study of the contents of numerous e-cigarette refills found formaldehyde and acrolein, along with several hydrocarbons.3 Lead, cadmium, and nickel were also found in e-cigarette refills and their inhaled vapors.1 Lead causes severe neurotoxicity,4 cadmium can cause organ damage,5 and inhaled nickel causes an inflammatory reaction in the lungs.6

The risk-to-benefit ratio of e-cigarettes as a means of tobacco cessation and the health consequences of breathing their vapors cannot be established until research is completed. What we do know is that the nicotine in e-cigarette vapors maintains continued addiction.

It’s up to us as physicians to educate our patients about the potential harm of e-cigarette chemical toxicity and encourage cessation of both tobacco products and e-cigarettes.

Kavitha Srinivasan, MD
Lee Smith, BA
Manasa Enja, MD
Steven Lippmann, MD

Louisville, Ky

References

1. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129:1972-1986.

2. Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control. 2005;14:315-320.

3. Varlet V, Farsalinos K, Augsburger M, et al. Toxicity assessment of refill liquids for electronic cigarettes. Int J Environ Res Public Health. 2015;12:4796-4815.

4. Skerfving S, Löfmark L, Lundh T, et al. Late effects of low blood lead concentrations in children on school performance and cognitive functions. Neurotoxicology. 2015;49:114-120.

5. Bernhoft RA. Cadmium toxicity and treatment. Scientific-World-Journal. 2013;2013:394652.

6. Das KK, Buchner V. Effect of nickel exposure on peripheral tissues: role of oxidative stress in toxicity and possible protection by ascorbic acid. Rev Environ Health. 2007;22:157-173.

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Electronic cigarettes (e-cigarettes) have become popular in the United States over the past decade.1 They have been widely marketed as an alternative to tobacco and as a way to quit smoking.

While the negative effects of smoking tobacco are well known (having as few as one to 4 cigarettes a day triples the risk of coronary artery disease and pulmonary neoplasia2), the potential risks of e-cigarettes are not as well known. There has been limited regulation and insufficient research into the harmful effects of inhaling their vapor.

The potentially harmful compounds within e-cigarette vapors include both organic and inorganic toxins.3 A study of the contents of numerous e-cigarette refills found formaldehyde and acrolein, along with several hydrocarbons.3 Lead, cadmium, and nickel were also found in e-cigarette refills and their inhaled vapors.1 Lead causes severe neurotoxicity,4 cadmium can cause organ damage,5 and inhaled nickel causes an inflammatory reaction in the lungs.6

The risk-to-benefit ratio of e-cigarettes as a means of tobacco cessation and the health consequences of breathing their vapors cannot be established until research is completed. What we do know is that the nicotine in e-cigarette vapors maintains continued addiction.

It’s up to us as physicians to educate our patients about the potential harm of e-cigarette chemical toxicity and encourage cessation of both tobacco products and e-cigarettes.

Kavitha Srinivasan, MD
Lee Smith, BA
Manasa Enja, MD
Steven Lippmann, MD

Louisville, Ky

Electronic cigarettes (e-cigarettes) have become popular in the United States over the past decade.1 They have been widely marketed as an alternative to tobacco and as a way to quit smoking.

While the negative effects of smoking tobacco are well known (having as few as one to 4 cigarettes a day triples the risk of coronary artery disease and pulmonary neoplasia2), the potential risks of e-cigarettes are not as well known. There has been limited regulation and insufficient research into the harmful effects of inhaling their vapor.

The potentially harmful compounds within e-cigarette vapors include both organic and inorganic toxins.3 A study of the contents of numerous e-cigarette refills found formaldehyde and acrolein, along with several hydrocarbons.3 Lead, cadmium, and nickel were also found in e-cigarette refills and their inhaled vapors.1 Lead causes severe neurotoxicity,4 cadmium can cause organ damage,5 and inhaled nickel causes an inflammatory reaction in the lungs.6

The risk-to-benefit ratio of e-cigarettes as a means of tobacco cessation and the health consequences of breathing their vapors cannot be established until research is completed. What we do know is that the nicotine in e-cigarette vapors maintains continued addiction.

It’s up to us as physicians to educate our patients about the potential harm of e-cigarette chemical toxicity and encourage cessation of both tobacco products and e-cigarettes.

Kavitha Srinivasan, MD
Lee Smith, BA
Manasa Enja, MD
Steven Lippmann, MD

Louisville, Ky

References

1. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129:1972-1986.

2. Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control. 2005;14:315-320.

3. Varlet V, Farsalinos K, Augsburger M, et al. Toxicity assessment of refill liquids for electronic cigarettes. Int J Environ Res Public Health. 2015;12:4796-4815.

4. Skerfving S, Löfmark L, Lundh T, et al. Late effects of low blood lead concentrations in children on school performance and cognitive functions. Neurotoxicology. 2015;49:114-120.

5. Bernhoft RA. Cadmium toxicity and treatment. Scientific-World-Journal. 2013;2013:394652.

6. Das KK, Buchner V. Effect of nickel exposure on peripheral tissues: role of oxidative stress in toxicity and possible protection by ascorbic acid. Rev Environ Health. 2007;22:157-173.

References

1. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129:1972-1986.

2. Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control. 2005;14:315-320.

3. Varlet V, Farsalinos K, Augsburger M, et al. Toxicity assessment of refill liquids for electronic cigarettes. Int J Environ Res Public Health. 2015;12:4796-4815.

4. Skerfving S, Löfmark L, Lundh T, et al. Late effects of low blood lead concentrations in children on school performance and cognitive functions. Neurotoxicology. 2015;49:114-120.

5. Bernhoft RA. Cadmium toxicity and treatment. Scientific-World-Journal. 2013;2013:394652.

6. Das KK, Buchner V. Effect of nickel exposure on peripheral tissues: role of oxidative stress in toxicity and possible protection by ascorbic acid. Rev Environ Health. 2007;22:157-173.

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The Journal of Family Practice - 64(8)
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Have we done enough to educate patients about e-cigarettes?
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Have we done enough to educate patients about e-cigarettes?
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Kavitha Srinivasan, MD; Lee Smith, BA; Manasa Enja, MD; Steven Lippmann, MD; e-cigarettes; electronic cigarettes; tobacco; smoking; coronary artery disease; CAD; cigarettes
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