E Cigarettes Flashcards
history of Ecigs
Term for a family of non-tobacco nonmedicinal nicotine delivery systems
Invented in 2003, by a Chinese pharmacist Hon Lik
- On sale in 2004
500 brands of ecigs mainly made in China
Ecigs the fastest growing product in British supermarkets in 2014
- See everywhere now
evolution of ECigs
1st generation: cigalikes
Rechargeable or disposable
2nd generation: tank (refillable)
3rd generation: big tank (customisable)
- Change constituents
what is an ECig?
Ecigs have a mouthpiece, battery, cartridge, atomiser or cartomizer (modern combination of atomiser and cartridge)
Current passes through a resistance coil that is in contact with a fluid.
Heat generates an aerosol, the vapour
Variety of formats, large tank systems most popular
- In 2020, 77% use tank systems
19% use cartridge pod systems (Juul systems etc ) newest addition to ecig range
- More subtle
what’s in the liquid in ECig (4)
Propylene glycol (PG)
- Thinner, more flavour, throat hit
- In asthma inhalers
Vegetable glycerine (VG)
- Thicker, big clouds, smoother smoke
- Cough medicine
Natural/ artificial flavourings
Nicotine level, mg/ml / 0.0%
- 0%, 1.5/0.15%, 3, 6, 12, 18 mg/ml
Also quote the % of PG and VG.
- Culture wyld75% VG 25% PG
- Vaporised Coconut PG 65% VG 35%
vegetable glycerine (VG)
- Thicker, big clouds, smoother smoke
- Cough medicine
propylene glycol (PG)
- Thinner, more flavour, throat hit
- In asthma inhalers
what is vaping
Vaping is the act of inhaling and exhaling the water vapour produced by an electronic device
E-liquid in gaseous form
Looks like thick smoke but dissipates more quickly
Smells better
nicotine
ADDICTIVE
Nicotine is the addictive element, in both tobacco and ecigs
Liquid nicotine level, max strength 20mg/ml , and many liquids are below that strength
‘90% of non smokers and 75% of smokers in Great Britain believe that nicotine is harmful to health, a fundamental misconception that we have not changed.
- It is the many other toxicants in cigarettes that cause disease & death’
who uses ECigs?
Population of GB adult vapers (18+)
In 2020
- Ex smokers are the highest users of ecigs (58.9%)
- Moderate numbers of smokers are use Ecigs and smoke(38.3%)
- Low numbers of non smokers use ecigs (2.9%)
smokers using ECigs
Ex smokers are the highest users of ecigs (58.9%)
In 2020, 64.1% of adult smokers have ever tried ecigs.
- Of smokers, 32.4% of smokers have never tried ecigs.
- Of smokers, 17.4% are co users of cigarettes and ecigarettes.
why use ECigs?
Main reason for vaping among smokers and ex smokers who vape GB 2020
For exsmokers, ‘stopping smoking’( 42 %) followed by ‘keep off tobacco (24%) main reasons
For co users (smoke+ecigs) cut down smoking (24%) main reason
- Harm reduction
maximum tar yields and nicotine relationship
present maximum tar yields are 12mg per cigarette, and there is no limit on nicotine (though this tends to have a roughly fixed 1:10 ratio to tar).
There is no meaningful regulation of tobacco additives - some 600 are approved for use in the UK.
- smokers adjust their smoking by taking more or deeper puffs and blocking filter holes to take in the nicotine they are seeking.
Smoking machines are not seeking nicotine and don’t ‘compensate’ in this way.
- Simply further reducing tar yields will make little difference to the amount of tar taken in by smokers.
Similar problems face any attempt to reduce nicotine - indeed an approach that increased nicotine concentrations in smoke could reduce tar intake for a given nicotine dose.
Patents show that the tobacco companies can remove specific toxic smoke constituents with chemically active filters, catalysts or manufacturing processes.
The warnings on packs are thought to be ineffective
- larger, bolder, high contrast hard hitting warnings have some success in Australia and Canada.
how to reduce tar intake by smokers
Smoking machines are not seeking nicotine and don’t ‘compensate’ in this way.
- Simply further reducing tar yields will make little difference to the amount of tar taken in by smokers
Indeed an approach that increased nicotine concentrations in smoke could reduce tar intake for a given nicotine dose.
