In Malaysia recent news, the law on the use of e-cigarette or vape will be expected to undergo comprehensive and integrated assessment to tackle the issue of the proliferation of its use among children and teenagers. There was also a strong call for more stricter control and even ban on use of vape in the country in order to curb abuse. The US Centers for Disease Control and Prevention (CDC) also recently advised people not to vape until further investigations in recent rise of cases of severe lung disease and mysterious death linked with use of vape.

In my clinical practice, I noticed there are a lot more patients especially the younger age group and female patient who are previously non-smoker now smoking vape. The youngest patient I met was 12 years old.

There are also a growing number of patients who switch completely from smoking to vaping most commonly for cost reason. There was a sense of pride in their voice when patient claimed they managed to quit smoking cigarettes but instead now they smoke only vape. Some patients perceived that vape is the lesser evil when it comes to smoking and the health effects are not as harmful compared to the regular cigarette. Worryingly, more and more people who are non-smoker especially children and teenagers becoming the target of these vape company who promote vape as a new fashionable lifestyle trend among youth.

Traditionally doctors are trained to quantify smoking history in a conventional manner of per pack history taking into account the number of cigarette per day and years of smoking but when it comes to vape, I was at lost on how to take a proper smoking history. I recently talked to a patient who switched from smoking cigarettes to vape as he wanted to save money. He consider himself a ‘moderate smoker’ and according to him he usually bought liquid vape in 30 ml or the 10 ml form. The smaller one is much travel friendly and easy to fit the size of his pocket while the bigger size fit nicely in his checkered fanny pack. Based on his ‘moderate’ use, he can finish the 30 ml liquid vape in two weeks duration.

There are various flavours to choose from and I denote a strong strawberry scent when conversing with him. There are also vape that contained no nicotine but most has different strength of nicotine contained in each preparation according to smoker’s preference. Most patients are not even aware that nicotine contained in the liquid vape were approximately two or three times more than regular cigarettes. Regular, cigarette contained between 1- 3 milligrams of nicotine but for vape, the content is around 4 to 12 mg of nicotine. A teaspoon of 12 milligrams liquid vape is almost equivalent to 60 cigarettes!

There are also additional chemical ingredients added to vape liquid leading to difficulties in quantifying the amount of exposure and which chemicals is the potential culprit causing patient’s symptoms. Nicotine- containing vapes are addictive and can still cause withdrawal symptoms after discontinued usage. There are reported cases of nicotine- induced seizure after usage of vape. Nicotine can also affect the heart by increasing adrenaline causing increase in heart rate and blood pressure. Some studies have linked usage of vape with cardiovascular events such as heart attack and coronary artery disease. There are also increase reported cases of respiratory symptoms such as coughing, wheezing, breathlessness and chest pain linked to use of vape. The radiologic evidence on the chest imaging showed pathophysiological changes consistent with acute lung injuries associated with chemical inhalation in aerosolized mixture contained in the vape.

Since vaping are still relatively new, there are sparse concrete evidence to ascertain the long term effects of vaping to an individual’s health. However, more and more evidence in the form of case reports showed that vaping is not as safe as it may claimed. Stricter regulations are needed on the purchase of vape as well as the use of chemical ingredients in the liquid vape preparations. I generally advised patient who smoked vape to stop just as I did with the regular cigarette as the health implications may be more hazardous in the long term.