What is known about the electronic cigarette
Where is the research? There is currently no relevant data assessing the impact of electronic cigarettes on the short and long term health. By cons, several studies have already addressed the e-cigarette. Here is a summary of recent studies:
1. A product fashionable
An analysis of search terms in Google showed that queries related to electronic cigarettes have increased overall in all English-speaking countries since 2008, even exceeding those related to cessation aid medicines; Moreover, it seems that e-cigarettes are used for smoking cessation, at least to circumvent restricives policies on tobacco, because there are more research related to these products in countries who have adopted coercive measures against tobacco - tax increases, bans, etc. - (Ayers et al., 2011).
Different figures may be hinged on the extent of the phenomenon, additional data are expected at the international and local level. In a study on new tobacco products, a research and prevention US found that 1.8% of the sample (over 3,000 US contacted by telephone) had used at least once electronic lacigarette; the rate was 6.6% among the sample smokers (McMillen, Maduka, Winickoff, 2011).
In France, the e-cigarette was tested by 6 million people, mostly smokers and 1 million people regularly use it.
In 2014 it is expected that the market for four electronic cigarette. It went from 250 million in 2011 to 500 million in 2012.
2. Quality of E-cigs. : What control?
Beyond the debate about the harmfulness of electronic cigarettes, the latter still they contain substances announced by the manufacturers? For example, some advertisements claim that their product does not deliver nicotine but what is it really?
One study (Hadwiger et al., 2010) suggests that there is currently insufficient quality control and analysis of electronic cigarettes. Indeed, this research demonstrated by chemical analysis techniques - chromatography - as products not to contain nicotine contained still and some electronic cigarettes were issuing derivatives not initially announced substances (of the amino Tadafil instead of Tadafil and oxidations rimonabant instead of rimonabant). The administration of food and medicines, Food and Drug Administration (FDA), reached similar findings in its report published in July 2009.
However, another study of May 2013 showed that the nicotine content displayed on the bottles of the best selling products generally corresponded to the measured value. (Etter JF, Zätter E, Svensson S, 2013).
The lack of transparency of the manufacturers and the great disparity in the products and the lack of control over the quality pose major problems for research: these issues must be resolved to determine the usefulness and dangerousness of E-cigarettes .
3. E-cigs and health: what do we really know?
Very little data exist and we are far from knowing the long-term effects of chronic use of electronic cigarettes. However, researchers are already working on the issue ..
One study concluded that blood pressure and heart function do not seem disturbed by the e-cigarette (Farsalinos K et al, 2012). However, another study suggests the opposite: Vansickel and Eissenberg (2013) and reported an increase in heart rate and the study reported that both smoking and vapoter induced a similar increase in heart rate and rate of nicotine in the blood.
The e-cigarette has a moderate effect on lung function. It was thus possible to observe a slight narrowing of the bronchi of the volume gauge in smokers electronic cigarette, but much less than in cigarette smokers. (Flouris AD, Chorti MS et al, 2013).
We do not know the long term effects of electronic cigarette use, especially if we ignore the inhalation of propylene glycol, glycerol or added flavors presents no long-term danger. However, so we warn users even if these effects remain unknown to the long term and if this cigarette, meanwhile, many other proven lethal effects and is therefore potentially more dangerous.
A clinical case study has questioned the use of the electronic cigarette in the appearance of a rare form of pneumonia (McCauley et al, 2012.): A 47 year old woman was hospitalized following an coughing period fat and fever accompanied by difficulty breathing (dyspnea). The patient had started using the e-cigarette 7 months ago, coinciding with the onset of respiratory symptoms. Note that using an electronic cigarette with glycerin, substance obtained from fats. He was asked to avoid using electronic cigarettes again and his condition would be improved. Such publications do not constitute sufficient evidence against e-cigarettes but raise questions, rightly
4. E-cig and weaning, a possible cessation aid?
Even if more stringent and more research is still needed, the data suggest that e-cigarettes are promising in aid to smoking cessation and they allow users to reduce their consumption or to stop; of 222 participants in an online survey, 31% became abstinent tobacco 6 months after the first use of electronic cigarettes, 66.8% said they decreased their consumption, 48.8% stopped completely for a period (Siegel et al., 2011 ).
