The Emerging Phenomenon of Electronic Cigarettes

Pasquale Caponnetto; Davide Campagna; Gabriella Papale; Cristina Russo; Riccardo Polosa

Disclosures

Expert Rev Resp Med. 2012;6(1):63-74. 

In This Article

Abstract and Introduction

Abstract

The need for novel and more effective approaches to tobacco control is unquestionable. The electronic cigarette is a battery-powered electronic nicotine delivery system that looks very similar to a conventional cigarette and is capable of emulating smoking, but without the combustion products accountable for smoking's damaging effects. Smokers who decide to switch to electronic cigarettes instead of continuing to smoke would achieve large health gains. The electronic cigarette is an emerging phenomenon that is becoming increasingly popular with smokers worldwide. Users report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms due to workplace smoking restrictions and to continue to have a 'smoking' experience but with reduced health risks. The focus of the present article is the health effects of using electronic cigarettes, with consideration given to the acceptability, safety and effectiveness of this product to serve as a long-term substitute for smoking or as a tool for smoking cessation.

Introduction

The status quo in smoking cessation presents smokers with just two unpleasant alternatives: quit or suffer from the harmful consequences of continuing to smoke. However, there is a third choice for smokers: switching to the electronic cigarette. The electronic cigarette is a cigarette-shaped electronic product, manufactured and marketed by several different companies, powered by a lithium-ion rechargeable battery that is designed to vaporize nicotine to be inhaled (Figure 1).[101] Although the early concept appeared in a patent acquired by Herbert A Gilbert in 1963, the modern electronic cigarette was invented by Chinese pharmacist Hon Lik in 2003 and introduced to the market the following year.[201] In 2004, the Chinese company Ruyan® (Hong Kong, China) introduced and marketed for the first time an electronic device capable of emulating cigarette smoking: the electronic cigarette was born. Within a few years the electronic cigarette market had greatly expanded and, besides Ruyan, several other companies began to introduce similar products. Currently, the electronic cigarette is continuously evolving, with new and improved models making it to the market at a yearly rate. Sufficient regulation of the electronic cigarette is currently lacking, but the WHO Study Group on Tobacco Product Regulation classifies electronic cigarettes as electronic nicotine delivery systems.[1]

Figure 1.

Structure of the electronic cigarette. The electronic cigarette is a battery-powered electronic nicotine-delivery device resembling a cigarette designed for the purpose of providing inhaled doses of nicotine by way of a vaporized solution to the respiratory system. This device provides a flavor and physical sensation similar to that of inhaled tobacco smoke, while no smoke or combustion is actually involved in its operation. It is composed of the following key components: the inhaler, also known as the 'cartridge' (a disposable plastic mouthpiece, resembling a tobacco cigarette's filter, containing an absorbent material saturated with a liquid solution of propylene glycol and vegetable glycerin in which nicotine may be dissolved); the atomizing device (the heating element that vaporizes the liquid in the mouthpiece and generates the mist with each puff); and the battery component (the body of the device – resembling a tobacco cigarette – which houses a lithium-ion rechargeable battery to power the atomizer). The body of the device also houses an electronic airflow sensor to automatically activate the heating element upon inhalation and to light up a red LED indicator to signal activation of the device with each puff. The LED indicator also signals low battery charge.

Besides vaporizing nicotine to be inhaled, electronic cigarettes may also provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures (e.g., the hand-to-mouth action of smoking), and for these reasons it is now perceived by users as a potentially more attractive substitute for smoking than low toxin smokeless tobacco.[202] Given that neither tobacco nor combustion are necessary for its operation, it is likely that this product could be used as a lower-risk substitute for tobacco cigarettes. In addition, people report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms due to workplace smoking restrictions and to continue to have a 'smoking' experience but with reduced health risks.[2] The electronic cigarette is an emerging phenomenon that has become increasingly popular in the past few years,[3] with groups of users (who call themselves 'vapers' because they inhale vapor, not smoke) who formed an active community (both online and in person) to strongly advocate for these products.[4] Contrary to all other smoking cessation products, the electronic cigarette has created a social phenomenon of global proportion, which calls for research, legislation and product development.

The focus of this article is the health effects of using an electronic cigarette, with consideration given to the acceptability, safety and effectiveness of this product to serve as a long-term substitute for smoking or as a tool for smoking cessation.

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