The use of electronic cigarettes (e-cigarettes) continues to dramatically increase, and the debate over their safety and appropriate use has heated up in parallel. We as pulmonary clinicians are called upon to advise our patients and others about e-cigarettes, which presents challenges given the current limitations of the data upon which our advice should be based. What do we say?
At first glance, the use of e-cigarettes appears to be an attractive option. Evaluation of the ingredients and particulates associated with e-cigarette vapors has demonstrated a substantial decrease in carcinogens compared with the traditional cigarette.1 e-Cigarettes can deliver nicotine in a form that is familiar to the traditional smoker, yet lacks many of the harmful constituents of cigarette smoke. The optimist envisions a cohort of multi-pack-year smokers switching to the e-cigarette with a resultant rapid decrease in risks of heart disease, chronic lung disease, and cancer. But is this optimism justified by empirical evidence of safety and favorable data on patterns of use or is this simply wishful thinking?