Safer Or Worse? Rising Numbers of Indian E-Cigarette Users May Be At Risk Of Lung Infection


New Delhi: Scientists have discovered that smoking e-cigarettes, a process known as “vaping”, could potentially lead to higher risk of bacterial infections in the respiratory tract leading to infections such as pneumonia.

Last month the British scientists published a comprehensive report examining the health effects of e-cigarettes. They found that although e-cigarettes exposed users to lower levels of toxic substances than conventional cigarettes, vaping may have its own unique set of harmful effects.

What are E-cigarettes?

Vaporizers, vape pens, hookah pens, electronic cigarettes (e-cigs) & e-pipes & other ENDS are battery operated smoking devices that create an aerosol by heating a mix of liquid nicotine, propylene glycol, water, glycerine & flavor, which when inhaled gives a feel of smoking a real cigarette.

Since the invention of the 1st cigalike by Hon Lik in China in 2003, as a healthy alternative to tobacco, according to WHO, this industry has grown into a global business estimated at $3 billion with 500 brands and 8000 flavors. The cost of an Ecig ranges between Rs 500-5000.

What happens when we vape?

This new study focused on a molecule called platelet-activating factor receptor (PAFR), which is produced by the cells that line our airways. PAFR has been previously shown to help pneumococcal bacteria stick to airway cells increasing the risk of infections.

The study included experiments in vitro with human cells, and in vivo with mice and human subjects. In both the in vitro cell tests and the human studies, the researchers found that vapor from e-cigarettes increased PAFR levels on airway cells three-fold.

When pneumococcal bacteria were subsequently introduced to the airways of PAFR-elevated mice a higher volume of bacteria was found to stick to the respiratory tract of the animals.

“Together, these results suggest that vaping makes the airways more vulnerable to bacteria sticking to airway lining cells,” says Grigg, lead researcher of the study. "If this occurs when a vaper gets exposed to the pneumococcal bacterium, this could increase the risk of infection."

It must be remembered that although vaping might increase susceptibility to pneumonia, the effect is likely to be lower than from regular smoking itself.

The research was published online Feb. 8 in the European Respiratory Journal.

Increase of vaping in India

In India E-cigarette sales are not regulated, making vapes easily accessible to adolescents. Ecig sales are rising in India both online and offline. It is difficult to track age of buyers unlike Europe where sales to children under 18 is banned.

At present there is little public information about scale of vaping in India. Based on data collected it appears that ~ 18% smokers will switch to vaping within a few years.

Market research also projects the compound annual growth rate of the Indian e-cigarette industry at 63.38 per cent in the period 2013-2018 (Research and Markets Report on E-cigarette Market in India 2014-2018).

Most e-commerce websites sell e-cigarettes as therapeutic products which enable people to quit smoking. Many prominent and easily accessible e-cigarettes were not sold with appropriate health warnings.

The current unregulated sale of e-cigarettes is dangerous for a country like India where the number of smokers is on the decline (WHO Global Report, 2015) as it increases the possibility of e-cigarettes inducing nicotine addiction and perpetuating smoking.

World scenario with relation to vaping

Tobacco use is the single largest preventable cause of disease & death in the US. Since 2009, FDA has regulated cigarettes, smokeless & roll-your-own tobacco. In 2016, FDA finalized a rule extending the regulatory authority to cover all tobacco products & all electronic nicotine delivery systems (ENDS).

It now regulates the manufacture, import, packaging, labeling, advertising, promotion & distribution of ENDS. However, products marketed for therapeutic purposes (to help people quit smoking) are regulated by FDA through the Center for Drug Evaluation and Research (CDER)

In 2015, approximately 3 million middle & high school students used Ecigs making it the most common tobacco product used among youth for the 2nd consecutive year in the US. In 2013-14, 81% of youth Ecig users cited availability of appealing flavors as the main reason for use. In 2014, 12.6% of US adults had tried an Ecig & ~ 3.7% used Ecigs daily.

However several studies indicate that Ecig vapor is harmful for children, teenagers & fetuses. A global 2016 Elsevier Ecig study stated that it may help people quit but encourage more people to start smoking as it is marketed as a product with no harmful effects. The minimum lethal dose of nicotine is 30-60mg. A Ecig vial contains ~ 10mg nicotine.

The FDA believes that vaping has both potential benefits and risks. If Ecigs, have reduced toxicity compared to conventional cigarettes then current smokers should be encouraged to switch completely.

But if any product prompts young people to become addicted to nicotine, reduces a person’s interest in quitting cigarettes, and/or leads to long-term usage with other tobacco products, the public health impact could be negative.





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