WHAT’S TRENDING IN

TOBACCO: E-CIGARETTES
INTRODUCTION

• History: invented by a Chinese pharmacist in 2003

• Rapid evolution of devices: a moving target, marketing

and appealing to smokers and non-smokers alike.
POLL QUESTIONS
1. Have you ever tried an e-cigarette?

2. Do smoke cigarettes, if so have you ever thought about quitting?

3. How open are you to discussing the potential benefits and risks of e-
cigarettes as a smoking cessation tool?

4. Are you willing to incorporate e-cigarettes into a smoking cessation

treatment plan?
VAPE DEVICES
COMPONENTS OF E-CIGARETTES
AND VAPE DEVICES
 WHAT IS IN THE FLUID/VAPE?
• Many come premixed from China, but some are now made in the US
and Europe
• Origins and quality of the ingredients are generally not known
• Fluids* may contain:
 Nicotine (in varying concentrations 0-100 ml/mg)
 Humectants: propylene glycol (or vegetable glycerin) for vapor production
 Flavorings (tobacco, menthol, coffee, vanilla, fruit, cotton candy, etc.)
*Metals particle have also been found in the fluids
WHAT ARE VAPERS INHALING?
DO THESE SOUND “HARMLESS”?
• E-cigarette fluid and vapor contains toxic metals and nanoparticles
• Vapor contains tobacco-related toxins and chemicals – less than
cigarettes, more than nicotine inhaler
 Formaldehyde
 Acrolein
 Acetaldehyde
 VOCs
 NNN and NNK
• Exposure studies - Puff Topography not accounted for
Goniewicz et al, Tobacco Control
2013
ATTRACTION/PROMOTION OF VAPING
IT IS CHEAPER THEN SMOKING ..
E-CIGARETTE USE: SMOKERS AND RECENT EX-SMOKERS

Percent of smokers and recent 50

45 Growth in prevalence of e-cigarette use may have
40 slowed
35 Green = Have Smoked, Orange= Daily Smokers
ex-smokers

30
25
20
15
10
5
0

N=11,666 adults who smoke or who stopped in the past year; increase p<0.001

www.smokinginengland.info/latest-statistics/
CLINICAL SCENARIO #1

“I’m a heavy smoker and both my

parents were smokers who died of
lung cancer. I’ve tied all the meds
but never quit for more than a
week. I’ve heard that e-cigarettes
can help smokers to quit and I really
want to give it a shot. What can you
tell me about them?”
WHAT WOULD YOU TELL THIS PATIENT?
 SCENARIO #1 RESPONSE
1. Support Quit Attempt
2. Assess motivation and dependence
3. Assess prior quit attempts and inform about all
treatment/support options
4. Inform on what we know and what we don’t know about
e-cigarettes
5. Assist smoker to develop a plan to quit smoking
6. Arrange a follow-up
 HOW TO HELP IF SOMEONE IS
“NOT INTERESTED” IN QUITTING?

• Have they said, “I’ve tried everything”

• Frequently NRT misused or incorrectly used
• Unassisted quit attempts
• Correct misperceptions of approved therapies
• Correct misperceptions of e-cigarettes
• Treat Depression, PTSD
• Incidents reported to the CDC
• Average 1 per month increased to 215/month
• Most common adverse events were vomiting, nausea,
and eye irritation
 QUESTIONS FOR YOUR DOCTOR
• Suggest to your PCP to provide for poly tobacco use
including e-cigarettes
• Discuss how field and devices are rapidly evolving
• Engage with new opportunities to discuss smoking cessation
• Misinformation and false claims are rampant
• Data are scarce: Though little research is available, that is
also a scare in itself. (You don’t know what you're putting in
your body)
• Continue to provide evidence based research on
approved NRTs and Rx
• Prior to a visit document and report health concerns
DON’T BE FOOLED! STAY INFORMED.