If you are thinking of trying to quit smoking, you may be tempted to turn to electronic cigarettes or e-cigarettes, which are commonly believed to be a way to ease the transition. But hold your horses, recent research has revealed that e-cigarettes can cause heart arrhythmias and can be ‘similar or worse than conventional cigarettes’.
A new study by researchers from the University of Louisville (UofL) in the US, which was published in scientific journal Nature Communications on October 25 this year, suggests that exposure to specific chemicals within e-cigarette liquids (e-liquids) promote arrhythmias and cardiac electrical dysfunction. “These findings suggest that e-cigarette use involving certain flavours or solvent vehicles may disrupt the heart’s electrical conduction and provoke arrhythmias. These effects could increase the risk for atrial or ventricular fibrillation and sudden cardiac arrest,” Alex Carll, assistant professor in the UofL department of physiology who led the study, was quoted as saying by media reports.
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Dr Vikas Maurya, director and HOD, department of pulmonology and sleep disorders, Fortis Hospital, Shalimar Bagh, New Delhi, agrees. “E-cigarettes have many side effects. They can contain potentially harmful substances, like nicotine and ultrafine particles, which can directly go into the lungs. They also contain flavouring agents, like diacetyl, which is the chemical linked to serious lung diseases. They also contain volatile organic compounds, cancer-causing chemicals and heavy metals such as nickel, tin and lead. All these substances are very harmful,” he adds.
The theory is that cigarette smoke contains known carcinogens and nicotine, an addictive substance. “Vapes contain only nicotine and not other smoke. We would need years of data to find out if the aerosols from vapes are carcinogenic or not. So, from a cancer perspective, yes, they may seem safer, but as far as nicotine addiction is concerned, they are equally addictive. E-cigarette or vaping-induced lung injury (EVALI) is another health hazard reported over the last few years,” says Dr Sonam Solanki, consultant pulmonologist and bronchoscopist, Masina Hospital, Mumbai.
EVALI is a severe and life-threatening lung disease with most of the patients recovering completely. However, 68 deaths have been found out of a total of 2,800 cases reported till February 18, 2020, as per the Centers for Disease Control and Prevention (CDC). “Also, another study published last year compared lung function between vapers, cigarette smokers or those who didn’t smoke any of those. It revealed that vaping has similar detrimental effects on pulmonary function as smoking. In addition, increasing vaping uptake among youth could stimulate uptake of cigarette smoking, creating a smoking-dependent generation,” explains Dr Richa Mittal, consultant at pulmonary and sleep medicine department, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai.
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As per Dr Solanki of Masina Hospital, each flavour of e-cigarettes is essentially a different chemical. “Diacetyl has been linked to sweet and cinnamon flavours, while cherry flavours have been linked to benzaldehyde; both are irritating to the lungs. Chemical-induced lung injury is known to occur. The addictive substance in the vapes is nicotine and not the flavours,” he adds.
What normally happens is that people start using e-cigarettes along with conventional cigarettes to reduce their dependency over the latter, but they end up using both.
“It is a well-known fact that smoking cigarettes has negative health effects. Depending on the individual, smokers who were previously going to stop were able to do it (by smoking e-cigarettes). However, those who start vaping but do not intend to stop smoking tend to smoke more cigarettes each day and frequently have the worst health consequences,” says Dr Mayank Kapoor, consultant, pulmonology and respiratory medicine, Paras Hospitals, Gurgaon.
Smoking kills
Smoking has numerous health hazards and can affect any body part, from head to toe, and is not just limited to lungs. It is the largest preventable cause of cancer and is responsible for 30% deaths related to cancer. “Smokers are at much higher risk of getting cancers of lung, oral cavity, nose and sinuses, stomach, pancreas, urinary tract, kidney or liver or uterus. It is a major cause of death from heart and lung diseases. Smoking is also a major risk factor for osteoporosis, reproductive disorders, erectile dysfunction, and cataract,” says Dr Mittal of Sir HN Reliance Foundation Hospital and Research Centre.
In addition to emphysema and chronic bronchitis, smoking also increases the risk of developing cancer, heart disease, stroke, lung conditions, diabetes, and chronic obstructive pulmonary disease (COPD), adds Dr Kapoor of Paras Hospitals, Gurgaon. “Smoking also raises the risk of developing tuberculosis, several eye conditions and immune system issues such as rheumatoid arthritis,” he adds.
According to Dr Maurya of Fortis Hospital, Shalimar Bagh, smoking can even affect pregnant women and their babies. “It can cause preterm delivery, still birth, low birth weight, sudden infant death syndrome (SIDS) and ectopic pregnancy. It can also affect men and can cause infertility,” he says, adding: “It can affect your teeth, your gums, and can cause tooth loss. It can increase the risk of cataract. It is also a risk factor for type 2, diabetes mellitus. It is also a cause of rheumatoid arthritis. So, as I said, it can affect any part of the body with no good effects. Therefore, it is better not to smoke.”
The way out
Two out of every three tobacco users wish to quit. While 50% try on their own, 30% seek help, but only 3–6% actually succeed in doing so, unaided. “Tobacco cessation clinics/ centres (TCC) help current tobacco users to quit tobacco in a scientific manner. At TCCs, pharmacological interventions are used along with behavioural strategies to produce quit rates of about 25-30%,” says Dr Vikas Mittal, associate director – pulmonology and sleep medicine, Max Super Speciality Hospital, Shalimar Bagh, New Delhi. “There are many tips which are taught in behavioural management. The five ‘Ds’ of healthy coping mechanisms that can be used to manage your cravings are ‘Delay, Distract, Drink water, Deep breathing and Discuss’,” he explains further.
“Combining therapy and medicine is the most effective strategy to stop smoking. They both assist. However, employing both increases your odds twofold compared to using only one,” offers Dr Kapoor of Paras Hospitals, Gurgaon. “Other than nicotine replacement, psychological support is important. Holding on to the urge for 5 minutes before smoking, nicotine gums/lozenges, and breathwork are certain tools people can use to help deal with cravings,” adds Dr Solanki of Masina Hospital.
Help at hand
Once you have decided to quit smoking, follow these tips
- Even if the urge is strong, remember that it will wear off in 5-10 minutes. So, just try to delay it as much as possible, and it will be gone
- Try nicotine replacement therapy. Nicotine can be taken in the form of chewing gums, nasal sprays, inhalers or nicotine patches
- Stay away from triggers. For example, avoid situations like going out with friends or to parties or bars till the time you are trying to quit smoking
- Chewing gum (maybe a sugarless gum), hard candy or any food, which can delay or resist the craving, can also be tried
- Physical activities like yoga, jogging or running can be done to distract yourself from tobacco craving
- Deep breathing exercises, relaxation techniques and massages can also be done to distract yourself; they have health benefits too
- You can also contact your family members, friends, or support groups and talk to them; they can counsel you as well
- Also try to remind yourself that if you quit, you will have many health benefits. You will save a lot of money too
— Dr Vikas Maurya, director and HOD, department of pulmonology and sleep disorders, Fortis Hospital, Shalimar Bagh, New Delhi