Already, case studies have postulated in favor of some use of the electronic cigarette in the cessation aid. Let us study of 3 cases conducted in Italy which concluded that the electronic cigarette is positively perceived by smokers with heavy smoking history, having already relapsed several times despite their care in weaning with consultations: patients state that their electronic cigarette is a great help, especially, according to the authors, because this way takes a similar gesture to that of smoking (Caponnetto et al., 2011). A study of 11 smokers in Canada (Darredeau et al., 2010) also showed that e-cigarettes decreased the urgent need to smoke, although the subjects used a few doses of electronic cigarettes.
A study by Chris Bullen et al. (2013) from the University of Auckland, published in The Lancet, showed that the electronic cigarette presented an efficiency at least equivalent to the patches for smoking cessation and well above the patches for reducing tobacco consumption. Just over half of those who tested the e-cigarette have managed to halve or more tobacco use, while only 41% of those using the patch have achieved this result.
4.1 A nicotine dispenser clinically tested
In a more clinical manner, Eissenberg (2010) and Vansickel (2010) tested in the laboratory the effects felt and perceived the electronic cigarette. This study of modest size (N = 32) could be the basis for an investigation larger, the purpose would be to clinically evaluate the effects of e-cigarettes and their utility in the suppression of withdrawal symptoms.
The authors brought together participants who have not smoked for at least 12 hours (check by measuring carbon monoxide). These deriners were divided into four separate groups:
A) Those who were smoking their usual cigarette; B) Those who would "act out" and use their usual cigarette without turning; C) Those who were going to use the e-cigarette cartridges with 16-mg nicotine; D) Those who were going to use the e-cigarette with 18-mg cartridges.
After the procedure, all participants are evaluated in blind with different physiological objective measurements (heart rate, carbon monoxide measurement and blood tests of the plasma concentration of nicotine) and subjective psychological (QSU Questionnaire-Brief on the desire to smoke, visual scales, etc.).
Tobacco Cigarettes cause a significant increase in nicotine in plasma, the concentration of carbon monoxide and heartbeat within 5 minutes after consumption. By cons, e-cigarettes do not show any of these effects. Yet recent decline significantly withdrawal symptoms and cravings (to a lesser extent however that the cigarettes smoked). Mime with unlit cigarettes shows meanwhile no significant effect on any action.
These results show that the e-cigarette can be a cessation aid. This means to reduce the lack of perceptions without having the same impact on the body than cigarettes smoked. This data is however to be cautious with the small number of study participants. In addition, no effects were observed on the longer term and this study did not address the question of the impact on health.
4. 2 The way to inhale is not the same for e-cigarette and a standard cigarette
Trtchounian, Williams and Talbot (2010) of the Department of Cell Biology and Neuroscience University of California were interested in specific inhalation properties of e-cigarettes, compared to those of conventional cigarettes. These researchers wanted to know whether to "pull" (inspiration) differently on that e-cigarette on a standard cigarette to achieve the desired cloud (aerosol and smoke respectively). To do this, they measured the necessary vacuum in the production of the cloud by coupling a pressure gauge to a smoking machine. The density of the aerosol cloud or smoke was also measured. It follows that the required vacuum to produce the cloud of smoke in the tests on cigarettes was different depending on the brand ( "light" or "ultralight" for example). In tests on the electronic cigarette it was almost every time a higher vacuum. Moreover, in constant vacuum, the density of the aerosol cloud for e-cigarettes decreased with the number of puffs, after ten puffs needed more vacuum to obtain the same cloud density: this property will not be recovering for tobacco cigarettes, the ratio of the necessary vacuum and the density of the cloud varying only function of the mark and not the number of puffs.
These differing properties observed in the laboratory, should be taken into account by the clinical studies of the use of the electronic cigarette.
The creation of a larger vacuum (suction) to produce the cloud can have adverse health effects due to deeper penetration into the airways. On the other hand, the lack of uniformity in the time of the suction force needed to produce the aerosol cloud might question the usefulness of e-cigarettes as nicotine and distributors so as substitutes, doses is not precisely controlled.
