LPNI Health Topic – June 2015


E-Cigarette: Friend or Foe?


The popularity and interest in e-cigarettes has grown over the past several years, and so have the health concerns over their risks. New research now questions the safety of these devices and directs us to reexamine what is known so far.


So, what is an e-cigarette, and what do we know about them? These are not easy questions to answer. There is no oversight of the manufacturing industry, no set standards and no quality process control. In a recent US Food and Drug Administration (FDA) investigation the ingredients in the vapor cartridges of 18 different cigarettes were reviewed with all but one labeled “no nicotine” did, in fact, contain nicotine, as well as other toxic and carcinogenic chemicals. Nicotine is a known addictive agent. The flavorings used are safe when one eats them, however, it is unknown what effects they have when inhaled. One flavoring chemical, diacetyl, (it gives the buttery flavor to popcorn) is known to be linked to obstructive lung disease when inhaled. 


From the January 2015 New England Journal of Medicine (NEJM) e-cigarettes are a combination of flavorings, nicotine and propylene glycol, glycerol, or both. The heating process, or “vaping,” converts the chemicals into formaldehyde-releasing agents, often at concentrations higher than concentrations of nicotine. Formaldehyde is an International Agency for Research on Cancer group 1 carcinogen. “If we assume that inhaling formaldehyde-releasing agents carries the same risk per unit of formaldehyde as the risk associated with inhaling gaseous formaldehyde, then long-term vaping is associated with an incremental lifetime cancer risk 5 times as high,... to 15 times as high, as the risk associated with long-term smoking. In addition, formaldehyde-releasing agents may deposit more efficiently in the respiratory tract than gaseous formaldehyde, and so they could carry a higher risk factor for cancer.”


Is there any good news? In contrast to regular cigarette smoking, “based on what we know, they are much less hazardous.” says Neal Benowitz, MD, a former FDA Tobacco Products Scientific Advisory Committee member. Giving off over 7,000 chemicals when burned with at least 69 of those chemicals know to cause cancer, “regular cigarettes are truly bad for you.” 


In the NEJM study both low voltage (3.3 volts) and high voltage (5.0 volts) e-cigarette vaping devices were studied. The results sited above were from the high voltage study. In contrast, when low voltage devices were tested, no formaldehyde-releasing agents were detected.


E-cigarettes do appear to be less dangerous to those exposed to secondhand aerosol. E-cigarette users exhale very little of what they inhale, says Benowitz, and their devices emit no areosol. Secondhand smoke from cigarettes pollute the atmosphere and other's lungs at a very high rate.


E-cigarettes may prove helpful to smokers trying to quite, but that issue needs much more study.


And for those who do not smoke: “There's no reason to try electronic cigarettes,” says researcher Maciej Goniewicz, PhD, PharmD from the Roswell Park Cancer Institute in Buffalo, NY, USA. “This is not a product for non-smokers. The nicotine is addictive.”


The e-cigarette: friend or foe?  The answer is unclear, but armed with information, the parish nurse can serve more effectively as health counselor to those in his/her circle of care.


Carol D. Zimmermann, MS, RN

Parish Nurse, Lutheran Church of the Living Christ

Madison, WI  53715  USA



(information for this article was compiled from The New England Journal of Medicine, January 23, 2015, The Sidney Morning Herald Online,and Web-MD and may be used by parish nurses in their ministries.)