Debate. Can we recommend e-cigarettes to our patients?

Recently, there has been a discussion about the harmfulness of e-cigarettes. There are even voices that they are equally harmful like the traditional ones. However, there is no evidence for this, and theoretical premises suggest that they should be definitely less harmful to health because it does not occur when used to burn tobacco and the formation of very harmful substances, especially carcinogens. Some data suggest that e-cigarettes may be used as a new form of nicotine replacement therapy, but this has not yet been confirmed. Therefore, further research into harmfulness and safety is needed use of e-cigarettes. Only arguments for recommending e-cigarettes will be presented below nicotine addicts.

Keywords: tobacco, electronic cigarette, nicotine replacement therapy, passive smoking

There has been some discussion for some time now the topic of electronic cigarettes (so-called e-cigarettes). vape marketplace
Tobacco Control recently sacrificed special notebook for this problem (2014 Supl.
2). In the conclusions of one of Callahan-Lyon’s works[1] stated that scientific evidence regarding their impact on human health is limited
and although the e-cigarette aerosol contains less harmful substances than a regular cigarette, it studies assessing their health effects are not conclusive and there is still no evidence to allow this to authorize their use in treatment nicotine addiction by the US Food and Drug Administration (FDA, Food and Drug Administration). It is also not known how passive the use of an e-cigarette affects the health of individuals from the environment of their users. There is more and more scientific research devoted to this issue, but no ratings yet in large randomized populations, method double-blind, multi-center and multi-center, which would provide accordingly strong and credible arguments for or against their use. We currently have only expert opinions that are not supported by evidence for extradition unequivocal recommendations. Doubts these will definitely be settled soon.
Only suggestions will be presented below for the possibility of recommending e-cigarettes to people nicotine addict.

The composition of tobacco smoke and aerosol e-cigarettes At the beginning it is worth comparing the composition of cigarette smoke and aerosol e-cigarette.

A cigarette is a tobacco product in which tobacco leaves they are wrapped in thin tissue paper. While smoking the cigarette is burned and inhaled smoke containing about 4,000 substances chemicals such as benzopyrene, tar, carbon monoxide, acetone, butane, chloride vinyl, ammonia, arsenic, toluidine, formaldehyde, phenols, hydrogen cyanide, naphthylamine, methanol, dibenzoacridine, dichlorodiphenyltrichloroethane, dimethylnitrosamine, cadmium, polonium, urethane.

E-cigarette is a device that allows inhalation of nicotine. The main difference in its use is the lack of combustion process tobacco, which results in an uprising so many harmful substances.
The liquid used in e-cigarettes contains glycol propylene, glycerin, nicotine, additives flavor and aromatic [3]. Heats it up to a temperature that allows transition from phase liquid in gaseous, which is inhaled into the lungs.

Trace amounts have been detected in the e-cigarette vapors certain toxic substances, but their concentration it was 9-450 times smaller than in cigarette smoke and did not exceed the authorized concentrations for use [4]. Their source was pollution tobacco used to produce nicotine used
in an e-cigarette.

Harm to nicotine smoke and aerosol from e-cigarettes Recent decades have brought very strong evidence of harmfulness of nicotine smoking [5, 6].
There is no doubt that this addiction is the reason many deadly diseases, shorten the lives of millions people, causes inability to work well generates enormous direct and indirect costs.

In the 20th century tobacco became the main killer and none of the wars caused so many deaths people what this plant. Prevalence of smoking tobacco caused a huge increase in incidence for cancer. At least 40 ingredients tobacco smoke (e.g. tar, cadmium, benzopyrene, vinyl chloride, dibenzoacridine, toluidine and naphthylamine) affect cancer malicious [7]. Relationship proved smoking nicotine with lung, larynx, throat cancer, esophagus, stomach, kidney and bladder, pancreas, liver, nose, cervix as well with leukemia [8]. It’s because of the prevalence smoking, lung cancer is the most common
malignant neoplasm, causing 30% all cancer deaths [9].

Harmful the impact of smoking on health is not limited to carcinogenic effects. causes it also has respiratory diseases such as as chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema, bronchial asthma etc. [10]. However dangerous the impact of cigarette smoke on disease development of the cardiovascular system and especially atherosclerosis, hypertension hypertension, ischemic heart disease, myocardial infarction heart, aortic aneurysm, and nervous system diseases, such as stroke, blood clots cerebral and subarachnoid bleeding [11, 12]. Every year because of smoking over 4 million people die [13]. vape marketplace – Smoking also contributes to greater vulnerability for bacterial and viral infections, including tuberculosis [14, 15]. It has also been proven high impact of smoking on disease development gastrointestinal tract such as illness gastric and duodenal ulcer, gastroesophageal reflux disease esophageal, LeĊ›niowski’s disease Crohn’s, ulcerative colitis and intestinal hernia [16, 17]. It has also been shown the impact of smoking on the development of osteoporosis, periodontitis, cataracts, macular degeneration, earlier skin aging [18, 19, 20].

Cigarette smoking also has adverse effects effects on the reproductive system, resulting in low weight newborn birth, premature detachment placenta or rupture of labor membranes, difficult pregnancy and earlier menopause [21, 22].

Reminder of harmfulness of nicotine smoke makes you aware of how much safer your health is is the use of an e-cigarette, the composition of which limited to several of the substances listed, of which significant harmful effects on health have only nicotine. It exerts an adverse effect on the circulatory system, because it has a shrinking effect on the walls of blood vessels (including also coronary heart disease), increases blood pressure, speeds up heart rate causes disorders heart rate and increase the risk of thrombosis [23].

It is also a strong neurotoxin and has an intermediate influence on cancer development, affecting negatively on the p53 gene that stops uncontrolled cancer cell development [24]. A harmful effect on the health of nicotine smoke is therefore incomparably larger than aerosol from an e-cigarette, and this one definitely less cytotoxic than tobacco smoke [25]. Despite that many flavoring agents used in e-cigarettes is considered safe when used in food products, however, concerns have been raised about the potential toxicity of these chemicals when they are inhaled [26]. Animal test results
and observation during occupational exposure showed that benzaldehyde is the main one a component of natural fruit flavors, may cause respiratory irritation.