4.3 The electronic cigarette could have similar properties to nicotine inhalers
Bullen et al (2010) also measured the short-term effects of electronic cigarette cravings and withdrawal symptoms, as well as its pharmacokinetics and side effects. The authors recruited 40 adult smokers, consuming more than 10 cigarettes a day and were not being or about to try to stop. They also asked them not to smoke overnight before testing (verification done with a measure of carbon monoxide). Upon arrival at the laboratory, the participants were randomly divided into one of the four following groups: A) Use of E-cigarettes, experimental group (capsule 16mg of nicotine) B) Use of E-cigarettes, control group (placebo capsule 0mg of nicotine) C) Use of nicotine inhalers D) Using tobacco cigarettes. After the procedure, all participants were evaluated blind with scales and questionnaires about their satisfaction, withdrawal symptoms, their intention to stop, etc. Pharmacokinetic indicators were also measured.
It appears that users of the e-cigarette had fewer cravings after surgery than the placebo and there was no difference between the e-cigarette group and that of the inhaler. Furthermore, electronic cigarettes were perceived as more pleasant and produce less irritation of the throat and mouth as inhalers. Finally, the pharmacokinetic indicators for e-cigarettes were closer to those inhalers as those of standard tobacco cigarettes.
Again, these results are rather positive for electronic cigarettes closer to the effects of nicotine inhalers, but should be taken with caution in view of the small number of study participants and non observation of the phenomenon on the long term. In addition, this study did not addressed the impact on health.
4.4 Electronic cigarettes provide as much nicotine as tobacco cigarettes
In an article published in the European Respiratory Journal, the results of a study on electronic cigarettes show users get as much nicotine from this product as smokers usually get tobacco cigarette.
The study, conducted by researchers from the Universities of Geneva (Jean-François Etter, 2011) and Auckland, analyzes the levels of cotinine (a breakdown product of nicotine by the liver) in users of electronic cigarettes recruited Stop-tabac.ch on the site. This is the first time are published cotinine data among experienced users of electronic cigarettes. So far, we had only laboratory data among novice users who have used this product briefly before blood nicotine tests are performed. These previous data showed that novice users obtained little or no nicotine products. Research published today shows instead that experienced users (all ex-smokers)
These results are important because governments in many countries are developing regulations on electronic cigarettes (currently, some countries prohibit it, others allow it with nicotine, others without nicotine). In this context, it is very important for the authorities, doctors and consumers, to know that electronic cigarettes can deliver as much nicotine as tobacco cigarettes.
5. Surveys of satisfaction among users
A study "in vivo", outside the laboratory, would support this notion of satisfaction what would bring the e-cigarette. Jean-François Etter (2010) interviewed 81 to electronic cigarette users on their opinions about this product. Most of them use them to help them quit smoking or reduce their consumption and found there a beneficial effect (less coughing, better breathing, improved fitness). Users appreciate the sensations during inhalation but were concerned about the possible toxicity of the product and its future legal status.
Also in this same concern for understanding the phenomenon through motivation "vapoteurs", a questionnaire on the Internet was proposed to 3'587 electronic cigarette users (Etter and Bullen, 2011). This study revealed that the e-cigarette was seen as helpful for smoking cessation (96% of respondents to the survey) or at least to reduce tobacco use (92%); many used it because of its lower toxicity compared to smoking (84%), others because it allowed them to avoid relapse (77%), manage cravings (79%) or withdrawal symptoms of tobacco (67%). More marginally, some users were motivated by lower cost than tobacco (57%) or seduced by the possibility of eating in places where smoking is prohibited (39%). Most ex-smokers feared a relapse if prevented them from using electronic cigarettes (79%).
This survey thus reveals that the electronic cigarette provides high satisfaction among its users and could be helpful in stopping smoking. However, the safety of this product for health is still not proven . Further studies are needed to evaluate the toxicity and efficacy of the new product.
Previously, a survey of 12,600 people in the UK (Dockrell 2010) showed that 9% of smokers have used the e-cigarette and 3% were currently using. These people were using the e-cigarette in places where smoking is prohibited and / or reduce their smoking. Users however, were not very satisfied with the sensations provided by these e-cigarettes.
