What are the health risks of vaping compared to smoking and how can one quit?

Vaping vs Smoking: Health Risks and Cessation Strategies

Both vaping and smoking are harmful to health, but combustible cigarettes pose significantly greater risks than e-cigarettes. However, e-cigarettes should not be characterized as harmless and should be avoided, particularly as a recreational product. 1

Comparative Health Risks

Smoking Risks

• Combustible tobacco products are clearly the most harmful form of nicotine delivery 1
• Smoking is strongly associated with:
  • Cardiovascular disease
  • Peripheral artery disease
  • Cancer
  • Respiratory diseases
  • Increased risk of albuminuria and microvascular complications 1

Vaping Risks

• While less harmful than combustible cigarettes, electronic products are not harmless 1
• Specific health risks of vaping include:
  • Cardiovascular and respiratory system effects 1
  • Nicotine dependence (confirmed by the Population Assessment of Tobacco and Health Study) 1
  • E-cigarette or vaping product use-associated lung injury (EVALI) 2
  • Respiratory symptoms including cough, shortness of breath, and chest pain 2
  • Increased risk of respiratory infections 2

Special Populations

• Youth and adolescents are particularly vulnerable to nicotine's harmful effects:

  • Neurotoxic effects on developing brains affecting learning, reasoning, and attention 2
  • Structural and functional alterations in brain areas related to emotion and decision-making 2
  • Higher vulnerability to addiction 2

• Pregnant women:

  • Nicotine crosses the placenta affecting fetal development 2
  • Can lead to impaired fertility, type 2 diabetes, obesity, and neurobehavioral defects in offspring 2

Smoking Cessation Approaches

Evidence-Based Cessation Methods

1. Combination approach is most effective:

   • Both counseling and pharmacologic therapy should be used together 1
   • This combination significantly increases cessation rates compared to either alone

2. Pharmacological options:

   • Varenicline is the most efficacious pharmacotherapy for people with diabetes when compared with placebo 1
   • American Thoracic Society recommends varenicline as first-line pharmacotherapy for tobacco dependence 1
   • Nicotine replacement therapy (NRT) in various forms (gum, patch, nasal spray, inhaler, sublingual tablets) 3
   • Bupropion as an alternative option

3. Behavioral support:

   • Telephone quit lines and web-based interventions have demonstrated efficacy 1
   • Motivational interviewing
   • Goal setting and action planning
   • Problem-solving strategies
   • Self-monitoring with feedback

Role of E-Cigarettes in Cessation

• Recent evidence suggests vaporized nicotine products (VNPs) may be more effective than NRT for smoking cessation, particularly among socially disadvantaged populations (28.4% vs 9.6% abstinence rates) 4
• However, major medical organizations (American Heart Association, American Academy of Pediatrics, American College of Cardiology) recommend against using e-cigarettes for smoking cessation 2
• If people are using e-cigarettes to quit smoking:
  • They should avoid using both combustible and electronic cigarettes simultaneously 1
  • They should have a plan to eventually quit e-cigarettes as well 1
  • E-cigarettes should only be considered if conventional smoking cessation treatments have failed 5

Common Pitfalls and Caveats

1. Weight gain concerns:

   • Post-cessation weight gain (average 3-5kg) is common but doesn't diminish the substantial cardiovascular benefits of quitting smoking 1
   • Cessation programs should address eating and physical activity needs 1

2. Dual use risk:

   • Using both combustible cigarettes and e-cigarettes simultaneously may maintain nicotine addiction without reducing health risks 1
   • Advise patients to avoid this pattern

3. E-cigarette misconceptions:

   • Many perceive e-cigarettes as harmless, which is incorrect 1
   • Long-term health effects of e-cigarettes are still being studied 2
   • Current knowledge is limited by lack of long-term studies and rapidly evolving e-cigarette technology 2

4. Cannabis vaping considerations:

   • Cannabis vaporizer use may reduce carbon monoxide exposure and chronic respiratory symptoms compared to smoking cannabis 6
   • However, THC-containing products have been linked to EVALI cases 2

Healthcare providers should routinely screen for all tobacco product use, including e-cigarettes, and strongly advise against initiating either smoking or vaping, with particular emphasis on youth and non-smokers 2.