Is vaping the same as tobacco smoking in terms of health risks?

Vaping vs. Tobacco Smoking: Health Risks Comparison

No, vaping is not the same as tobacco smoking in terms of health risks, but it still poses significant health hazards and should not be considered safe or harmless. 1

Key Differences Between Vaping and Smoking

• Vaping exposes users to lower levels of toxic volatile organic compounds (VOCs) compared to conventional cigarette smoking, though it still contains harmful substances 2
• E-cigarettes produce aerosols rather than smoke, containing fewer toxic substances qualitatively and quantitatively compared to combustible tobacco products 3
• While combustible tobacco products are clearly the most harmful, electronic products should not be characterized as harmless, as health risks affecting the cardiovascular and respiratory systems have been identified 1

Health Risks Associated with Vaping

Cardiovascular Effects

• Nicotine, regardless of delivery method (smoking or vaping), is highly addictive and affects many body systems 4
• Nicotine has significant cardiovascular effects and may play a major role in the development of coronary artery disease, atherosclerosis, and aortic aneurysms 4
• Studies show similar acute effects of heat-not-burn tobacco products and traditional cigarettes on heart rate, blood pressure, and arterial stiffness 5

Respiratory Effects

• E-cigarette use may pose health risks in the form of respiratory diseases 6
• Vaping exposes users to VOCs such as acrylamide, benzene, and propylene oxide at levels higher than abstention, which may pose health risks to nonsmoking users 2
• Acute lung injury may be associated with the use of e-cigarettes, though the underlying mechanisms continue to be studied 6

Addiction Concerns

• E-cigarettes contain nicotine, a highly addictive drug, which explains why their use can be persistent 7
• The addictive power of nicotine and its untoward effects should not be underestimated 1

Public Health and Regulatory Concerns

• E-cigarettes are not approved as smoking cessation aids by regulatory agencies, unlike standard nicotine replacement therapies 4
• The US Preventive Services Task Force concludes that evidence on the use of e-cigarettes for tobacco smoking cessation is insufficient, and the balance of benefits and harms cannot be determined 1
• The Forum of International Respiratory Societies recommends that electronic nicotine delivery devices should be regulated as medicines or tobacco products 1
• Passive inhalation of vaporized droplets, particles, nicotine, and other substances into indoor air may have significant adverse health effects 4

Recommendations for Clinical Practice

• Advise all people not to use cigarettes, other tobacco products, or e-cigarettes 1
• As a routine component of care, ask patients about the use of cigarettes or other tobacco products, including e-cigarettes 1
• For those trying to quit smoking, recommend and refer for combination treatment consisting of both tobacco/smoking cessation counseling and FDA-approved pharmacological therapy rather than e-cigarettes 1
• If patients are using e-cigarettes to quit smoking, advise them to avoid using both combustible and electronic cigarettes simultaneously, and if using only e-cigarettes, they should have a plan to quit these as well 1
• For children and adolescents, provide interventions, including education or brief counseling, to prevent initiation of tobacco or e-cigarette use 1

Special Considerations

• Weight gain after smoking cessation (average 3-5 kg) does not diminish the substantial cardiovascular benefit realized from smoking cessation 1
• E-cigarette devices allow for the use of other drugs, including THC, while lax regulation may allow for the introduction of toxic compounds that can lead to acute toxicity 7
• Different e-cigarette devices may pose varying levels of risk - variable-power tank users showed higher levels of 1,3-butadiene and propylene oxide metabolites compared with users of cig-a-likes 2

In conclusion, while vaping exposes users to fewer toxic substances than conventional smoking, it still poses significant health risks and should not be considered a safe alternative to smoking or a harmless recreational activity.