🔒Doctors grapple with where e-cigarettes fit in for smoking cessation

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The vaping industry added nearly $512,000 to the state's coffers last fiscal year, but not everyone thinks that's a good thing.

Proponents see vaping — which typically involves a battery-powered device that produces a nicotine-laced vapor or aerosol inhaled by the user — as a less harmful alternative to smoking, and some studies have started to bear that out. But health experts in the state said they aren't yet ready to endorse the practice as a tool to quit smoking.

Barbara Walsh, supervisor of the state Department of Public Health's Tobacco Control Program, said that long-term health effects of Electronic Nicotine Delivery Systems, commonly called e-cigarettes or vaping, are not yet known.

“We also know that the aerosol from [e-cigarettes] can contain ingredients that include ultrafine particles, volatile organic compounds, such as benzene, a known carcinogen, and heavy metals, such as lead and tin, so DPH continues to work on smoke-free policies that include protections from exposure to secondhand aerosol as well as secondhand smoke,” Walsh said.

One UConn Health doctor is trying to build on the growing body of research on vaping and its health effects, good or bad.

Dr. Mario Perez, UConn's assistant professor of medicine at the Pulmonary, Critical Care and Sleep Medicine Department, is conducting a study that seeks to determine differences in how smoking and vaping impact airways.

He said inflamed airways is one of the negative effects from smoking conventional cigarettes, so he is trying to determine if vaping has similar effects.

As part of the study, he's assessing 50 vapers and comparing their results to 50 conventional cigarette smokers and 25 non-smokers.

Other studies, Perez said, have shown that vapers may have increased upper airway respiratory problems — cough, sore throat, etc. — and recently at least three studies have linked vaping with asthma in teenagers.

Perez is currently collecting preliminary data. He started enrolling study participants earlier this year and plans to continue through this coming spring.

One of Perez's study subjects is Geraldo Santiago, 24, of Hartford.

Santiago, who works as a security guard, said he visited his UConn Health doctor after experiencing chest pain. He had only smoked cigarettes for about four months, but had been vaping nicotine for longer, about three years.

A full CT scan didn't reveal anything to worry about, but his doctor recommended the study to him, which pays its participants.

Santiago said he views vaping and smoking as “kind of the same thing,” but he wants to stick to vaping because he views it as a healthier option.

“It's just the fact that cigarettes contain way more chemicals than vape juice does,” he said.

Lesser of two evils?

Many vaping proponents, including some doctors, believe vaping is a safer choice than smoking.

England's public health department in 2015 said it believed vaping is 95 percent less harmful than smoking.

Last year, the Royal College of Physicians said in a report that nicotine inhalation itself is “inherently unlikely” to contribute to the mortality or morbidity caused by smoking tobacco.

“The main culprit is smoke, and if nicotine could be delivered effectively and acceptably to smokers without smoke, most if not all of the harm of smoking could probably be avoided,” the report said, while acknowledging there are still uncertainties about the long-term impacts of the relatively new practice of vaping.

But plenty of skepticism about vaping remains, particularly as a quitting tool.

Former U.S. Surgeon General Dr. Vivek Murthy issued a report on vaping last year that said “evidence supporting the effectiveness of e-cigarettes as an aid for quitting conventional cigarettes remains extremely weak for adults and untested and nonexistent among youth.”

The report concluded that further research is needed, a task made more challenging by an array of factors.

“The huge variety of products of different origin and design, the rapid emergence of new products, and the varied ways in which consumers use these products make the development of standard measurement conditions challenging,” Murthy's report said.

Perez shares Murthy's skepticism about vaping as a cessation strategy.

“I do believe that further research is highly needed … as these products are accessible to the general public and very popular among school-age children,” he said.

The Smoke Free Alternative Trade Association, which represents vaping stores in Connecticut and other states, does not believe government regulation should treat vaping products the same as tobacco products.

The Association's website argues that vaping products are “the solution to a public health scourge.”

However, its members must be careful not to run afoul of federal rules related to advertising health claims.

“SFATA and its members do not make any health or cessation claims in their marketing,” the industry group's website says.

If e-cig manufacturers truly believe their products can be used for cessation, they should apply to the U.S. Food and Drug Administration for permission to commercialize them as a medical product, Perez said.

Ruth Canovi, manager of public policy for the American Lung Association in Connecticut, agrees.

“Until and unless the FDA approves a specific electronic nicotine delivery system or e-cigarette as safe and effective for use as a tobacco-cessation aid, the American Lung Association does not support their use for cessation or any direct or implied claims that e-cigarettes help smokers quit,” Canovi said.

The FDA has approved various smoking-cessation products, from the nicotine-free medication Chantix to replacement therapies like nicotine gum. But vaping is not yet an approved therapy.

One challenge for vaping research, which is not entirely unique, is that industry money funds a number of the studies, Perez said.

The state of Connecticut began regulating vaping in 2016, when it required dealers and manufacturers to start registering with the Department of Consumer Protection and banned vaping in any place where smoking is not allowed, such as restaurants and bars.

As of DCP's most recent data, there were 1,087 vaping dealers and 30 manufacturers registered in the state.

In fiscal year 2017, those businesses generated $511,850 in state tax dollars through application, initial registration and renewal fees.

A doctor's word — the best medicine?

Perez said when a health provider just tells a patient to quit smoking, it has a substantial effect.

“We also know that using proper counseling along with nicotine replacement therapy and FDA-approved pharmaceutical interventions does have a significant effect on helping patients quit smoking,” he said.

The DPH's Walsh said that smokers report an average of seven attempts at quitting before successfully doing so for good.

Walsh said using the seven FDA-approved tobacco-use cessation medications — the patch, gum, inhaler, nasal spray, lozenge, Zyban or Chantix — in combination with tobacco-use cessation counseling is proven to work.

Walsh added that cessation services are available to all Connecticut residents through the telephone Quitline (1-800-Quit-Now).

Canovi said that the U.S. Public Health Service has found that the seven therapies approved by the FDA in combination with individual, group or phone cessation counseling are the most effective way to help smokers quit. y