The Unknowns of E-cigs
Some patients try e-cigarettes. Per advertising, e-cigarettes are potentially safer than regular cigarettes and may even serve as an anti-smoking aid.
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Explore This IssueMarch 2019
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However, little is known about the effects of e-cigarettes on the incidence or worsening of rheumatological disease. In fact, little is known about their effects overall.
“There’s a lot of work to be done,” Dr. Rizzo says. “E-cigarettes have flooded the market, and they are very popular among the teen and middle-school crowd,” he says. E-cigarette use is actually more prevalent in this younger age group than regular cigarette use. However, using them could become a gateway for regular cigarettes.
Although advertising may claim e-cigarettes can help people stop smoking, the U.S. Food and Drug Administration (FDA) has found no such product safe and effective in helping smokers quit. The FDA does not approve of e-cigarettes as anti-smoking aids. It also announced in September 2018 action aimed to reduce the amount of e-cigarette advertising geared toward younger people.
The presence of some form of nicotine—albeit a smaller amount—in e-cigarettes, along with other kinds of chemicals, can’t be good for the body and could cause chronic bronchitis, Dr. Rizzo says.
“The body’s reaction to many of the chemicals in traditional cigarette smoke causes long-lasting inflammation, which in turn leads to chronic diseases, like bronchitis, emphysema, and heart disease,” Dr. Nayyar says. “Since e-cigarettes contain many of the same toxic chemicals, there is no reason to believe that they will significantly reduce the risks for these diseases.”
Even if e-cigarettes prove not be entirely dangerous, they still can be highly addictive due to the nicotine in them, Dr. Askanase says. “Additionally, e-cigarette aerosols produced by heating the e-cigarettes are likely to have a negative impact on people’s and teenagers’ health in particular,” she says.
The real risks from e-cigarettes may take 15 to 20 years to become clear, Dr. Nayyar adds.
The ACR does not currently have any recommendations regarding e-cigarette use, Dr. Lai says. However, the CDC says e-cigarettes can be used as an alternative to all forms of smoked tobacco in nonpregnant adult smokers.8 The CDC does not recommend that non-smokers start using e-cigarettes; it only suggests them instead of traditional cigarette use.
Prompting Patients to Quit
One consideration in anti-smoking research is how to convince patients of the importance of quitting.
“I always discuss smoking cessation with my patients regardless of if they express interest or not,” Dr. Lai says. Many times, he’ll explain the association of smoking with the rheumatological disease a patient has. He finds most patients are receptive because they are in significant pain.
However, rheumatologists, primary care physicians and other specialists may need to repeat the anti-smoking message several times, Dr. Rizzo says. That’s because most smokers try to quit 10 to 11 times over their lifetime. It’s a hard sell due to the overwhelmingly addictive effect of nicotine.
Dr. Barbhaiya has also observed this challenge. “Although patients are very knowledgeable about the hazardous effects of smoking on [their] general health, the fact remains that it can be very difficult to quit,” she says.
A lack of uniformity among physicians about smoking advice also can complicate the picture. “In half of the departments, most doctors give advice to quit smoking to all or almost all patients with inflammatory diseases. However, very few departments have a specific protocol for smoking cessation,” Dr. Nayyar says.
The American Lung Association has found that a combination of FDA-approved quit smoking medications along with counseling and a patient commitment to stop smoking are most effective, Dr. Rizzo says.