E-Cigarettes: What We Know And Don’t Know



EcigElectronic cigarettes (or e-cigarettes), a $2.5 billion industry, are getting a lot of media coverage lately and e-cigarette retail shops and Internet sites are becoming more widespread. What are these products? And are they different from traditional cigarettes that are known to be dangerous to people with asthma?

How they work

An e-cigarette is a battery-powered device that turns nicotine and other products into a vapor, which is then inhaled. When a person inhales an
e-cigarette, it triggers the battery within the device that vaporizes the liquid
nicotine and other substances.

Some are manufactured to mimic traditional cigarettes by producing a glowing light at the tip. Others come in shapes that look like cigars or even pens. They are available as either disposable or refillable with liquid nicotine.

E-cigarettes are sold in a variety of candy and adult drink flavors, as well as a menthol flavor that appeals to traditional smokers. Many of these flavors – there are 7,000 in all – tend to appeal to young people. Studies show that youth who have never smoked traditional cigarettes are using e-cigarettes. (Traditional flavored cigarettes were banned in the United States in 2009.)

E-cigarette marketing to teens and young adults appears to be working. The U.S. Centers for Disease Control and Prevention’s National Youth Tobacco Survey revealed that approximately 263,000 middle and high school students experimented with e-cigarettes in 2013, compared to 79,000 in 2011.

It’s also worth noting that people who use e-cigarettes often say they are
“vaping” and not “smoking.” This change in terminology allows users to “vape” in buildings and other indoor spaces where traditional smoking is not allowed, undermining smoke-free laws.

Health concerns

Any product with “cigarette” in its name should be a red flag for anyone who has asthma or allergies. E-cigarettes are a new product with no studies on long-term health outcomes. However, numerous organizations, including the American College of Allergy, Asthma & Immunology (ACAAI), have raised health and safety concerns about e-cigarettes.

More research is needed to determine the respiratory effects of directly or indirectly inhaling e-cigarette vapors.

In addition to nicotine, which is potentially very addicting, e-cigarettes contain glycerin, an additive that can cause respiratory tract irritation. The propellant in e-cigarettes is a substance called propylene glycol that when heated and vaporized forms propylene oxide, a potential cancer-causing agent, according to the International Agency for Research on Cancer.

Recent e-cigarette studies have found cancer-causing agents such as acetaldehyde and formaldehyde – the latter of which is known to irritate eyes and the throat and has been associated with triggering asthma symptoms.

Several studies also show that e-cigarettes produce pollutants in the air that can be inhaled secondhand.

Is using e-cigarettes a way to quit smoking tobacco, as some manufacturers suggest? Currently there is not enough evidence to support this. The only over-the-counter, evidence-based smoking cessation aids are nicotine replacement therapies such as gum, lozenges or the patch.

Since e-cigarettes contain nicotine, there’s concern that they could be a gateway to tobacco smoking. The Food and Drug Administration (FDA) conducted a study on brands of e-cigarettes and found the actual amount of nicotine varied to what the manufacturer stated. This prompted the FDA to announce in April 2014 greater regulation of e-cigarettes promoted for therapeutic purposes.


By Mary P. Martinasek, PhD, RRT, AE-C


Mary P. Martinasek is assistant professor in public health at The University of Tampa. She is also a certified asthma educator and registered respiratory therapist.


Reviewed by Eileen Censullo, RRT