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E-cigarettes

E-cigarettes, also known as vapourisers or ENDS (electronic nicotine delivery systems), are handheld battery-operated devices which can deliver nicotine containing vapour. These devices can come in a variety of forms, and generally consist of a cartridge containing liquid nicotine (or ‘e-liquid’), an atomiser (heating device) and a mouthpiece. Solutions of e-liquid typically contain nicotine, propylene glycol and/or glycerol, as well as flavourings.

Increasing numbers of smokers are using e-cigarettes, with many people finding them helpful in cutting down or quitting cigarette use. There are clear potential benefits to e-cigarettes in reducing the harms associated with smoking, and consensus that e-cigarette use is likely to be significantly safer than smoking. It remains important, however, that in realising any benefit to health, any potential risks associated with e-cigarette use are minimised.

The BMA Board of science have published a position paper on the regulation of e-cigarettes – aiming to balance the risks and opportunities associated with the use of these devices. In addition, we’ve put together some answers to common questions that doctors and their patients may have about these devices.

 

Balancing risks and opportunities

Reflecting on the evolving regulatory and policy environment for these devices in the UK, the BMA Board of science has published a new position paper on the regulation of e-cigarettes. This paper sets out what the BMA believes is an appropriate policy response that would minimise potential risks associated with e-cigarette use while maximising their potential to reduce the health burden associated with smoking.

Download the paper

 

More information

  • What should doctors say?

    There are increasing numbers of smokers using e-cigarettes, many of whom are hoping to quit smoking or cut down using them.

    We’ve tried to answer some common questions about these devices, to support doctors when discussing their use with patients. It is not intended to be prescriptive, or to provide clinical advice, but to provide guidance highlighting some of the key factors to consider.

    It is likely that the majority of these conversations will occur in primary care, though doctors working in hospitals and other community settings may also frequently give advice on smoking cessation.

     

    Key points

    • There is growing consensus that using an e-cigarette is substantially safer than smoking tobacco.
    • Unlike smoking, e-cigarette use does not involve combustion. While the constituents of e-cigarette vapour can vary, and some of the toxicants present in tobacco smoke have been detected in e-cigarette aerosol, they are typically present at levels which are much lower than in tobacco smoke.
    • E-cigarettes currently available are consumer-regulated products which have to meet product safety standards, but the standards are not as rigorous as for licensed medicines.
    • Given the limited time for which these products have been widely available, there is limited information about the long-term health impact of their use.

     

    What should I advise a patient who is asking whether they should use an e-cigarette?

    • Evidence favours a combination of behavioural support and pharmacotherapy as providing the highest chance of successfully quitting tobacco use.
    • There are now significant numbers of people using e-cigarettes, with many finding them useful for quitting cigarette use or cutting down.
    • While the safest option is to use neither tobacco nor e-cigarettes, there is no situation in which it is safer to continue smoking than to use an e-cigarette.
    • The clearest benefit to health will likely be achieved for patients who are using e-cigarettes to stop smoking tobacco altogether. If individuals continue to smoke tobacco, there are unlikely to be major benefits from using e-cigarettes.
    • All smokers, including those who wish to use e-cigarettes as an aid to quit smoking, should be able to access the support of local smoking cessation services, and be aware of the full range of smoking cessation interventions and support available.

     

    Are e-cigarettes effective in helping people stop smoking?

    • E-cigarettes are now the most popular aid used in attempts to quit smoking. Many individuals who have attempted and failed to quit smoking using other methods have reported finding e-cigarettes useful in quitting or cutting down.
    • The evidence-base in this area remains weak, though most studies demonstrate a positive relationship between the use of e-cigarettes and smoking cessation.
    • Combining e-cigarettes with behavioural support is likely to increase the chance of successfully quitting tobacco use.

     

    Is it safe to use an e-cigarette in the long-term?

    • In the absence of long-term studies it is not possible to be certain about the long-term health risks, but there is growing consensus that use of e-cigarettes is significantly safer than smoking.
    • Unlike cigarette smoking, e-cigarette use does not expose users to the products of combustion, and most of the toxicants causing smoking-related disease are absent or significantly reduced in e-cigarette vapour.
    • Indications to date are that complete switching can lead to improvements in the levels of toxins and carcinogens in urine similar to that in smokers who switch completely to NRT (nicotine replacement therapies).

     

    Should e-cigarettes be used in pregnancy?

    • The Smoking in Pregnancy Challenge Group – a coalition of health organisations – have highlighted that although little research has been conducted into the safety of e-cigarettes in pregnancy, they are likely to be significantly less harmful to a pregnant woman and her baby than smoking cigarettes. The group suggest that while licensed NRT are the recommended option, if a pregnant woman chooses to use an e-cigarette to stay smoke free, she should not be discouraged from doing so.
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