E-Cigarettes: Risk Assessment and Possible uses for Patients with Severe COPD - An Update
Pulmonology Clinic, Germany
Submission: February 13, 2017; Published: February 20, 2017
*Corresponding author: Thomas Hering, Head Physician, Pulmonology Clinic, Schloßstraße 5, 13507 Berlin, Germany, Europe,
Tel:+49 30 32601511; Email:firstname.lastname@example.org
How to cite this article: Thomas H. E-Cigarettes: Risk Assessment and Possible uses for Patients with Severe COPD - An Update. Glob J Add & RehabMed. 2017; 1(1): 555555. DOI: 10.19080/GJARM.2017.01.555555
Taking market data as a basis, e-cigarettes continue to enjoy major success . Topulmonologists it falls to assess this development, to advise patients adequately and if appropriate to support their use. Even though for long-term risk assessment the state of information is still unsatisfactory, their use has become increasingly established. The clearest statement has been that of the Public Health Authority of the British government: this clear statement published 2015 on e-cigarettes classified their global risk as extremely positive compared to tobacco cigarettes. The risk from consumption of e-cigarettes is assessed as one twentieth of the risk of tobacco cigarettes . According to this, in a hypothetical world where only e-cigarettes were consumed instead of tobacco cigarettes, after the dropping of tobacco-related morbidity and mortality – the mortality would drop by 95%. Instead of the now roughly120 thousand tobacco-related deaths eg. in Germany , we would be left with only 6000 “e-cigarettes-deaths.” That is according to the hypothesis, which speaks for itself
But how should pulmonologists classify their use in consultations, how should they advise patients?
Two significant arguments against e-cigarettes state that they constitute
A potential gateway drug for youth…
A potential risk of cancer from e-cigarette substances, even if it is less…
Clearly these arguments cannot be brushed off without further consideration. On the other hand: for which patients, from the treating pneumologist’s perspective, would switching
to e-cigarette need to be considered? It is first and foremost those patients who already have advanced COPD - according to the current GOLD-Classification  4B or 3B i.e, those with severely restricted lung functioning and significant symptoms, for whom we must most urgently ensure that further exposure of bronchial system to toxic smoke is prevented. As a rule it is always important that a complete, effective breaking of the tobacco addiction without fallbacks would be the first priority [4,5].
But what if breaking the tobacco addition is not a realistic alternative? We all know how great the challenge is in order to actually break the tobacco addiction, beginning from the challenges that the lawmakers and the health insurers impose, to the challenges represented by the limited own resources of the patients in cases of severe addiction. Tobacco consumption is in large part now mostly a problem of the educationally deprived classes . For patients in this situation with extremely advanced COPD mostly at advanced ages, the abovementioned counterarguments (“potential gateway drug” and “potential risk of bronchial carcinoma”) are scarcely to be adduced.
Thus it is important, in cases of a strong urge to smoke, if there is no realistic chance of overcoming tobacco addiction, that the e-cigarette be a feasible alternative . The latest studies and recommendations show that modern products are superior in ensuring the nicotine dosage . It is important to recommend to patients with high degrees of nicotine dependence an e-cigarette that provides sufficient nicotine in order to hinder the impulse to fall back on tobacco cigarettes.