By Dr Roger Henderson
Dr Henderson is a GP and has worked with tobacco cessation for many years. In this piece, he explores the evolution of vaping and why Public Health England has recommended the usage as part of the quitting journey
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A Doctor Shares How He Helps Smokers Quit Cigarettes
Harm Reduction and Vaping - What You Need to Know
You could be forgiven for thinking that e-cigarettes are a new thing. In fact, the first ‘electrical vaporizer’ patent was filed in New York in 1927 by Joseph Robinson. This device, which was probably for medicinal purposes, allowed for a compound to be vaporised into a mouthpiece - not a million miles from what vaping is today.
The device went nowhere and was forgotten in the mists of time. In the 1980s and 1990s various patents for nicotine-based inhaling devices were lodged but it was left to a three-pack-a-day Chinese businessman called Hon Lik to start the race to what we now call e-cigarettes.
Heating Nicotine
Lik had been trying to quit using conventional nicotine patches (and would watch his smoking father die from lung cancer) when in 2003 he filed a patent for a high-frequency piezoelectric device that vaporized a pressurised jet of nicotine-containing liquid. Its novelty, he claimed, lay in the fact that the nicotine was protected from being vaporised until it was heated, and its appearance was of a tobacco-free cigarette producing a smoke-like vapour.
The first e-cigarette went on sale in China in 2004 and there have been at least half a dozen evolving generations of device since then, with many different types of e-cigarette now available. Generally speaking, all of them – whatever their appearance – have three key elements: a battery (typically rechargeable) that heats up an atomiser or coil, which then vaporises an e-liquid or ‘juice’ into vapour that is then inhaled.
How They Work
There are two main e-cigarette systems in use across the globe – open and closed. Open systems allow a user to customise their system with different parts and liquids whereas with a closed system, disposable cartridges of e-liquid are used then discarded.
For most users, the e-liquid is the key to their satisfaction rating of whatever system they choose to use. There are four key components in these: glycerine, propylene glycol, nicotine (some preparations can be nicotine-free) and flavouring.
The vegetable glycerine (VG) provides the vapour, and the thinner propylene glycol (PG) carries the flavour. This VG/PG ratio determines the amount of vaping ‘cloud’ produced as well as the flavour intensity.
Vaping is Not Making Cigs Cool Again, Study Finds
A higher VG score gives more cloud but less flavour, and a higher PG score gives less cloud but a bigger ‘throat hit’ and often more flavour. Many hardened smokers using e-cigarettes try to reproduce the throat ‘hit’ they feel when dragging hard on a conventional cigarette by increasing the level of PG in their device.
When vaping devices first appeared, the term ‘e-cigarette’ was appropriate since the vast majority had the appearance of a cigarette but with such a wide range of products now available the term is becoming somewhat obsolete.
However, there is currently no agreed consensus as to a common terminology and so e-cigarette remains the nomenclature of choice here for the moment.
Who Uses E-cigarettes?
The use of e-cigarettes around the globe varies considerably, but it’s thought there will be 55 million users by 2021 [Euromonitor. Global tobacco: key findings part II; vapour products. Euromonitor, 2017, p.11]. It depends on where you live how popular vaping is - usage varies between one and six percent. A 2017 European Commission survey found that two percent of the European population used e-cigarettes and that this had remained stable since 2014.
The UK Trends
The latest figures from Britain broadly reflect these trends with an estimated 3.2 million adults in the country currently using e-cigarettes – a significant rise from 700,000 in 2012 – and this rise has been driven by public demand rather than any kind of national health programme or medical campaign.
There are now more ex-smokers in the UK who use e-cigarettes than current smokers
There are now more ex-smokers (1.7 million) in the UK who use e-cigarettes than current smokers (1.4 million), and over half (52 percent) of e-cigarette users are ex-smokers with 44 percent being current tobacco smokers. The main reason given by vapers as to why they use e-cigarettes is that they have helped them stop smoking and are a safer alternative to tobacco.
Only two percent of current UK vapers report using an e-liquid containing over 20 mg/ml (the limit in the EU Tobacco Products Directive) and overall, users are more likely to report that they have decreased rather than increased their strength over time. Most vapers typically stick to a single flavour with menthol, tobacco and fruit-based flavours being the most popular types.
Attitudes to Vaping Risks
Individual countries vary in their approach to potential risk, ranging from the Public Health England view that they are 95 percent safer than conventional cigarette smoking. The Hong Kong government currently pushing ahead with a blanket ban on all e-cigarettes that would make anyone who imports, makes, sells or promotes new smoking products liable to a HK $50,000 fine and up to six months in jail.
Whatever the possible health issues that may or may not surround e-cigarettes – and many more years of data will be needed to obtain a definitive view on their long-term impact – most clinicians working in the area of tobacco harm reduction believe they are significantly less harmful than inhaling tobacco smoke.
The best smoker is still a quit smoker
And, for me, that is simply a matter of common sense and pragmatism rather than any kind of high science.
Using e-cigarettes as part of any quit attempt remains a helpful option for smokers wishing to stop smoking, although there is currently inconclusive evidence in England that their use has contributed to the decline in demand for stop smoking services (this is more likely to be an issue of central funding).
Combining such services with what is the most popular source of support now used by smokers in the general population – e-cigarettes remains an option to be recommended to smokers although one salient point is always absolute here. The best smoker is still a quit smoker, both with their conventional tobacco and their e-cigarette of choice.
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