Hema Roslin Samson＊,Aisha Al Shdefat

1 Adult Health&Critical Care Nursing.College Of Nursing Sultan Qaboos University

The WHO newsroom May 2020 - states that tobacco epidemic is a gigantic public threat the world has ever faced.Furthermore, greater than 7 million deaths are owed to definitive tobacco usage& 1.2 million due to non-smokers being exposed to secondhand smoke or passive smoking [2].Of preventable deaths, caused by use of tobacco, United States of America tops the list.Ironically, there is a steady decrease in estimated number of smokers globally and a rapid increase in number of vapers [3].Nicotine derived from tobacco or nicotiana tabacum is a component of E-cigarettes.Consumption of nicotine in any form has protracted ramifications on one's health.

E-cigarettes or electronic cigarettes,is also known as vaping devices, e- vaporizers or Electronic Nicotine Delivery System (ENDS).Use of e-cigarettes is generally referred to as vaping, since it creates vapor which is inhaled [4].Chinese pharmacist Hon Lik,from Beijing invented E- cigarette in 2003.ECigarettesare rechargeable battery-operated device that emit vaporized nicotine to inhale.It is made of a cartridge attached to the end of a tube containing liquid solution, an atomizer that heats the liquid causing it to vaporize, a sensor that activates the atomizer when the user sucks the device and the e-solution /e- liquid that incorporates a combination of nicotine diluted in propylene glycol solution and flavoring agent [17].E-cigarette's are available in different shapes, some look like regular cigarette,or like a pen or a flash drive.All forms of tobacco are harmful, with no safety level of exposure to tobacco (nicotine) smoke [2].The effects of regular cigarettes (contains nicotine) is well highlighted with the statutory warning being mention in BOLD on every commercially available cigarette packet.Regrettably, though due to lack of awareness regarding the components and fable imagination that electronic cigarettes are not addictive has left a conspicuous number of people addicted to nicotine.

Vaping&It's Aftermath

Cigarette smokers, invariably realize they are addicted to smoking when there is a noticeable alteration in their health parameter.Smoking starts out of curiosity,due to peer pressure, as a social obligation or out of sheer boredom.The vulnerable age group being high school and university students.Injurious effects of addiction when evident, arouses the individual to seek medical support.

The perpetual reason for smoking in the United Kingdom is to assist in smoking cessation (51.5%),succeeded by ‘other' reasons (21.5%), enjoyment and social activity with friends (NHS Digital 2019)[10].Despite reasons stated by vapers, the impact of vaping reverberates across the physiological and psychological domains of human beings.Irritation of the mouth and throat along with dry cough are experienced at initial use [11].Among E-cigarette users, enormous quantity of nicotine absorption by the body generates plasma concentration levels equivalent to smoking, consequently increasing the risk of cardiac arrhythmias and hypertension[12].Thus,among vapers due to the effects of nicotine, prevalence of cardiac conditions secondary to vaping could seemingly be soaring given the number of e-cigarette consumers as stated by World Health Organization(WHO).

A midst critically ill E-Cigarette user patients hospitalized, due to fatal conditions with Methicillin Resistant Staphylococcus Aureus (MRSA) growth, the virulence of MRSA fiercely intensifies due to exposure of E-cigarette vapors, stimulating the organism to produce acids within the first 3 hours of exposure as a defense mechanism.E- Cigarette vapors cause the organism to have an increased positive surface charge decreasing susceptibility to antimicrobials [15],consequently response to antimicrobial therapy of such patients could be poor.Secondhand aerosol (SHA)exposure to vaporized particles, nicotine and cancer-causing substances have detrimental health effects [4].“If you are around someone who is smoking E-cigarette, you are breathing an aerosol of exhaled nicotine, ultrafine particles, volatile organic compounds and other toxins” (-Dr.Stanton Glantz,Director for the Centre for Tobacco Control Research& Education, University of California, San Francisco.)It also has an immediate effect on respiratory mechanics and exhaled inflammatory biomarkers.Aerosol is delivered into the users'lung following the use of E-cigarette (inhalation), during expiration,remaining aerosol is exhaled into the environment [7]forming an inadvertent pollution source of particulate matter (secondhand aerosol-SHA) to which bystanders are inevitably exposed8.A passive exposure to E-cigarette emission for 30 minutes results in immediate alteration of small airway and exhaled biomarkers reflected by increased resonant frequency and reduced fractional exhaled nitric oxide (FeNO)during an Impulse Oscillometry [9].Hence, if a 30-minute exposure to passive E-cigarette aerosol, can cause airway inflammatory changes, one can imagine the repercussions due to long term exposure to these aerosols.A crowded environment, exposes greater number of people to health risks, thus multiplying the number of innocent victims affected by nicotine.

The long-term effects of e-cigarette use on cancer risk are still under study.However, the use of ECigarette increasingly exposes the users to known carcinogens, such as formaldehyde that makes a user's lifetime risk of cancer as much as fifteen times greater than the risk from prolonged smoking [16].The deleterious effects of nicotine remain the same regardless of the form or mode it is consumed.

Discussion

E-Cigarette vapors contain exceptionally high level of oxidizing free- based nicotine (a form of nicotine) that is profoundly addictive, contrary to the belief that the concentration of toxic chemicals from e-vapors is lower than in regular cigarette[13].

Furthermore, these products are often mislabeled so that users believe they are using nicotine free products,but most likely contain nicotine [14].The prevailing global morbidity statistics and the fact that E-cigarettes can aid in smoking cessation signals one to pause and ponder.Before one could indulge in any activity,consumption of a food product or medication-be it for pleasure, for health or for therapeutic purposes, it is imperative to ascertain the components, and the consequences both immediate and long term on one's mind and body.

Conclusion

Productive years of an individual's life maybe hampered, especially amongst the youngsters if health has been affected related to nicotine addiction.The impact of nicotine on human health is well documented.The World Health Organization estimates that by 2030,10%of the annual deaths globally will be tobacco (nicotine) related [18].As of 1st April 2020,955 municipalities, 19 states and 3 territories include electronic smoking devices as products that are prohibited from use in 100%smoke free environments,in United States of America.There is no credible evidence showing that vaping products are safer than traditional cigarettes [6] (Theo Moraes, respirologist and clinical scientist at Toronto's Hospital for Sick Children).Let our political machinery, community milieu and family members reach out to support youngsters and those addicted who are wanting to quit and be freed from the bondage of nicotine.