Vaping versus Smoking: A Quest for Efficacy and Safety of E-cigarette.

BACKGROUND: Electronic Cigarettes (ECIGs) are devices with a heating element which produces aerosol for inhalation. They have been propagated as a healthier alternative to tobacco smoking and a potential device for smoking cessation, despite non-documentation of their long-term adverse health effects.

OBJECTIVES: With the glorification of ECIG, its use has increased even among non-tobacco users. This makes it critical to understand and discuss a true picture of safety and utility of ECIGs by reviewing the literature.

METHODS: Literature search for narrative review was done on PubMed, Scopus and Web of Science databases using the keywords viz electronic cigarette, e-cigarette, electronic nicotine delivery systems, NRT, vaping and electronic nicotine delivery device. The review was sub-categorized into four themes (potential role in smoking cessation, chemicals in the smoke of traditional cigarette and ECIGs, pharmacology of nicotine delivery via ECIG and current regulatory status across the globe).

RESULTS: Search revealed a total of 40 articles out of which 29 were included in the review. ECIGs achieved modest cessation rates with benefits of behavioral and sensory gratification. On the contrary, in many studies where ECIGs were introduced as an intervention, participants continued to use them to maintain their habit instead of quitting. A total of 22 toxic substances apart from nicotine were reported in liquid of ECIG cartridges and its emissions. Many compounds had lower concentrations in ECIG compared to tobacco smoke. There existed a wide variation in the content of ECIG cartridges and strengths of nicotine in refill solutions. It has been observed that the second generation ECIGs delivered nicotine with a similar kinetic profile as conventional cigarettes. In 2013, US FDA gave market authorization to ECIG as substitutes for quitting smoking and cigarette substitutes. The United Kingdom also advocates ECIGs as a medicinal quit aid but bans it from workplaces and other public spaces. India along with many other countries still need to come up with a formal regulatory stand regarding ECIGs.

CONCLUSION: There is a need to conduct large long-term global clinical trials in real life settings to ascertain the potential uses, adverse effects of ECIG and achieve harmonization of nicotine solution concentration.