Aiman Rehan  ( Dow Medical College, Dow University of Health Sciences, Karachi )
Mashal Binte Ali  ( Dow Medical College, Dow University of Health Sciences, Karachi )
Manahil Akmal  ( Dow Medical College, Dow University of Health Sciences, Karachi )

Madam, the popularity of electronic smoking has seen a tremendous increase worldwide, including developing countries like Pakistan. One of the reasons for this spike may be due to the ban on Sheesha (water pipe) smoking which has caused urbanites to set their eyes on a novel alternative: vaping. Another reason for this rise may be the widespread \\\'pro-electronic cigarette\\\' view that exists among the public. Electronic cigarettes are not only regarded comparatively less harmful than conventional cigarettes but are also being recognized as a tool for smoking cessation. This attitude is alarming because the efficacy of e cigarettes as a method for quitting has not been fully established and their hazardous potential is not clearly known.^1,2 The contents of the hand held e-cigarette include propylene glycol, glycerin, water, nicotine and flavours, and have been shown to have deleterious effects on haemodynamic parameters and carbon monoxide exposure.³ Experimental studies show that even at low levels, long term use of e-cigarettes cause derangements in cardiovascular function.⁴ Studies have also found potential links of the contents of e cigarettes to Asthma.5 Moreover, e cigarettes are known to have an unpredictable nicotine delivery system and the concentration of nicotine has to be strictly regulated in order to prevent an overdose, but this is not the case in many developing countries including Pakistan. Hence, the rising use of e cigarettes in such countries is of even more concern. Despite the ongoing debate about the benefits of vaping and its growing use as a smoking termination device next to nicotine replacement products, the long-term effects of this alternative remain unexplored. Hence the US Preventive Services do not recommend using e cigarettes as a smoking cessation tool.⁶ Foremost precaution should be taken when expressing favourable views and opinions about e-cigarettes. Although they have not been labelled as deleterious to health as traditional cigarettes yet, this area is still highly under researched and the results may be completely contradictory to the perceived attitude. Keeping this uncertainty in mind, public awareness and educational health messages should be advertised highlighting e-cigarettes as devices with possible adverse consequences. The establishment of a proper healthcare body regulating the use and content of e-cigarettes is mandatory, along with proper labelling of this new product. Furthermore, healthcare professionals should understand the paradigms behind the growing use of e-cigarettes and educate patients against their use until further research is able to empirically draw out a clear conclusion about the health implications and cessation effects of e-cigarettes. 

Disclaimer: None declared.
Conflict of Interest: None declared.
Funding Disclosure: None declared.

References

1.  Manzoli L, Flacco ME, Ferrante M, La Vecchia C, Siliquini R, Ricciardi W, et al. Cohort study of electronic cigarette use: effectiveness and safety at 24 months. Tob Control. 2017; 26: 284-92.
2. Tomashefski A. The perceived effects of electronic cigarettes on health by adult users: A state of the science systematic literature review. J Am Assoc Nurse Pract. 2016; 28: 510-5.
3.  DeVito EE, Krishnan-Sarin S. E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure. CurrNeuropharmacol. 2017 Oct 16.
4.  Olfert IM, DeVallance E, Hoskinson H, Branyan KW, Clayton S, Pitzer CR, et al. Chronic exposure to electronic cigarette (E-cig) results in impaired cardiovascular function in mice. J ApplPhysiol (1985). 2018; 124: 573-82.
5.  Clapp PW, Jaspers I. Electronic Cigarettes: Their Constituents and Potential Links to Asthma. Curr Allergy Asthma Rep. 2017; 17: 79.
6. Final Recommendation Statement: Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions. U.S. Preventive Services Task Force. [Online] 2017 [Cited 2017 November 12]. Available from URL: https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendation
StatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions.