Is Vaping Better Than Smoking?

In the quest to stop smoking, are electronic cigarettes (vapes) an ally or an adversary?

The jury is still out, but they certainly aren’t harmless.

“There’s a lot of interest in whether e-cigarettes can help people quit smoking,” says UNC Health pulmonologist Brad Drummond, MD, MHS. “The initial studies were all over the place.”

A combined analysis of several different studies indicated that e-cigarettes had a slightly higher success rate at helping smokers quit than nicotine replacement therapies, such as patches or gum, he says.

Last fall, the Food and Drug Administration authorized a company that manufactures e-cigarettes to market the products in the United States to adult addicted smokers. An FDA news release said the approved products are “appropriate for the protection of public health” because people who participated in a study of the products were exposed to fewer harmful ingredients than those who smoke regular cigarettes, also called combustibles.

In other words, the FDA has determined that e-cigarettes are less harmful than traditional cigarettes. However, the FDA approved only e-cigarettes that taste like tobacco, not those flavored like fruits, candy or mints, which other studies have shown to be more appealing to younger users.

“E-cigarettes are not harmless,” Dr. Drummond says. “The toxins are lower than the levels we see in combustible cigarettes. What we don’t know, though, is how low is low enough.”

Long-Term Effects of Vaping Remain Unknown

No one knows what the long-term effects of vaping could be, Dr. Drummond says.

“It took 50 years to know for certain that combustible cigarettes cause lung cancer,” he says. “It will take time to know the long-term harm of e-cigarettes.”

Like combustible cigarettes, e-cigarettes contain nicotine, a highly addictive chemical compound. Nicotine is so addictive that only about 6 percent of smokers are able to quit in any given year, although about half of them try.

E-cigarettes have three components: a battery, a chamber with a heating element and a liquid. The heating element turns the liquid into vapor, which can be inhaled. Early e-cigarettes looked like combustibles, but now they look more like a USB flash drive.

“It’s very discreet,” Dr. Drummond says. “With a combustible, people smoke the whole cigarette. You feel the effects of nicotine, then you come down. It’s like a roller coaster. With the e-cigarette, you can take a puff here and there and maintain regular nicotine levels.”

Often, people don’t realize how much nicotine they are inhaling.

“I ask patients how much they smoke, and they can usually tell me something, like a pack a day,” he says. “But people view e-cigarettes as a harmless thing, and they just take a puff now and then. They often can’t say how frequently they are puffing.”

Leading Experts Advise Against E-Cigarettes for Smoking Cessation

Even though the FDA has authorized the use of tobacco-flavored e-cigarettes as a safer alternative to combustibles, Dr. Drummond and many other pulmonologists don’t think they’re a useful tool for most smokers. In a news release after the FDA’s decision, the American Thoracic Society restated its position that “all e-cigarettes have significant health risks, including nicotine addiction and respiratory disease.”

Other methods for quitting have proved more effective with fewer harmful side effects, Dr. Drummond says. These include nicotine patches, nicotine gum and lozenges, and medicines such as Chantix (varenicline) and Wellbutrin (bupropion).

“We have a greater understanding of the harms and benefits of other FDA-approved treatments for nicotine addiction,” he says. “We don’t know about the long-term harms and effectiveness of e-cigs for smoking cessation. We just want to keep people from jumping out of the frying pan into the fire.”

Dr. Drummond is especially concerned about the harm that cigarettes, both electronic and combustible, pose for teens and young adults.

“The human lung is growing and developing until about age 30,” he says. “We don’t know how that growth is impaired by the use of e-cigarettes. They may never achieve maximum lung function, so as they age, they may be more susceptible to long-term lung disease.”

Of course, for people who have not started smoking or vaping, the best path is to avoid nicotine products completely.

“Big Tobacco has marketed e-cigarettes as less harmful alternatives,” Dr. Drummond says, “but less harmful does not mean safe. … The safest thing to breathe is air.”

Want to learn more about smoking cessation? Check out the UNC School of Medicine’s Tobacco Treatment Program. If you are concerned about your lung health, talk to your doctor, or find one near you.

Brad Drummond, MD, MHS, is a pulmonologist at UNC Medical Center and an associate professor of pulmonology at the UNC School of Medicine.