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Opinion: Is there now an argument for banning e-cigarettes in Ireland?

E-cigarettes are not harmless, but now is not the time for mass hysteria, writes Professor Des Cox.

Des Cox

E-CIGARETTES HAVE HIT the headlines across the world over the past month because of a spate of lung illnesses associated with their use in the US.

There are now over 800 reported cases, including 11 deaths, across 46 states in the US.

Most of these cases resulted in the patients being admitted to hospital and several required admission to the intensive care unit with respiratory failure.

From the published studies, we know that all of the affected patients used e-cigarettes containing a range of different compounds, but we don’t know which of those compounds led people to become sick.

One line of enquiry is that some patients used tetrahydrocannabinol (THC) or cannabidiol (CBD) products, both of which are found in cannabis, purchased on the black market.

The patients may have been exposed to a mixture of compounds that had an acute toxic effect on the lungs, but it is too early to point the finger at any one agent or device.

A full investigation is underway to determine the exact cause of the outbreak of vaping associated lung illnesses across the US. Until we have more information, we remain in the dark about what the relationship is between this outbreak of respiratory illnesses and e-cigarettes.

Vaping is less harmful than tobacco smoking

Reassuringly, on this side of the Atlantic, no such reports have emerged to date and this outbreak seems to be isolated to North America.

Vaping has been commonplace in many countries for over ten years now so you would have expected to have seen similar outbreaks of respiratory illnesses across different countries prior to this current epidemic.

Smoking is still our biggest public health issue in Ireland. The Healthy Ireland Survey 2018 reported that one in five of the Irish population are current smokers.

Lung cancer remains the most common cause of cancer deaths in Ireland and tobacco-related diseases remains the most common cause of preventable deaths worldwide. Decreasing the prevalence of smoking must remain a top priority for Irish health policymakers.

E-cigarettes can help people quit tobacco smoking. Public Health England maintained their stance this week that vaping is less harmful than tobacco smoking and continue to encourage people who smoke tobacco products to switch to e-cigarettes.

However, it is apparent now that e-cigarettes are not completely harmless. Although vaping may not lead to lung cancer, it may lead to other lung diseases.

A study published last month by a research group in North Carolina reported that long-term vaping might lead to chronic lung diseases such as emphysema.

Clearly this is an evolving situation, with new research in the area being published weekly. Misinformation and myths tend to come to the fore when there is uncertainty around a topic.

Now is not the time for mass hysteria in relation to e-cigarettes.

It is important that physicians keep the public informed about the most up to date evidence available and the potential risks associated with vaping.

For ex-smokers who currently vape, the best advice at the moment is to speak to your GP if you develop any respiratory symptoms such as cough, shortness of breath and fever. It would also be advisable to avoid buying unregulated products on the black market until there is some clarity around the recent deaths in the US.

Protecting children

For those who don’t smoke, don’t take up vaping. We need to ensure that e-cigarettes are only used by smokers trying to quit. Earlier this month, a study reported that the number of adolescents using e-cigarettes in the US continues to grow.

The study surveyed over 40,000 teenagers and reported that the prevalence of vaping doubled from 2017 to 2019. The US are in the midst of a public health crisis and are considering a ban on flavouring in e-cigarettes. A number of states have also banned e-cigarettes outright.

We have no evidence that a similar picture is evolving here in Ireland so it’s important not to adopt a knee jerk reaction to the current epidemic seen in the US. However, we need to protect children from the dangers of both tobacco smoking and nicotine addiction by ensuring they never start either tobacco products or e-cigarettes.

Flavouring in e-cigarettes has most likely contributed to the upsurge in adolescence vaping in the US, so it is certainly worthwhile discussing a placing some restrictions on flavouring here in Ireland.

There is little evidence that the flavouring in e-cigarettes has resulted in more people quitting tobacco smoking. We may be able to prevent the onset of widespread teen vaping here by removing the flavours which attract young non-smokers to the e-cigarette market.

This would not hinder ex-smokers who could continue to vape menthol and tobacco flavoured products.

If someone wishes to quit tobacco smoking, they should preferably select a quitting strategy with long-term evidence-based medicine behind it and do so in consultation with their GP or HSE smoking cessation services.

Although vaping can help people quit smoking, it is not a harmless activity and we need to get this message out there, particularly to young people.

Professor Des Cox is Chair of the Royal College of Physicians in Ireland policy group on tobacco and consultant in respiratory medicine at Children’s Health Ireland, Crumlin.

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