Electronic Cigarettes: the Good and the Bad

Electronic cigarettes (“E-cigs”) are gaining popularity. But could they do more harm than good?

Electronic cigarettes (also referred to as “e-cigs”) offer smokers a less smoky, less stinky alternative to tobacco. Convenience aside, many smokers switch to the e-cig to protect their children and loved ones from the risks of secondhand and thirdhand smoke (tobacco smoke residue that settles into clothing, upholstery, and carpets).

But as the studies and statistics are published on the e-cig, they seem like less and less of a healthy alternative to tobacco.


Can the E-Cig Help You Quit Smoking?

At first glance, one would expect tobacco and cigarette companies to feel threatened by the new, allegedly cleaner and safer smoking technology of the e-cig. But Big Tobacco has actually joined in  the electronic cigarette movement! Why? Is it fear of losing market shares? Or could it be that they know something that most of us don’t: that studies have shown electronic cigarettes are associated with an overall increase in tobacco use. In other words: people who use e-cigs smoke more than people who smoke regular cigarettes.

A study recently published in JAMA (March 2014) concludes:

“Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.

Because the e-cig comes in two different potencies, many smokers like the idea of using the e-cig as a stepping stone to quit smoking altogether. Unfortunately, however, we have little to no proof that the e-cig is an effective smoking cessation tool. And, as the above study demonstrates, using the c-cig may make it harder to quit.

One of Dr. Thomas’ family members has struggled trying to quit cigarettes, has tried using e-cigarettes twice and both times resumed smoking regular tobacco.


Is the E-Cig Safer Than Regular Cigarettes?

The jury is still out on whether or not the e-cig is safer than regular cigarettes. One of the biggest health risks associated with the e-cig is the liquid nicotine that’s loaded into them. Nicotine in this potent, liquid form is highly toxic. The toxicity is only made worse by the known neurotoxins polyethylene glycol 400 (PEG400) and/or propylene glycol (PG) which are also found in the e-cig liquid. These e-liquids are not regulated by the FDA.

In our own clinical and personal experience, we have yet to be impressed with the e-cig.

Dr. Zelfand has had several patients insist on switching to the e-cig. Of the three un-related patients who switched in the last four months, two have experienced a worsening of their respiratory symptoms. Both of these patients had mild asthma to begin with, which was well controlled with occasional use of a rescue inhaler (albuterol). They had hoped the e-cig would be more gentle on their lungs. Within weeks of switching to the e-cig, however, both of these patients had a dramatic worsening in their asthma symptoms. Both of these patients had to begin using daily steroid inhalers. One of these patients also needed a short course of oral prednisone to get his breathing under control. Dr. Zelfand was able to convince one of these patients to switch back to regular cigarettes and work with her on smoking cessation, and slowly his asthma symptoms improved. The other patient refused (he had a new baby in the house and was worried about secondhand smoke). He is currently struggling to pay for his expensive asthma medications, as he requires daily steroids to keep his airways open.


Is the E-Cig Safer For Your Children?

The e-cig is a smoke free method for delivering nicotine to the smoker. This means there’s little to no secondhand smoke or thirdhand smoke to worry about. In fact, people often switch to the e-cig when they have children, hoping to protect the young ones from cigarette smoke.

The trouble with e-cigs, however, is that they come in brightly colored casings, and the liquid comes in different flavorings like bubble gum and cherry. This makes the e-cig look a bit like candy, making a child more likely to express interest in the e-cig and reach for one when unsupervised.

The liquid in e-cigs has a much more potent nicotine content than is found in regular tobacco. This means if your child finds you e-cig and starts playing with it, s/he could be at serious risk. Within the last year alone, the number of children who were rushed to the hospital after drinking nicotine liquid skyrocketed by 300%.

The e-liquid can also deliver nicotine simply through contact with the skin. In Kentucky, an e-cig broke in a woman’s bed and the liquid absorbed through her skin as she slept. She was rushed to the hospital with cardiac problems.

These stories illuminate the importance of treating the e-cig like a serious drug, and keeping it out of a child’s reach.


You CAN Quit Smoking

If you struggle with smoking, consider professional help. I work with patients on the mental/emotional aspects of smoking (cravings, irritability, etc.) in addition to disrupting the physiological pathways of addiction.


Make smoking cessation your number one priority. Act like your life depends on it. Because it does.










This entry was a collaboration by Dr. Paul Thomas & Dr. Erica Zelfand

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