When a patient tells me they smoke cigarettes, they usually know the next thing I will say: “You need to quit.” 

After years of public educational campaigns, it should come as no surprise that smoking cigarettes causes many preventable illnesses. Smoking causes everything from cancer to simply making breathing harder. You may not feel the effects of smoking today or tomorrow, but you will feel them eventually. 

The most harmful part of a cigarette is the tar and other irritants in each puff of smoke. The addictive part of a cigarette, however, is the nicotine. That is why the majority of cessation aids from gums to patches and lozenges focus on providing the nicotine without all of the other toxic chemicals in a cigarette. What these methods miss, however, is replacing the physical act of smoking.

Enter electronic nicotine delivery systems, more commonly known as e-cigarettes, to fill that need. E-cigarettes work by vaporizing a liquid that is then inhaled; thus the term “vaping” to describe the use of an e-cigarette. The first e-cigarettes became available in the US in 2007 and the most famous brand currently is Juul.  E-cigarettes are certainly safer than conventional cigarettes. They contain far fewer chemicals and allow you to control the amount of nicotine being inhaled. But safer does not mean safe. E-cigarettes still deliver chemicals to the lung that do not need to be there.

If you keep up with the news, you have heard about a number of mysterious respiratory-related deaths that started over the summer of 2019. Investigations by the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) eventually led a new diagnosis: e-cigarette or vaping associated lung injury (EVALI). 

During the investigation, a number of “vapers” had samples of their lung fluid tested. Of these patients, all of them contained Vitamin E-acetate while none of the healthy control subjects did. 

Of the samples with vitamin E-acetate, 86% contained tetrahydrocannabinol (THC), the main psychoactive component of marijuana. Only 62% of these samples contained nicotine. Further investigation found that products used in these cases were often second-hand or not manufactured by established companies.

That does not mean it is safe to vape using nicotine containing e-cigarettes. Nor is it a license to vape using nicotine free e-cigarettes. And certainly no one should start vaping recreationally or socially. The long term effects of any kind of vaping are unknown. The black market nature of second-hand e-cigarette liquid adds an extra layer of uncertainty and danger. The safest thing to do is to not smoke or vape at all.  

For current users, I realize that it may be unrealistic to expect cessation from the beginning, so I encourage smokers to start with smoking moderation and step from there to complete cessation. 

That’s where vaping can have a role. Several studies have shown improved lung function in smokers who switched to vaping compared to those who continued smoking regular cigarettes; therefore, for those already smoking, vaping nicotine-only e-cigarettes may be a stepping stone to that goal of complete cessation.