Intended for healthcare professionals

Rapid response to:

Observations Yankee Doodling

Teenagers, smoking, and vaping

BMJ 2015; 350 doi: (Published 21 April 2015) Cite this as: BMJ 2015;350:h2110

Rapid Response:

Electronic cigarettes - Solution or A big problem.

I agree with the author. Electronic Nicotine Delivery Systems (ENDS), of which electronic cigarettes are the most common prototype, are a recent development in tobacco harm reduction. In the year 2004 the first e-cigarettes, a Chinese invention, came from the Ruyan company as a pathway to the reduction of tobacco smoking or tobacco harm reduction (THR); e-cigarettes were marketed as less harmful alternatives to smoking.[1] The Oxford Dictionary named "vape" the 2014 word of the year, marking the rise of a billion-dollar electronic-cigarette industry. There are two views: some experts welcome ENDS as a pathway to the reduction of tobacco smoking, while others do not support their use, hence ENDS are the subject of a public health debate.

E-cigarettes have become a fashion statement among young tobacco users & their use has spread to nearly all corners of the globe. Currently the use of e-cigarettes is apparently booming as “gateway devices” for smoking among young people. Studies have revealed that e-cigarettes are not free from adverse effects, and the use of e-cigarettes by teenagers, especially middle-school children, has increased, resulting in the criticism of e-cigarettes worldwide. Vaporizer refills of e-liquid (or “juice”) are available in little colored bottles in different flavors & nicotine concentrations. The colored bottles containing flavors, better to say “flavored bottles of poison”, attract infants and young children. Now nicotine is in the hands of minors, recently there are reports of e-liquid poisonings in childrens and in adults. Accidental e-liquid ingestion is an emerging paediatric problem. E-cigarettes have 10 times carcinogens such as formaldehyde and acetaldehyde in vapour (Research from Japan)[2].

Ultrafine particles are similar to traditional cigarettes, and cytotoxic metals in vapour produced by heating elements have been identified in e-cigarettes.[3,4] It has the potential to kill as inhaling nicotine could be dangerous. Flavourings, such as diacetyl, & other chemicals,are known to cause serious lung disease. Nicotine is a potent poison & harmful for passive smokers.[5] The most common side effects from e-cigarette use are sore throat, dry cough, and headache due to inhalation of PG/VG and/or nicotine. There is health risks to users, non-users and bystanders.[6] Appropriate legislative and regulatory measures to prevent the use of e-cigarettes are necessary.

E-cigarettes must be appropriately regulated to maximize the benefits and to minimize the risks. There is a need for well designed studies & pharmacovigilance programme for Electronic Nicotine Delivery Systems.

1. Backgrounder on WHO report on regulation of e-cigarettes and similar products. Geneva: World Health Organization (WHO), 26 Aug 2014.


3. Zhang Y, Sumner W, Chen DR. In vitro particle size distributions in electronic and conventional cigarette aerosols suggest comparable deposition patterns. Nicotine Tob Res 2013;15:501–8.
4. Williams M, Villarreal A, Bozhilov K, et al. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLoS ONE2013;8:e57987.
5. Diethelm PA, Rielle JC, McKee M. The whole truth and nothing but the truth? The research that Philip Morris did not want you to see. Lancet 2005;366: 86–92.
6. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013;382:1629–37.

Competing interests: No competing interests

21 April 2015
Rajiv Kumar
Professor, Deptt. of Pharmacology,
Dr.Jagjit Singh, Assistant Professor & co author.
Government Medical College & Hospital, Chandigarh 160030. INDIA