E-Cigarette Education Needed for Patients as Use Increases

Sherry Zhou, MD, MSc

In an anonymous, 32-question survey of general practitioners, allergists, and pulmonologists, it was revealed that allergists and general practitioners are not as comfortable as pulmonologists with providing proper counsel on the use of electronic cigarettes, or e-cigarettes

The survey was presented in a poster at the 2018 American Academy of Allergy, Asthma & Immunology (AAAAI)/World Allergy Organization (WAO) Joint Congress in Orlando, Florida.

“This is a survey study from the University of Michigan looking at what’s known about electronic cigarettes in allergists, pulmonologists and general practitioners,” lead author Sherry Zhou, MD, MSc, told MD Magazine. “We wanted to do this study because, first of all, e-cigs are becoming popular, especially among high school students. The worry is that these kids pick up these e-cigarettes and eventually become cigarette users or users of other tobacco products.”

These devices produce aerosols by heating liquids that often contain nicotine, flavoring, and additional chemicals, and as their use has rapidly increased, there has been much debate in the medical community regarding if they have gateway effect to tobacco use or are a positive method for traditional cigarette cessation.

Survey data from 2014 has shown that 12.6% of all adults (14.2% of men, 11.2% of women) in the United States have tried an e-cigarette, and the National Tobacco Survey of middle and high school students from 2011—2015 showed that from 2013 onward, there has been a sharp increase in 30-day use of the devices, the highest of which among high school students.

“We, as doctors, have the responsibility to provide knowledge and cessation for the products,” Zhou said. “What we found is allergists in general, when compared to pulmonologists, we are not as comfortable providing e-cigarette cessation, even though up to 22% of adults are users of e-cigarettes. Pulmonologists know a little bit more and are more comfortable providing cessation.”

Zhou and colleagues found that very few (>5%) of health care professionals surveyed partook in the practice themselves ever, in the past year, or in the past month, although more than 15% admitted to having used cigarettes, cigars, hookahs, and marijuana at some point. Those same groups, however, used them in the past year or month in less than 5% of cases.

In regard to knowledge, pulmonologists scored the highest in terms of self-reported knowledge (mean score, 3 [somewhat knowledgeable]; P <.05) and scored the highest on the percent of correct answers at just above 30%. Allergists and general practitioners had self-reported scores around 2.5, between not so knowledgeable and somewhat knowledgeable, with allergists scoring slightly higher than general practitioners on the percent of correct answers.

“We don’t know enough, and we need to incorporate e-cigarettes into our practice and research agendas,” Zhou added.

As e-cigarette use increases around the United States, the circulating belief has been that their use is not that bad comparatively. However, there may be a lack of data to back up that belief.

“There are animal models that show e-cigs can cause irritations of the respiratory tract. But in terms of long-term use, correlations with cancer, correlations with other allergic diseases and asthma, they’re really aren’t enough studies showing that,” Zhou said. “One can imagine the inhalation of all these vapors with nicotine flavoring—I don’t think it’s going to be beneficial, at all. In terms of the harm induction, we don’t know, but I would not recommend e-cigarettes to anybody.”

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