Another survey of 257 users of electronic cigarettes in Poland (Goniewicz, 2010) showed that half of them used the e-cigarette to stop smoking and 41% took her as a safer alternative to cigarettes.
A US survey of 104 users found that it was highly recommended to use the therapies for quitting smoking - smoking cessation consultation, cognitive behavioral therapy, alternative treatments, etc. - e-cigarettes is preferable to smoking (Foulds et al., 2011). Again, users had mostly use electronic cigarette to quit smoking and felt that it helped them (75% of the sample). By cons, two-thirds were using products with moderate nicotine concentration at high (over 13mg). In addition, only 8% of people used the most current models; the majority of users opted for other models delivering a more intense vapor.
6. Who are the vapoteurs?
A qualitative study took care to identify the interests and concerns of electronic cigarettes users by conducting interviews with 15 "vapoteurs" regular (McQueen, Tower, Sumner, 2011). Some recurring themes emerged from these discussions. For example, the authors speak of a learning curve for the electronic cigarette. Indeed, these objects are more complex than tobacco cigarettes, users learn to use it and to know the technology that composes. A true community specific jargon born of this phenomenon experienced users welcome and explain all the "tricks of vapote" to newcomers. These features of
7. The e-cigarette, an incentive for young people?
Associations fight against smoking are concerned that the e-cigarette encourages young people to smoke. Recent studies suggest that a priori this would not be the case. Cho et al. (2011) based on data from a project KoreanHealth Project identified in a study that 10.2% of students surveyed knew the 4353 e-cigarettes, but only 0.5% of these students had actually tried. Pepper et al. (2013) conducted a national survey of 228 homes youth (age 11-19 years) and reported that <1% of them have tried. Moreover, smokers were more likely to try than nonsmokers.
Directory of articles on the topic
The "National Vapers Club" maintains a directory of scientific articles on the electronic cigarette. Check it out at:
- JC Ayers, Kurt R. Brownstein JS (2011). Tracking the rise in popularity of electronic nicotine delivery systems ( "electronic cigarettes") using search query monitoring , American Journal of Preventive Medicine.
- Bullen C, McRobbie H., S. Thornley, Mr Glover, R. Lin, Laugesen M. (2010). Effect of an electronic nicotine delivery device (e cigarette) we desire to smoke and withdrawal, user preferences and nicotine delivery: randomized crossover trial , Tobacco Control, 19: 98-103
- Bullen C. Howe C. [ongoing research]. A three arm single blind parallel group randomized controlled clinical trial to evaluate-the efficacy, acceptability, safety and use of an electronic cigarette (ENDS) as a smoking cessation aid (ASCEND) .
- Cho JH, Shin E, Moon SS .Electronic-cigarette smoking experience Among adolescents. J Adolesc Health (2011) 49: 542-6.doi: 10.1016 / j.jadohealth.2011.08.001
- Christopher Bullen Colin Howe, Murray Laugesen, Hayden McRobbie, Varsha Parag Jonathan Williman, Natalie Walker, Electronic cigarettes for smoking cessation: a randomized controlled trial The Lancet, Volume 382, Issue 9905, 1629 Pages - 1637 16 November 2013 doi : 10.1016 / S0140-6736 (13) 61842-5Cite or Link Using DOI
- Caponnetto P. Polosa R., C. Russo, Leotta C. Campagna D. (2011). Successful smoking cessation in smokers with electronic cigarettes with a documented history of recurring relapses: a case series , Journal of Medical Case Reports 2011, 5: 585 doi: 10.1186 / 1752-1947-5-585
- Darredeau C. Campbell M., K. & Barrett Temporale SP (2010). Reinforcing and subjective effects of electronic cigarettes in male and female smokers, Paper presented at the 12th annual meeting of the Society for Research on Nicotine and Tobacco Europe, Bath, UK, September 6-9
- Mr Dockrell (2010). "It sounds like the replacement I need to help me stop smoking": use and acceptability of "e-cigarettes" Among UK smokers, Paper presented at the 12th annual meeting of the Society for Research on Nicotine and Tobacco Europe, Bath, UK, September 6-9
- Eissenberg T. (2009) Electronic nicotine delivery devices: ineffective nicotine craving delivery and removal after-acute administration , Tobacco Control, 19: 87-88
- Etter JF. (2010) Electronic cigarettes: a survey of users , BCM Public Health, 10: 231
- Etter JF., Bullen C. (2011). Electronic cigarette user profile, utilization, satisfaction and Perceived efficacy . DOI: 10.1111 / j.1360-0443.2011.03505.x [ pdf ]
- Etter JF, Bullen C. Saliva cotinine levels in users of electronic cigarettes . European Respiratory Journal. 2011, Nov 1, vol 38, 1219-1220.
