Nicotine and vapes

Nicotine dependence is a chronic and relapsing disease that profoundly affects physical and mental health.2 In recent years, a shift in understanding nicotine addiction from a behavioural issue to a chronic disease has gained momentum. Nicotine dependence is a compulsive brain disorder with repeated quit attempts and high relapse rates.3 This change in perspective is crucial for effectively addressing the problem and providing comprehensive support to those struggling with nicotine dependence. Smoking and vaping practices both involve the inhalation of substances that can profoundly impact human health. 

Vaping emerged as a purported harm reduction strategy compared with traditional smoking. However, the chronic nature of vaping remains a concern. Long-term exposure to higher nicotine levels is known to increase the risk of atherosclerosis and further promote stroke risk.16 According to Kaiser et al,17 e-cigarettes, like traditional smoking, can cause a loss of blood brain barrier integrity and vascular inflammation. Although vaping eliminates the combustion process responsible for harmful byproducts in traditional cigarettes, the aerosols produced by e-cigarettes still contain potential health hazards 

Smoking and vaping share a common denominator, which is the inhalation of harmful substances. Cigarette smoke contains numerous toxic compounds, including nicotine, tar, and carbon monoxide, which can lead to chronic respiratory diseases, cardiovascular issues, and even cancer.3,4 Vaping, on the other hand, often involves the inhalation of aerosols containing nicotine, flavourings, and other chemicals. Although touted as a safer alternative to smoking, recent research raises concerns about the potential long term impacts of these aerosols on lung health. The aerosolized vapours from e-cigarettes have been shown to deliver carcinogenic, toxic, and irritating substances such as formaldehyde, acetaldehyde, and acrolein. Vaping, or the inhalation of these toxic chemicals, can lead to inflammation in bronchial epithelial cells and pulmonary disease.5 

Beyond their physiological effects, smoking and vaping both have potent psychological dimensions that contribute to their chronicity.4 Nicotine, a highly addictive substance present in cigarettes and in many vaping products, plays a crucial role. The development of nicotine dependence can perpetuate these habits, making cessation challenging. Moreover, the ritualistic aspect of smoking and vaping, intertwined with social and emotional triggers, reinforces their chronic nature. Long-term nicotine consumption can have adverse effects on brain function by disrupting dopamine pathways and distorting the crucial coping mechanism for depression, particularly in younger individuals.8 

A holistic approach in recognizing and treating nicotine dependence is needed. Recognizing nicotine dependence as a chronic disease underscores the necessity of a comprehensive approach to treatment. This approach should encompass medical, behavioural, and psychological interventions tailored to the individual’s needs. Just as medications are prescribed for other chronic diseases, the pharmaceutical aids listed in Table 2 can significantly enhance the chances of quitting. These interventions help manage withdrawal symptoms and cravings, making the journey to a smoke-free life more manageable.22 Behavioural support is the cornerstone of managing chronic diseases.23 Counselling, support groups, and cognitive-behavioural therapy can empower individuals to develop coping strategies, recognize triggers, and modify behaviours associated with smoking. Adopting a healthier lifestyle is crucial. Encouraging regular exercise, a balanced diet, and stress-reduction techniques will minimize relapse. Similar to regular check-ups for chronic diseases, consistent follow-ups with health care providers can prevent setbacks and provide continuous guidance.