The word vape was the Oxford English Dictionary’s 2014 Word of the Year. It was defined as a verb meaning “to inhale and exhale the vapour produced by an electronic cigarette or similar device.” Vapers have become a familiar sight on our high streets. Specialist vaping shops are proliferating rapidly. Vaping is now a mainstream activity, seen to require the usual controls on anything that is popular. Consequently, many public signs have appeared specifically prohibiting vaping on the premises. At the time of writing, however, reports are emerging from the United States of vaping-related lung illnesses, providing ammunition to those who oppose vaping.
On September 6, 2019, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, issued an urgent investigation notice regarding vaping, in the light of a spike in reports of vape-related lung illnesses, including 450 possible cases and as many as five deaths that could possibly be linked to vaping. These reports originated from 33 states and the US Virgin Islands. Earlier, on August 23, the CDC reported the first death that could be attributed to vaping- that of a man who died in an Illinois hospital from an unexplained respiratory illness. Vape-related lung illnesses in the US have been reported to present with difficulty in breathing and with chest pain. Some victims also described symptoms of nausea, vomiting and diarrhoea. Other reported symptoms include fatigue, fever, chills, and weight loss. Chest x-rays in these patients have demonstrated a wide range of abnormalities, frequently due to inflammation of, or bleeding into, the lungs. The CDC has subsequently named the condition as EVALI (e-cigarette or vaping product use-associated lung injury).
So, when did the vaping industry begin? Electronic cigarettes (e-cigarettes) made their debut as devices to assist with the cessation of smoking and are increasingly being promoted as safer alternatives to the smoking of conventional cigarettes. Herbert A. Gilbert submitted a patent application for his “Smokeless” nicotine-free cigarette-the first e-cigarette- in 1963. He obtained a patent in 1965, but his prototypes were never marketed. Gilbert thus never made any money on his patent. In 2001, a Chinese pharmacist, Hon Lik, started work on the first e-cigarette, which was patented in 2003. A heavy smoker, he wanted to stop smoking, especially after his father, also a heavy smoker, had died of lung cancer. His device used ultrasonic energy to vaporise a nicotine solution in a cigarette-like device.
The e-cigarette arrived in Europe and the US in 2006. Hon Lik’s company, Dragomite, sold all his patents to Fontem Ventures, the Netherlands-based subsidiary of Imperial Tobacco for $75 million in 2013. Today, there are many brands to choose from, several of them owned by, or subsidiaries of, major tobacco companies.
Today’s electronic cigarette consists of a battery, a disposable or refillable cartridge or reservoir that contains a flavoured nicotine solution (the “juice”), a heating element or atomiser which vaporises the liquid, and a mouthpiece. Sucking on the mouthpiece activates a sensor that detects air flow, thereby activating the battery-powered heating coil. The solution is heated and then evaporates. The resulting vapour is inhaled into the respiratory tract. The solution contains nicotine, flavourings, additives, and propylene glycol or glycerol. Extra-strength cartridges can provide even higher concentrations of nicotine, while nicotine-free liquids are also available. In the US, there are no limits on the strength of nicotine permitted, while in the UK the nicotine concentration cannot exceed 20 mg/ml. Some devices have a light-emitting diode which lights up when inhaling, to simulate the glowing end of a burning conventional cigarette.
Numerous vaping devices are currently available. First generation e-cigarettes have been followed by second generation refillable vape pens, third generation MODs or modified devices, and sophisticated fourth generation innovations. Coils and tanks are newer components of vape devices that have varying capabilities. Vape shops can hence offer a wide range of products, ranging from E-liquids, vape kits and other vaping hardware. Some products can be customised to meet the user’s specific needs. The market offers lots of choice and continues to diversify, in what is a most lucrative business with its own vocabulary.
Vaping has become increasingly popular, especially among the young, even though the selling of vaping devices to under 18s is currently illegal in the UK. There are reportedly as many as 3.2 million vapers in the UK. Many are vaping as an alternative to cigarette smoking, rather than from a desire to stop smoking, and may even go on to use conventional cigarettes.
Vaping may encourage reckless behaviour, as it is perceived to be relatively harmless. The wide choice of vaping liquids available may cause undesirable and hitherto unrecognised side-effects. Some constituents of the vaporised liquid, such as tetrahydrocannabinol, may be responsible for lung disease linked to vaping. This is because vaping is not merely a vehicle for flavoured nicotine, but also for some synthetic illicit drugs. While the long-term effects of vaping are being studied, further information is awaited about the results of the CDC’s investigations in the US. Early indications are that some cases of vaping-related lung illness may be caused by lipoid pneumonia-possibly the result of inhaling cannabis oil. Other cases may be the result of as yet unidentified toxic substances. There is nothing yet to suggest that vaping is unsafe for the large majority of those who vape regularly and it remains an important aid to tackling the more serious issue of nicotine addiction.
Ashis Banerjee (has a vaper in the family)