They are neither harmless nor do they help to stop to smoke. The e-cigarettes and (misnamed) vaping devices burst onto the market as a kind of “salvation” for citizens seeking to get rid of conventional tobacco. However, over the years and scientific evidence have shown that this type of product constitutes a new risk for Health and one “barrier” in the global fight against smoking. Pulmonologists are particularly concerned about its consumption among adolescents, which is on the rise and which “can encourage them to become addicted to tobacco and other drugs”, which is why they demand from the Ministry of Health that these devices be measured by the same regulatory standard as the usual cigarettes. “We cannot consent to the current accessibility for the purchase of these products,” they highlight.

    “We are on the subject very worrying. Sales of electronic cigarettes and their consumption are increasing, especially in vulnerable sectors of the population, such as adolescents, whose central nervous system is still developing and, therefore, the administration of nicotine, through these devices, can encourage them to become addicted to tobacco and other drugs”, warns Dr. Carlos Rábade, pulmonologist at the University Hospital Complex of Santiago (CHUS) and coordinator of the Smoking Area of ​​the Spanish Society of Pneumology and Thoracic Surgery (Separ), who insists that, “for a long time”, there has already been “evidence” that electronic cigarettes “are not effective for smoking cessation” and that the smoke they emanate “contains toxic components” (formaldehydes, propylene glycol and/or vegetable glycerin and even heavy metals, and also nicotine, on many occasions), which “can increase the risk of developing cardiovascular and respiratory diseases”, among others, and “also carcinogens”.

    “That some of these products do not contain nicotine does not make them harmless agents. In addition, they promote in adolescents the behavior of taking a system very similar to a cigarette and inhaling. This is a very worrying issue and a threat to tobacco control because normalizes smoking”, considers Dr. Rábade.

    A problem that, warns this expert, “does not only affect adolescents”, but also “adults who want to quit tobacco and resort to electronic cigarettes because of their accessibility”. “Perhaps a consultation to quit smoking is not as accessible to the population as it is, on many occasions, to look for a point of sale for electronic cigarettes and heated tobacco devices. This is delaying a significant percentage of the population from making a serious attempt to quit tobacco with the treatment that has really been shown to be effective, the combination of drugs with psychological advice”, emphasizes the coordinator of the Separ Smoking area, who recalls that this scientific society has been “for years” demanding that this type of product “be equated and have the same regulation as conventional tobacco”.

    “You cannot consent to that accessibility and that ease of acquisition. The regulationboth in sales and in taxes, has to be the same as that of conventional tobacco, since these devices do not stop containing toxic agents, they have not been shown to help people quit smoking and they represent a barrier in the control of tobacco use”, emphasizes Dr. Rábade, and stresses: “On the one hand, they are a gateway to the consumption of tobacco and other drugs in adolescents and, on the other hand, they keep many smokers in the habit of smoking. As one piece of information shows, 80% of consumers of this type of product are also consumers of conventional cigarettes”.

    In this context, from Separ they urge the Ministry of Health to incorporate “five fundamental points” in future regulations of prevention and control of smoking (in the process of elaboration), which go through that comparison of electronic cigarettes and the so-called vaping devices with conventional cigarettes; the increase in the price of tobacco; the introduction of gene packaging; the expansion of smoke-free spaces; and the financing of smoking cessation treatments.

    “In Spain tobacco is too cheap. we seem the tobacconist Europe. Its price should be doubled or even tripled, equating it to that of other countries in our environment, such as France or the United Kingdom,” says Dr. Rábade, who highlights plain packaging as “another measure that has proven effective” in the fight against smoking . “In countries like Australia, it has been found to reduce adolescents’ attraction to tobacco, and it has also helped smokers themselves make serious attempts to quit,” he notes.

    Regarding the expansion of smoke-free spaces, the coordinator of the Separ Smoking area claims the “important role” of the 2010 anti-smoking law “in the protection of non-smokers”, and considers that “Spain has to continue in that line.”

    “There are still places where non-smokers are unprotected. Smoking continues on beaches, on terraces or in sports venues,” warns Dr. Rábade, who also urges “much better monitoring” of compliance with the ban on smoking in smoke-free spaces. “It must be constituted a body that is responsible for ensuring that compliance. Someone has to do it, because every day we see how the regulations are broken in those places, ”he says.

    The coordinator of the Separ Smoking area also insists on the need to “offer assistance to smokers and tobacco addiction through smoking cessation services”, with “equal access in all autonomous communities”, and that the treatments to quit smoking “have a financing in the health system”. “These treatments have indeed shown efficacy, in fact, they can triple the rate of quitting tobacco”, remarks Dr. Rábade.

    At this point, the expert draws attention to the impact of the SARS-CoV-2 pandemic on the prevention of smoking, and urges the reopening of care units —such as the Complexo Hospitalario Universitario de A Coruña (Chuac)— that had to paralyze its activity to meet the demand derived from the covid health emergency.

    “We want and hope that smokers will once again be offered that path to quitting. smoking It’s not a vice, it’s a illness and, as such, it needs the same treatment that we can offer to hypertension, diabetes, ischemic heart disease or COPD. At Separ, we have been making a tremendous effort for many years to create a series of accreditation criteria on how tobacco addiction units have to work. Those that were already operating in Spain before the pandemic had very good results and it is urgent to reopen them. Smokers cannot feel unprotected when it comes to giving up tobacco, they must always have a reference professional who provides them with help and support”, points out Dr. Rábade, who also insists that smoking units, whether in Primary or specialized care, constitute “one of the most cost-effective medical interventions and that more they save lives”.

    “It is extremely important that the administrations put all their efforts into controlling this terrible epidemic and disease that is smoking. And it is also essential that health professionals, when we are in front of a smoker, put all the meat on the grill so that they quit tobacco. I am not just referring to my fellow pulmonologists or doctors from other specialties. It is key that nursing staff and pharmacists make this health advice as well. We have to work all togetherhand in hand, on this issue, which does not concern only smokers, but the whole of society”, he concludes.

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