World No-Tobacco Day: E-Cigarettes Can Be More Harmful Than Regular Cigarettes, Cause Lung Injury, Experts Say

According to the American Heart Association, e-cigarettes negatively impact the heart's blood flow, possibly more chronically than regular cigarettes. Experts say e-cigarettes cause acute lung injury.

World No-Tobacco Day: Tobacco smoking harms nearly every organ of the body, is responsible for a large number of diseases, including cardiovascular diseases, diabetes, cancer, and chronic obstructive pulmonary disease, and increases the risk for illnesses such as autoimmune diseases, eye problems, tuberculosis, depression and anxiety. However, smoking is not just limited to the use of traditional cigarettes, but also involves electronic cigarettes (e-cigarettes). Using e-cigarettes is also known as vaping. 

The Indian government banned e-cigarettes in September 2019, in the interest of public health, because beyond the issue of nicotine addiction, the ingredients used in flavouring agents and additive agents such as propylene glycol and vegetable glycerine can be harmful for health, a 2020 study published in The Lancet Public Health, said. 

Additive agents such as propylene glycol and vegetable glycerine, when heated, can produce various compounds, including formaldehyde and acetaldehyde. These are carcinogenic to humans. Since the increased use of e-cigarettes among adolescents was of particular concern, the Indian Council of Medical Research recommended through its white paper that e-cigarettes be completely prohibited in India.

However, the study said, Indian authorities are struggling to regulate the use of e-cigarettes in particular due to black market, which is threatening the country's efforts to control tobacco. 

A 2023 study published in the journal Preventive Medical Reports said that e-cigarettes are a continuing public health challenge in India despite comprehensive bans. This is because e-cigarettes are available to young people in India. Surprisingly, those with higher levels of education are among those most likely to vape, while low prevalence of daily vaping was found among educated young adults, the study said. 

The study authors noted that vapers sourced e-cigarettes from retail outlets such as vape shops and tobacconists, and their social networks. 

How e-cigarettes can be more harmful than traditional cigarettes 

According to the Centers for Disease Control and Prevention, e-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavourings such as diacetyl, and other chemicals such as ultrafine particles, volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin and lead, that help to make the aerosol. The aerosol is then inhaled into the lungs. E-cigarettes are also known as "electronic nicotine delivery systems", or ENDS. 

Most e-cigarettes contain nicotine, which is highly addictive, can harm adolescent and young adult brain development, is toxic to developing foetuses, poses a health danger to pregnant adults and their developing babies, harms the heart and lungs, raises one's blood pressure, increases adrenaline levels, raises the heart rate, increases the chances of having a heart attack, and is linked to chronic lung disease and asthma. 

“E-cigarettes or vapes don't contain tobacco. But, they contain nicotine, which is the main addictive substance in tobacco. Nicotine impacts the lungs, heart, blood vessels, and gastrointestinal system in a bad way. It increases the chances of asthma, lung diseases, coronary artery disease, stroke, and gastric ulcer, among others. Nicotine has very high addiction potential and can act as a gateway to other drugs, or smoking tobacco,” Dr Akshat Malik, Senior consultant- Surgical Oncology, Max Super Speciality Hospital, Saket, told ABP Live.

According to Johns Hopkins Medicine, e-cigarettes are just as addictive as traditional ones, but many e-cigarette users get even more nicotine than they would from a combustible tobacco product, because they either increase the voltage of the e-cigarette to get a larger amount of nicotine, or buy cartridges with a higher concentration of nicotine. 

According to the CDC, e-cigarette aerosols contain cancer-causing chemicals and tiny particles that reach deep into the lungs, and acute nicotine exposure is extremely toxic. There are also chances of children and adults being poisoned by breathing, swallowing or absorbing e-cigarette liquid through their skin or eyes. 

The American Heart Association said in a 2019 release that e-cigarettes negatively impact the heart's blood flow, possibly more chronically than traditional cigarettes.

Two separate studies whose findings were presented at the American Heart Association's Scientific Sessions 2019 showed that e-cigarette smokers had more negative heart disease risk factors, which are total and low density lipoprotein cholesterol. Also, e-cigarettes reduce blood flow in the heart. Both studies were published in the American Heart Association Journals.

One of the studies compared cholesterol, triglyceride and glucose levels in healthy adult non-smokers, traditional cigarette smokers, e-cigarette smokers, and dual smokers, and found that total cholesterol and bad cholesterol were higher in sole e-cigarette users than non-smokers. 

The other study found that e-cigarette use is associated with coronary vascular dysfunction, the effect being possibly worse than from smoking traditional cigarettes. 

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In the statement, study author Florian Rader said in smokers who use traditional cigarettes, blood flow increased modestly after traditional cigarette inhalation, and then decreased with subsequent stress, but in smokers who used e-cigarettes, blood flow decreased after both inhalation at rest and after physiologic stress. This indicated that e-cigarette use is associated with persistent coronary vascular dysfunction at rest, even in the absence of physiologic stress. 

Quoting study co-author Susan Cheng, the statement said e-cigarettes may confer potentially even more harm to users, than traditional cigarettes, especially to patients at high risk for vascular disease.

“There are studies of people being admitted in the intensive care unit (ICU), and requiring oxygen and ventilator support because of using e-cigarettes. E-cigarettes contain nicotine, which can produce harmful vapours and can cause severe lung injury. This can lead to a condition called ARDS which is a very serious condition,” Dr Vikas Mittal, Associate Director - Pulmonology, Max Super Speciality Hospital, Shalimar Bagh, told ABP Live.

ARDS refers to acute respiratory distress syndrome, which is a life-threatening condition where the lungs cannot provide enough oxygen to the body's vital organs, due to fluid buildup in the lung alveoli.

Dr Mittal explained that the common notion that e-cigarettes are less harmful can make people more attracted to its use, leading them to using it more frequently.

“Since e-cigarettes were initially promoted as harmless by manufacturers, and because it just contains nicotine vapours, the younger generation is attracted to it. Many teenagers vape in school, which is a major cause of concern. So, not only should the government look into this matter, but also make stricter rules to ensure that these vaping instruments and e-cigarettes are not available on any e-commerce websites, or any other source. People should be made aware about the harmful effects of inhaling nicotine in vapourised form, and the lung injury it can cause. This can be very dangerous, and can lead to acute lung injury. This makes e-cigarettes more dangerous than traditional cigarettes, which usually cause a long term injury,” Dr Mittal said.

As experts said, spreading awareness among people, especially the youth, about the harmful effects of vaping, and stringent measures by the government to ensure that e-cigarettes are not obtained by citizens through any source can help reduce the use of these products.