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Health benefits of e-cigarettes should not be overestimated

Although e-cigarettes are less hazardous than combustible cigarettes, they emit potentially harmful chemicals and should not be used as a smoking cessation aid, according to a commentary published in Annals of Internal Medicine.

“E-cigarettes have the potential for enormous benefit if they help smokers quit... This benefit must be balanced against potential harm if e-cigarettes entice youths who would otherwise not have become cigarette smokers to try e-cigarettes, become addicted to nicotine and then switch to combustible cigarettes,” Nancy A. Rigotti, MD, from Massachusetts General Hospital and Harvard Medical School, wrote.

Millions of Americans, especially youths, use e-cigarettes; however, their health risks and benefits are uncertain, according to Rigotti. Data showing that the net benefits of e-cigarettes exceed their risks to the individual user and the population are lacking, she wrote.

Rigotti noted that the National Academies of Science, Engineering and Medicine (NASEM) recently evaluated the health effects of e-cigarettes using all available evidence. The NASEM found that while e-cigarettes produce potentially toxic chemicals, they are less hazardous and emitted at lower levels than those found in combustible cigarettes, she wrote.

The report also revealed that individuals who substituted combustible cigarettes with e-cigarettes lessened their exposure to the harmful chemicals emitted by cigarettes and had fewer short-term adverse health outcomes, she wrote.

Whether the use of both e-cigarettes and combustible cigarettes reduces health risks is unknown; however, 59% of e-cigarettes users continue to use cigarettes and may overestimate the health benefits of e-cigarettes, according to Rigotti.

Rigotti recommends that physicians communicate to patients that although using e-cigarettes poses fewer harms than continuing to smoke cigarettes, the long-term safety of e-cigarettes is not known yet. Physicians should advise patients to use FDA-approved smoking cessation aids with validated safety and efficacy to stop smoking rather than e-cigarettes, according to Rigotti. If patients choose to use e-cigarettes then physicians should advise them to switch completely and avoid flavored e-cigarettes and encourage them to eventually quit e-cigarettes as well, she wrote. – by Alaina Tedesco

Disclosure: Rigotti reports receiving personal fees from UpToDate and grants from Pfizer.