(Slideshow) E-cigarettes: What physicians need to know

Electronic cigarettes, or e-cigarettes, have been touted by their manufacturers as a cleaner and safer alternative to traditional tobacco products. But after years on the market with no regulations, controversy has swelled around e-cigarettes. Studies show that more teenagers are beginning to use them, and the effects of the vapor produced by the devices are still unknown. 

Last week, the U.S. Food and Drug Administration (FDA) proposed new rules to regulate the sale of e-cigarettes. The rules would prohibit the sale of e-cigarettes to minors and require manufactures to include health warnings with them. Makers of e-cigarettes would also be required to report their product ingredients to the FDA for review. The FDA’s proposed rules will be available for public comment for 75 days. 

Because many people have been using e-cigarettes as a way to stop using tobacco products, healthcare providers need to know the latest information on whether these new devices are safe for their patients.

What is an e-cigarette? A brief history

E-cigarettes are battery-powered devices that use interchangeable, liquid nicotine cartridges. When inhaled, the device creates a vapor, rather than the smoke created by traditional cigarettes. The cartridges come in a variety of flavors, including everything from cherry to peach schnapps.

Much of the controversy about e-cigarettes revolves around the key question: What’s in them? The FDA is hoping to answer that question with its proposed regulations that would require e-cigarette manufacturers to report their products ingredients.

The popularity of e-cigarettes has boomed since they entered the U.S. market in 2007, and there are about 250 brands for sale in the U.S. It’s estimated to be a $2 billion a year industry that continues to grow, according to Reuters.

Do e-cigarettes help with smoking cessation?

About 18.1% of all adults in the U.S. smoke cigarettes, according to the U.S. Centers for Disease Control and Prevention. A recent study published in the Journal of the American Medical Association Internal Medicine casts doubt on e-cigarettes’ ability to help smokers quit. The study looked at self-reported data from 949 participants, including their use of cigarettes per day and their intentions to quit. “E-cigarette use by smokers was not followed by greater rates of quitting or by reduction in cigarette consumption one year later,” the authors concluded.

Currently, e-cigarettes are not an FDA-approved smoking cessation aid, and e-cigarette manufacturers might prefer to keep it that way, according to the New York Times. In an article looking at the e-cigarette industry’s expansion in Oklahoma, the newspaper reports that being labeled a smoking cessation product would require the manufacturers to conduct research to support that claim.

Physician groups’ response

The major medical societies representing primary care physicians endorse some form of government control over e-cigarettes. The American Medical Association says it supports the FDA “for its new effort to regulate…electronic cigarettes, cigars, and hookahs.” The American College of Physicians “believes that since e-cigarettes…may contain a host of dangerous carcinogens and chemicals, they should be aggressively reviewed and regulated by the FDA.” The American Academy of Family Physicians wants to end advertising of e-cigarettes “until their safety, toxicity, and efficacy are established.” The American Osteopathic Association recommends that health agencies “take positive action to discourage the American public from using cigarettes and other tobacco products.”

Controversy: Marketing to children

The use of e-cigarettes among teens doubled from 3.3% in 2011 to nearly 7% in 2012, according to a Centers for Disease Control and Prevention report released in March 2014.

Many experts believe that e-cigarettes with flavors such as strawberry, cherry, and chocolate and their easy availability of purchase online and at low prices make
e-cigarettes appealing to younger buyers.

“Be aware that e-cigarette companies are targeting adolescents by making candy-flavored e-cigarette vapor and creating advertisements that target youth,” says Center for Tobacco Control Research and Education postdoctoral fellow Lauren Dutra, ScD, of the University of California-San Francisco.

Is liquid nicotine deadly to children and adults?

Refilling e-cigarettes requires the use of liquid nicotine, or “e-liquids,” that can cause adverse reactions such as vomiting, seizures, cardiac problems, and death to both children and adults when absorbed through the skin or ingested.

Widely available online, the concentration of nicotine sold in e-liquids varies from 1.8% up to 10%, which can can be deadly. Experts say children are lured by the bright-colored, sweet-smelling substance. The number of calls to poison control concerning liquid nicotine increased 300% from 2012 to 2013, according to the National Poison Data System.

E-cigarettes are being banned in big cities

States and cities across the United States are regulating and banning e-cigarettes, similar to regular cigarettes.

According to the American Nonsmokers’ Rights Foundation, 13 states have regulations either prohibiting use of e-cigarettes in non-smoking venues or banning them from specific areas, such as schools, workplaces, and public property.

In addition, more than 170 cities across the country, including New York City, Chicago, and Boston, have banned the use of e-cigarettes in smoke-free places as of April 29, 2014, according to the foundation.

The reason for the bans, according to the medical profession, is the numerous unanswered questions as to how these devices affect health.

"They are nicotine delivery devices intended to be used like a cigarette,” Norman Edelman, MD, chief medical officer for the American Lung Association, told WebMD. “What happens to someone who stops inhaling the tars of cigarettes and inhales only nicotine? We don't know. There is at least the potential for harm."