Patents show that the tobacco companies can remove specific toxic smoke constituents with chemically active filters, catalysts or manufacturing processes..
nicotine additives in cigarettes
There is no meaningful regulation of tobacco additives - some 600 are approved for use in the UK.
- smokers adjust their smoking by taking more or deeper puffs and blocking filter holes to take in the nicotine they are seeking.
- that is what they are addicted to
Smoking machines are not seeking nicotine and don’t ‘compensate’ in this way.
- Simply further reducing tar yields will make little difference to the amount of tar taken in by smokers.
Additives need to be assessed for the impact they have on smoking behaviour - not just their own toxicity.
- An additive does its damage indirectly by contributing to increased smoking.
ECig Shops
Ecigs and liquids freely available
Online suppliers
Specialist suppliers have sprung up everywhere, sell devices and liquids
Liquids now legally sold only in smaller sizes (10ml), though can be purchased in multipacks
Tank size limited to 2ml
Ex-current smokers
Banned for under 18s
Strongly advise against buying to non-smokers
why do people use ECigs
Aid to quitting (evidence)
Less toxic alternative (evidence)
Cheaper alternative
Harm reduction/reduce smoking
Alternative to cigs when cigs are banned
Hand to mouth habit maintained
Psychosocial aspect of addiction maintained
Recreation and socialisation
Vaping community
public health pros to ECigs (2)
Public health costs of smoking are vast
Consideration must be given to harm reduction argument, because tobacco so lethal
I can think of no other area, in 30 years, where public demand has leapt ahead, leaving the development of the evidence base, policy and regulation, trailing behind
public health cons to ECigs (4)
Renormalisation of smoking?
Gateway or pathway?
Evidence Base?
Involvement of Big Tobacco Firms
NICE 2013, updated 2018
Encourage those who can’t quit, to cut down ( harm reduction)
Good communication about the relative safety of nicotine
Ecigs ( 2018)
Many people have found them helpful to quit smoking cigarettes
People using e-cigarettes should stop smoking tobacco completely, because any smoking is harmful
3 guidances on ECigs
NICE 2013, updated 2018
Royal College of Physicians Report Harm Reduction 2016
NHS Health Scotland 2017
Royal College of Physicians Report Harm Reduction 2016
‘…the hazard to health arising from long term vapour inhalation from the e cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco…’
- Not harmless but less harmful
‘…e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely…’
‘….in the interests of public health it is important to promote the use of ecigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK…’
NHS Health Scotland 2017
more cautious advice in favour of ecigs
Outlines their use as a route to quitting (rather than harm reduction)
Emphasises that ECIGS NOT RISK FREE, and don’t fully know long term implications.
safety of ECigs
Safety of devices
Number of examples of exploding batteries
Case study of the management of such patients JADA 2016
Cluster of lung disease deaths in the US not repeated in UK (linked to THC use – particular brand in US)
Safety of liquids
We know that they are much safer than cigarettes, but are they safe?
oral side effect of ECigs
Largely unknown.
- Surprisingly little attention considering the relationship between e-cigarette aerosols will contact oral mucosa when they are at their hottest.
Mouth and throat dryness
Oral cancer?
Periodontal disease?
Benign mucosal lesions?
Lichenoid eruptions associated with use of an ecigarette
evidence of use of ECigs and success in quitting
Pathway to Quitting – Evidence
Evidence base still developing (Cochrane updated on 14 Oct 2020)
50 trials with 12,430 adults who smoked
- For 100 people using nicotine ecigs, 10 would stop smoking compared to 6 using NRT/non nicotine ecigs and 4 with behavioural support/no support
Side effects mouth irritation, headache, cough feeling sick
Further high quality work needed
patient’s perspective on ECigs may be
Quitting is hard. I tried an EC, not as good as a cig, but I could live with it.
Are they worth the bother?
Are they any better than cigarettes?
What would you say?
advice for smokers who want to quit strategies
Ask, advise, refer
Ask advise assist
advice for Co-Users
Encouragement that they are reducing their exposure to tobacco by using ecigs
While it is likely they are safer, evidence base is still developing, particularly with regards to oral health.
advice for E cig uses (ex smoker)
Strong encouragement that they have quit tobacco
Evidence base still developing, with regards to e cigs.
smoke Vs ECig
There are NO circumstances where it is safer to smoke, than to use e cigarettes.
With so many controversies and lack of long-term studies, it is not surprising the we are naturally cautious, with no defining guidelines with regards to existing?