- Etter JF, Zätter E, Svensson S, Analysis of Liquids Refill for Electronic Cigarette, Addiction, May 23, 2013
- Farsalinos K et al, Acute effects of using an electronic nicotine delivery device (e -cigarette) is myocardial function: comparison with the effects of regular cigarettes European Society of Cardiology Congress 2012; August 26, 2012; Munich, Germany. Abstract 1375
- Flouris AD Chorti MS et al, Acute Impact of Active and Passive Smoking Electronic Cigarette is Cotinine Serum and Lung Function, Inhal Toxicol, 2013 Feb; (2): 91-101
- Foulds J. Veldheer S., Berg A. (2011). Electronic cigarettes (e-cigs): views of fans and clinical / public health perspectives , Int J Clin Pract . doi: 10.1111 / j.1742-1241.2011.02751.x
- Goniewicz ML (2010). Patterns of use of electronic nicotine delivery devices (ENDS) Among Polish e-smokers, Paper presented at the 12th annual meeting of the Society for Research on Nicotine and Tobacco Europe, Bath, UK, September 6-9
- Hadwiger ME, ML Trehy, Ye W, Moore T, J Allgire, Westenberger B. (2010). Identification of amino-tadalafil and rimonabant in electronic cigarette products using high pressure liquid chromatography with diode array and tandem mass spectrometric detection . Journal of Chromatography A, 1217 (48): 7547-7555.
- Lindsay McCauley Catherine Markin, Danielle Hosmer (2012). An Unexpected Consequence of Electronic Cigarette Use, Chest ; 141; 1110-1113 / DOI 10.1378 / chest.11-1334
- A. McQueen, S. Tower, Sumner W. (2011). Interviews with "vapers": Implications for future research with electronic cigarettes . Nicotine Tob. Res doi:. 10.1093 / ntr / ntr088.
- PepperJK, ReiterPL, McReeAL, CameronLD, GilkeyMB, BrewerNT.Adolescent males'awareness of and willingness to try electronic cigarettes. J Adolesc Health (2013) 52: 144-50.doi: 10.1016 / j.jadohealth.2012.09.014
Siegel MB, Tanwar KL, Wood KS (2011). Electronic Cigarettes have a smoking-cessation tool: results from an online survey , American Journal of Preventive Medicine.
Trtchounian A. Williams Mr. Talbot P. (2010). Conventional and electronic cigarettes (e-cigarettes) tuxedo-have different characteristics , Nicotine Tob. Res. , 12 (9): 905-12
- Vansickel A., C. Cobb, Mr. Weaver, Eissenberg T. (2010). A Clinical Laboratory Model for Evaluating the Acute Effects
of Electronic "Cigarettes": Nicotine Delivery Profile and Cardiovascular and Subjective Effects , Cancer Epidemiol. Biomarkers Prev. , 19 (8); OF1-9. © 2010 AACR.
Vansickel AR, Eissenberg T, Electronic cigarettes effective nicotine delivery after-acute administration. NicotineTobRes (2013) 15: 267-70.doi: 10.1093 / ntr / ntr316
- Vardavas, Anagnostopoulos, Kougias, Evangelopoulou, Connolly Behrakis (2011). Acute pulmonary effects of using an e-cigarette: Impact is respiratory flow resistance, impedance and Exhaled nitric oxide ,
- FDA and Public Health Experts Warn About Electronic Cigarettes
- FDA: Evaluation of e-cigarettes , full report
- WHO: Electronic cigarettes have no proven therapeutic effects
- Position of the Swiss authorities: Federal Office of Public Health (BAG), 12 May 2009, Art. 37 of the Ordinance on foods and consumer products .