What We Should Know About Vaping?

Smoking is a known health issue. Evidence has shown that besides the nicotine which is responsible for the addiction to smoking, each cigarette stick contains over 4000 chemicals which are toxicants and carcinogen (can cause cancer). Smoking has been related with many diseases like COPD, ischaemic heart disease cancer of the lungs, prostate, breast and in asthmatics it worsens the condition. All these effects are also seen amongst the second hand smoke ii the people who breathes in the smokes produced by the people smoking around them.
Smoking evolves from burning tobacco which is wrapped with a leaf (rokok daun) to what is available now. Similarly interventions and activities to quit smoking evolve. From counselling and behaviour therapy to NRT (Nicotine replacement therapy) and pharmacotherapy (eg: varenicline). Along the way E cigarettes has been produced and it too evolves from appearing exactly like a cigarette stick to the present e cigarette which is better known as Vape.
Why E cigarette or Vape?
Majority uses E cigarettes because they:
1. Want to stop or quit smoking
2. Feel Vaping or e cigarette is safer
3. Believe Less addictive
4. Want to flow with the currents trend
5. Have more freedom to use in public places
6. Think it has Less effect to people around them (second hand vapers)
7. Believe it is Cheaper,
And for various other reasons like for fun, it’s the technology and youngsters used it out of curiosity!
Facts on vaping.

A. Is it true that Vaping or smoking e cigarette is safe
  1. Vaping is still not safe, even though it contains lesser harmful chemicals (toxicants & carcinogens) compared to conventional cigarettes. The prophylene glycol which is responsible in producing the vapours, will be converted to acetaldehyde (ex: formaldehyde which is used to preserve dead body) when burnt. There are studies on industrial use of propylene glycol and exposure to theatre fog (produced from prophylene glycol) that show negative health effects. These effects include throat and eye irritation, cough, mild airway obstruction, headache, and dizziness. So, inhalation of this humectant is not as safe as most people think.
  2. The problems with the labs studies that examined the presence of toxicants & carcinogens in e-cigarettes only tested for known toxicants and carcinogens of conventional cigarettes. Other impurities or by-products of heating e-juices are not known.
  3. You can become a drug addict by vaping! There has been a recent news about the juices has drugs added to it to increase its effects when used. You may start vaping to quit smoking or out of curiosity but end up a drug addict.
B. People can get addicted to vaping

As mentioned earlier the chemical responsible for addiction is nicotine. It has been found that even the e juice labelled as nicotine free contain certain amount of nicotine. Studies have shown that people do not use vape forever. Majority quit vape. They end up smoking conventional cigarettes.

C. Are people around the e cigarette vaping affected?

There are studies which show that vaping changed the air quality around them. The concentration of PAH (polycyclic aromatic hydrocarbon) increases. Another study also found an increase in serum cotinine in the ‘second hand’ vaping. Unfortunately there are no studies to confirm the long term impact of vaping to the people around them. Let’s make sure our children and spouses are not the ‘guinea pigs’ for this study.

D. What is the issue with our children and adolescents?

Adults may vape to quit smoking. However adolescents do it out of curiosity, to fit in with the peer group and to follow the trends. This will not be for long until they become dependent on nicotine and later become chain smoker although they might not have planned to smoke in the first place. This is actually another public health concern. Vaping can cause gateway to nicotine addiction/ smoking conventional cigarettes especially among adolescents’.

E. Can E cigarette be used to quit smoking?
  1. There are evidences that demonstrate ‘vaping can help smoking abstinence or cessation’. It showed that vapers had 2.2 times the chance to stop smoking conventional cigarettes for at least 6 months compared to smokers who do not vape.
  2. However, vaping still allows maintenance of nicotine addiction. Vapers still receive nicotine from e-cigarettes. Studies that examine its effectiveness as a treatment of smoking cessation (comparing with NRTs and Champix) are also lacking.
  3. So, it’s effectiveness as a treatment for smoking cessation (like nicotine replacement therapy) is still not proven. One of the possible reasons because the amount of nicotine that the vapers get from inhaling the vapours are varied, and it is quite difficult to titre down the concentration of nicotine. Even though they use the lowest concentration labelled on the bottles of e-juices, it is not guaranteed that they inhale nicotine of the stated concentration.
  4. The concentrations of nicotine are different from puff-to-puff, and across the brands and models of e-cigarettes.
  5. Furthermore, this smoking abstinence may not be sustainable as studies have shown that substantial number of vapers does relapse to smoking conventional cigarettes due to many reasons.
F. Vaping can be hazardous

The latest news on the hazards caused by vaping is the fire in a flight which developed from a vape kept in the pocket in one of the passenger. It has been reported that the device explodes while using causing injuries to the users hand and face

Ingestion of the ejuice can be fatal. It can cause nicotine toxicity. The initial symptoms are mainly due to stimulatory effects and include nausea and vomiting, excessive salivation, abdominal pain, sweating, low blood pressure, increased heart rate, tremors, headache, dizziness, muscle fasciculation and seizures. Later the depressor effect will take place where it causes low blood pressure, low hear rate, muscle weakness/paralysis, difficulty in breathing, central nervous system depression and coma
To really combat problems with nicotine addiction, it must involve all bodies, organisations, employers, and even all Malaysians to create a norm that ‘smoking or vaping is unacceptable’. For those who have chosen a wrong step in the past and already addicted to nicotine, their struggle to free themselves from this addiction should not be undermined. We have to help them to treat their nicotine addiction by ensuring that they can appreciate their risks of smoking, helping them to overcome their barriers, providing them necessary skills to change their habits and psychological dependence, and prescribing the proven effective pharmacotherapy. As majority of the smokers are in pre-contemplation stage, doctors should be trained to provide counselling for these smokers so that they want to stop smoking. Doctors should be trained to provide effective interventions for smoking cessation. Doctors should also be provided with adequate medication and non-pharmacological assistance for treating nicotine addiction. Smokers need to be assisted adequately to quit and their difficulties in the battle must be taken care and intervened as best as possible. The most important thing is we should aim for no smoking and no vaping. Smokers need to come forward to seek help and get rid of their addiction problem.
As vaping device can also be used to inhale illicit drugs openly without being notice by narcotic enforcement team and our country Malaysia is well known to have strict drug law hence any possibility of facilitating illicit drug use must be taken action seriously. In fact it was recently discovered by the ESERI, Universiti Sultan Zainal Abidin Terengganu that vape liquid studied in the laboratory also contain cannabis precursor (both synthetic and natural).

In conclusion smoking conventional cigarette and vaping are both addictive and harmful. Although the cigarette and vape industries may create great wealth to some, we must always remember, our greatest wealth is health.


Dr Salmah Nordin & Dr Hizlinda Tohid
Family Medicine Specialists Association Malaysia (FMSA)