Following a high-profile Royal College of Physicians’ report encouraging smokers to consider e-cigarettes as a less harmful alternative, Cancer Research UK asked Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training, to answer some of the most commonly asked questions about the devices. His response to these questions can be found below.
Dr McEwen: Yes. Experts think that e-cigarettes are, based on what we know so far, much safer than cigarettes. Smoking is associated with a number of very serious health risks to both the smoker and to others around them. So switching from tobacco to e-cigarettes substantially reduces a major health risk.
Dr McEwen: Nicotine doesn’t cause smoking-related diseases, such as cancers and heart disease, but it is addictive. However, there’s a common misconception that you can overdose on nicotine using e-cigarettes. But you are in no danger of poisoning yourself, nor have there been any cases of overdose from inhaling the nicotine-containing fluid that an e-cigarette vaporises, known as e-liquid. So you can use your e-cigarette as often as you need to help manage nicotine withdrawal and urges to smoke.
Much the same as with Nicotine Replacement Therapy, if you do have more nicotine than you’re used to, then you might feel a little nauseous or lightheaded, both of which pass quickly. If this happens, just reduce the level of nicotine in the e-liquid that you buy, or use the e-cigarette less.
Dr McEwen: Some studies have found chemicals in e-cigarette vapour that are known to cause health problems. But these studies have tended to use artificial conditions, and when good quality e-cigarettes are used normally (e.g. not overheated), there are far fewer harmful chemicals present in the vapour than in tobacco smoke. If the e-liquid is being overheated it tends to produce an acrid, unpleasant taste – you’ll know if this happens.
As with any rechargeable device, such as mobile phones and laptops, it’s important to charge e-cigarettes with the right charger, and don’t leave it unattended while charging. Ensure that you buy from reputable suppliers and avoid generic charging equipment. There have been reported cases of e-cigarettes causing fires, but far fewer than the number caused by cigarettes, which are the most common cause of lethal house fires.
Dr McEwen: There’s no evidence that smoking cigarettes and vaping at the same time is any worse than just smoking tobacco. But the greatest health benefits are seen when people stop smoking tobacco completely, so quitting smoking should be the goal.
Some people manage to switch completely to vaping quickly, while others take a little time. You may have to try a number of different e-cigarettes and e-liquids before you find one that helps you to stop smoking completely, but this is quite normal.
Dr McEwen: Yes. If you choose to use an e-cigarette, Stop Smoking Services can still support you in your quit attempt – and these services are the most effective way to quit. These trained stop smoking practitioners provide behavioural support, advice on what might be the best way for you to stop and access to approved stop smoking medications.
Dr McEwen: This is very much a personal choice. The refillable tank system e-cigarettes might take a bit of getting used to, but they allow you to use more flavours, and generally deliver more nicotine than e-cigarettes that look like tobacco cigarettes. Users tend to say these types are more satisfying. Specialist e-cigarette retailers can give you advice, and you can also chat to other e-cigarette users on a range of internet forums.
How much nicotine you need will depend upon how much nicotine you’re used to getting from your cigarettes. And, of course, how much nicotine you get from your e-liquid will depend upon the type of e-cigarette that you use and how you use it. As a rough guide, most 20-a-day smokers find that 18mg/ml (1.8 per cent) of nicotine is sufficient, so you could start with this and see how you get on.
Dr McEwen: Using an e-cigarette is different from smoking a cigarette. It usually involves taking slower and longer puffs over a longer period of time. This is because e-cigarettes heat a coil in a liquid (similar to a kettle). You may find you need to take a few puffs on an e-cigarette at times when you wouldn’t have smoked, but this is nothing to worry about, and the way you use your e-cigarette will develop over time. It’s not like a cigarette in which you smoke from start to finish. With an e-cigarette you can use it once or twice, and then put it away. If you find you’ve got it in your mouth all the time, you might need to consider using a stronger e-liquid.
If you get a bit of a cough when you use your e-cigarette, this isn’t unusual and it might help to switch from an e-liquid with a high proportion of propylene glycol to one with more vegetable glycol, which can be more soothing.
Dr McEwen: Yes, and you’ll notice savings very quickly compared with buying cigarettes. A starter kit for the tank-style devices can range from £20-70. You’ll then only need to replace the atomiser (heating coil or ‘head’) occasionally for a couple of pounds and buy your e-liquid, which can start at £3.00 for 10 ml. How often you need to change the atomiser will depend on how you use the device, but typically it’ll be around every two weeks or when you get a ‘burnt’ taste or low vapour production.
Dr McEwen: There are no laws preventing or restricting where you can use e-cigarettes. Some places, such as some sports stadiums and most airports, do not allow vaping while others do. If there are no signs indicating this, then you should always ask. But it helps to be respectful when using e-cigarettes around others, especially non-smokers.
Dr McEwen: Unlike second-hand smoke from cigarettes – which is known to cause cancer – there’s no evidence that second-hand e-cigarette vapour is dangerous to others. Some studies have found traces of toxic chemicals in second-hand vapour, but at such low levels that they’re not harmful to those around you. It’s important to remember that e-cigarettes aren’t recommended for use by non-smokers and children.
In order to prevent accidental poisoning, for example by young children drinking e-liquids, you should store your e-cigarettes and liquids away safely, just as you would with household cleaning products and medicines.
Questions asked by Cancer Research UK to Dr Andy McEwen of the National Centre for Smoking Cessation.