The truth about vaping

Vaping is estimated to be 95% less harmful than smoking. Where did this figure come from?

"The 95% estimate was developed by independent academics," explains a spokesperson for Public Health England (PHE). "PHE's 2015 independent e-cigarette evidence review agreed that, based on the available evidence, the figure was a reasonable estimate. The Royal College of Physicians came to a similar conclusion in its 2016 report."

Despite these statistics and the evidence available, in light of vaping-related deaths in the United States, the proportion of smokers correctly believing that vaping is less harmful than smoking has fallen to just 48%.

Vaping deaths

Deaths and serious illnesses thought to be caused by vaping are becoming more commonly reported in the US. According to the US Centers for Disease Control and Prevention, as of mid-January 2020, more than 2,600 people had been hospitalised for EVALI (e-cigarette or vaping product use-associated lung injury) or related deaths, across fifty states. Of these, 60 deaths had been confirmed across 27 states.

The majority of these cases of EVALI were in people who admitted to having used illegal, unregulated THC vaping products, explains a spokesperson for PHE. "The US outbreak of vaping-related lung disease has been linked to the use of illicit vaping fluids containing THC, a derivative of cannabis, and vitamin E acetate. Both are prohibited from UK regulated nicotine-containing e-cigarette products."

The products were illegal to buy in the US, but even regulated US vaping products differ to what's available on the UK market.

"In the UK, nicotine-containing e-cigarette products are tightly regulated for quality and safety by the Medicines and Healthcare products Regulatory Agency (MHRA). They operate the Yellow Card Scheme, encouraging vapers to report any adverse effects," explains PHE's spokesperson. "PHE's advice on e-cigarettes remains unchanged, that they carry a small fraction of the risk of cigarettes, that smokers should consider switching completely and vapers should stop smoking."

In the UK, newspapers flocked to a case of a teenager left fighting for his life after months of vaping. It was later found that he had had a rare but serious allergic reaction to the product. This is being investigated further but allergic reactions of this kind don't not pose a threat for the vast majority of the population.

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Relative risk

Each year, 78,000 people in the UK and 480,000 people in the US die from smoking - and this doesn't begin to account for hospital visits related to smoking which don't end in deaths. These numbers are so vast and deaths so common that, naturally, it's impossible to report on them individually. Investigations are underway to investigate any unknown factors linked to the EVALI deaths in the US. But it's important to note that the reason the deaths are being so heavily reported is because they are so uncommon.

"Cigarettes are a uniquely risky and harmful product because tobacco smoke contains over 5,000 chemicals. When people smoke, these chemicals damage the lungs but also pass into the bloodstream and spread through the body," explains Dr Nick Hopkinson, medical director at the British Lung Foundation.

"Whilst people smoke because they become addicted to nicotine, they are harmed by the tar and other chemicals, including carbon monoxide. Smoking causes around 7 out of every 10 cases of lung cancer and can also worsen symptoms of lung conditions such as asthma. Smoking not only harms the lungs but also causes heart attacks, strokes and cancer."

When it comes to using e-cigarettes, it's about the relative risk of vaping against smoking normal cigarettes. "E-cigarettes are not risk-free but they are far less harmful than cigarettes. E-cigarettes don't contain tobacco and don't produce tar or carbon monoxide, two of the most harmful constituents in tobacco smoke," explains PHE's spokesperson.

Risks of vaping

"Vaping is far less harmful than smoking but does carry some risks," they continue. E-cigarettes contain some of the harmful chemicals contained in cigarettes but at much lower levels. Some e-liquids contain nicotine, an addictive substance which does have some side effects like increased blood pressure and heart rate. But nicotine replacement therapy has been used for years in smoking cessation programmes, and the risks of getting nicotine by vaping are far lower than the risks from smoking. Nicotine is not the main risk factor in most smoking-related causes of death.

"Risks can be much reduced by using only UK-regulated e-cigarettes and vaping liquids and never vaping home-made or illicit e-liquids or adding substances. We strongly advise people not to vape cannabis or any other illicit products," says PHE's spokesperson.

Although there are thousands of existing and ongoing studies into vaping, the long-term effects are yet to be seen since e-cigarettes only went on sale in 2007. But from what we know so far, the risk is a fraction of the risk of smoking regular cigarettes. The advice remains that current smokers should switch to e-cigarettes but non-smokers should not start vaping or smoking.

Quit smoking with e-cigarettes

More than half (54%) of the 3.6 million people who vape in the UK are ex-smokers, suggesting that vaping does help people to quit smoking. Just under 40% of vapers smoke as well as vape and only 6% have never smoked cigarettes.

"E-cigarettes are part of a menu of options to help people quit smoking, and can be a very effective quitting tool," says Hopkinson. "A study from Queen Mary University of London found that e-cigarettes are almost twice as effective as nicotine replacement treatments, such as patches and gum, at helping people quit smoking when they're also given behavioural support. E-cigarettes may work in particular for people who have tried other ways of quitting but haven't been successful."

Those using vaping to quit smoking should only do so with regulated products. Your local stop smoking service can advise on the best product for you. "We'd encourage anyone using e-cigarettes as a quitting tool to reduce the nicotine they vape and then stop when the time feels right, and you won't go back to cigarettes," he continues. It's important to do this at your own pace so you won't go back to smoking.

"To really feel the benefits of using an e-cigarette you need to stop smoking cigarettes completely," Hopkinson explains. "Once you quit smoking, health benefits happen quickly. The risk of having a stroke or a heart attack starts to go down within a few hours. The risk of getting cancer in the future also starts to go down once people quit smoking. Symptoms of cough and sputum are likely to improve as well."