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Tradition and a brave new world

Smoking continues to be one of the government’s biggest public health challenges, while the smoking cessation industry is growing rapidly. But, despite a decades-long drop in smoking, the figures are now levelling out.

Health officials are therefore left wondering how to make further progress while the tobacco industry is riding both horses – continuing to produce its traditional brands, and at the same time developing and promoting nicotine replacement products.

Alongside this, the rapid growth of electronic smoking is providing those who want to quit smoking with a new option, albeit one which inevitably leaves many questions unanswered.

Part of the confusion around electronic smoking derives from the variety and the rapid development of various e-cigarette technologies. Generally e-cigarettes comprise three parts: the battery, often made of lithium ion; the nicotine cartridge containing the nicotine solution; and the atomiser in which the nicotine solution is turned into vapour. A small amount of the battery power goes towards lighting the “cherry” tip, but the majority of the battery is used to heat the nicotine solution inside the cartridge.

The solution consists of propylene glycol, which provides the throat hit and vegetable glycerine, which attracts water from the air to form the vapour. Both propylene glycol and vegetable glycerine are found in normal cigarettes and not known to be carcinogenic. Propylene glycol is also used in asthma inhalers. Some 3 per cent of the population is allergic to propylene glycol.

We know a lot more about what is in electronic cigarettes than in regular cigarettes

The nicotine solution comes in a multitude of flavours, including menthol and bubblegum among others, and varies in nicotine strength. For example, some solutions contain no nicotine at all and so the e-cigarette only serves to simulate the act and taste of smoking.

When you inhale, the device is activated. A small amount of the solution makes contact with a metal “wick” and flows down the atomiser to a highly resistant filament, which then heats the solution and turns it into the vapour. Usually this vapour condenses on the mucus membrane around the mouth. There is still some question about how much, if any, of this vapour actually reaches the lungs and, if so, what happens to it there?

Their short life on consumer shelves means there is no conclusive evidence regarding the long-term effects of using e-cigarettes or “vaping” as it’s commonly known.

However, in a study carried out in 2010, Dr Michael Siegel from Boston University argued that what we do know of e-cigarettes is already enough to conclude that they are far safer than real cigarettes. He says: “The truth is we know a lot more about what is in electronic cigarettes than in regular cigarettes. Our review shows that carcinogen levels in electronic cigarettes are up to 1,000 times lower than in tobacco cigarettes.”

Compared to their conventional predecessors, e-cigarettes are potentially more eco-friendly and the vapour they produce means better quality of air in general.  

Fans of e-cigarettes are keen to point out that the nicotine, which these devices give out, is only one of more than 4,000 chemicals and poisons in a conventional cigarette. Nicotine is a highly addictive drug, which enters the blood stream and stimulates the feeling of calm. However, in large doses it can become a depressant, inhibiting the flow of signals between nerve cells.

Conventional cigarettes also contain tar – a cancerous, tacky brown substance made from burnt tobacco – which builds up in the lungs. In the UK each year, smoking causes 100,000 deaths, 87 per cent of which are due to lung cancer. The paper and tobacco in a cigarette are biodegradable, but the filters are not. Cigarette butts continue to pollute our streets and oceans, and take from 18 months to ten years to decompose. The toxins inside these discarded cigarette butts also pollute the environment.

In recent years, the nicotine replacement therapy (NRT) sector has enjoyed rapid growth. It’s currently the most common cessation aid, giving smokers several options for steadily coming off nicotine. NRT currently comes in a nasal spray option, chewing gum, patches and lozenges or tablets. Each one releases nicotine into the blood stream at a much lower rate than cigarettes, without the tar, carbon monoxide and thousands of other poisonous chemicals. GPs and pharmacists recommend a 12-week course on NRT until a lower or even zero nicotine dosage has been reached.

Possible side effects of NRT can include a skin rash, headaches, dizziness, vivid dreams, stomach upset and nose irritation. It’s generally accepted that NRT used in the right way should pose little or no threat to the environment. How it fares against the growth of e-cigarettes remains to be seen.