Vaporising or vaping occurs when a chemical is heated to the temperature on or above its boiling point. This causes it to evaporate into the white steam cloud we know as vapour. This vapour is then inhaled to get the desired effect of the product.
Every vaping device uses a battery that powers a coil inside the e-cig to heat up the e-liquid. This results in the vapour that looks like a white hazy cloud. Unlike cigarettes, there is no tobacco involved, which means no smoke or lingering unpleasant smells. Besides nicotine, most vapes contain three main components: PG, VG and a flavour.
E-cigarettes use heat to cause vaporisation whilst traditional cigarettes use heat that cause combustion, resulting in smoke. Vaporisation occurs at a far lower temperature than combustion. At higher temperatures, smoke causes the production of many more carcinogenic compounds, such as benzene.
Some of the differences between vaping and smoking include:
Smoking | Vaping |
Dark smoke | Clean vapour |
Lingering unpleasant smell | Short-lived |
Over 7,000 chemicals including tobacco | Usually only 3 ingredients + flavour |
Have to smoke a whole cigarette | Can take as many or little puffs as needed |
Gross taste | Choice of preferred flavour |
Supporting smoking cessation through nicotine replacement therapy (NRT)
- Smoking cessation using NRT is always less harmful than continuing to smoke.
- When used correctly, all forms of NRT (at equivalent doses) are similarly effective in achieving long-term cessation.
- All forms of NRT monotherapy can increase the rate of quitting by 50–60%.
- More than one form of NRT (ie combination NRT) can be used concurrently with increased success rates and no greater safety risks.
Nicotine is the main substance in tobacco that causes addiction as it makes people dependent on cigarettes. However, it is the other chemicals in combusted tobacco products that cause cancer, accelerate heart disease and affect other areas of health. While nicotine also has the potential for adverse effects in vulnerable developmental life stages, including pregnancy, childhood and adolescence,18–20 it is considered to be a safer alternative to tobacco smoking.
The aim of NRT is to reduce craving and withdrawal symptoms by providing some of the nicotine that would normally be obtained from cigarettes, without providing the harmful components of tobacco smoking. NRT provides lower doses of nicotine at a slower rate than tobacco smoking; none of the available forms of NRT (ie transdermal patch, gum, inhalator, lozenge, mouth spray) offer the same rapid nicotine delivery of a cigarette.
Electronic cigarettes
Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine in a vapour without tobacco or smoke. The device heats a liquid into an aerosol for inhalation, simulating the behavioural and sensory aspects of smoking. The liquid is usually made up of propylene glycol and glycerol, with or without nicotine and flavours, stored in disposable cartridges or refillable tanks. The nicotine content of e-cigarettes can vary from zero to 50 mg/mL. E-cigarette users are sometimes referred to as ‘vapers’ and e-cigarette use as ‘vaping’.
The use of nicotine-containing e-cigarettes to support cessation is controversial.
As they have only been on the market for a short time, and are continually changing, their long-term safety is unknown. Concerns about e-cigarettes include:
- no tested and approved e-cigarette products are available
- a lack of high-level evidence for efficacy for smoking cessation
- a lack of evidence on health effects, particularly in the long term
- continued concurrent use with smoking (ie dual use)
- acting as a gateway to tobacco use
- the potential to promote nicotine use and renormalise smoking among those who do not smoke, especially young people.
Nicotine-containing e-cigarettes are not first-line treatments for smoking cessation.
The strongest evidence base for efficacy and safety is for currently approved pharmacological therapies combined with behavioural support. The lack of approved nicotine-containing e-cigarettes products creates an uncertain environment for patients and clinicians, as the constituents of the vapour produced have not been tested and standardised. However, for people who have tried to achieve smoking cessation with
approved pharmacotherapies but failed, but who are still motivated to quit smoking and have brought up e-cigarette usage with their healthcare practitioner, nicotine containing e-cigarettes may be a reasonable intervention to recommend. This needs to be preceded by an evidence-informed shared decision-making process, whereby the patient is aware of the following:
- no tested and approved e-cigarette products are available
- the long-term health effects of vaping are unknown
- possession of nicotine-containing e-liquid without a prescription is illegal
- in order to maximise possible benefit and minimise risk of harms, only short-term use should be recommended
- dual use (ie with continued tobacco smoking) needs to be avoided.
https://www1.racgp.org.au/ajgp/2020/august/smoking-cessation-1
The Royal Australian College of General Practitioners, Supporting smoking cessation: A guide for health professionals, 2nd edn, East Melbourne, Vic, RACGP, 2019, p. 7–8
Safety of Nicotine Replacement Therapy
While long-term health benefits of smoking reduction is limited, those who embark on this path may have an increased likelihood of quitting, even if they did not initially intend to do so. For example, those who use nicotine replacement therapy (NRT) for smoking reduction are approximately twice as likely to progress to quitting as those who do not.
https://www.athra.org.au/blog/2019/12/23/vaping-is-95-safer-than-smoking-fact-or-factoid/