Tanuwihardja RK, Susanto AD. J Respir Indones. 2012;32(1):53-61.
Tobacco is a worlwide problem. The World Heatlh Organization (WHO) predicted that approximately 2.5 billion smoker worldwide with twothirds are in developing countries. Indonesia is ranked third among 10 countries with highest number of smoker, after China and India. Riset Kesehatan Dasar (RISKESDAS) in 2007 showed the prevalence of adult smoker is 46.8% male and 3.1% female. The combustion of a tobacco cigarette not only harming the user but also the surroundings, called the second-hand smoker. Study showed that the exhaled cigarette smoke contain 4-6 times nicotine than those inhaled by the user. Currently WHO is fighting the epidemic of tobacco in various strategies, one of them is stop smoking by using nicotine replacement therapy (NRT) such as gum, lozenges, skin patch, inhaler, and nasal spray. Electronic cigarette or e-cigarette is a bettery-driven inhalers that delivers nicotine that termed by WHO as electronic nicotine delivery systems. E-cigarette is used as a regular cigarette and consist of 3 parts: battery, atomizer and cartridge. When inhaled, the chip inside will activate the atomizer and vaporized the nicotine liquids in the cartridge. The nicotine liquids has various mixtures but only contains nicotine, propylene glycol, flavoring (to simulate the tobacco taste), and water. Without the hazardous tar and toxic chemical additives. Intially marketed as a safe alternative to tobacco smoking, with several analytic study result that favoured e-cigarette with lower nicotine consumption, unmeasureable polycyclic aromatic hydrocarbons, and no tobacco. A study found that the nicotine amount of e-cigarette decreases after 10 puffs and another study reported that due to the decreasing amount of nicotine delivered, e-cigarette user also consumes regular tobacco cigarette to compensate it. In 2009 FDA sponsored a study to evaluate e-cigarette and found that e-cigarette still contain tobacco specific nitrosamines (TSNA) and diethylene glycol (DEG) which known to be toxic and carcinogen. A counter reassessment study, funded by a manufacturer of e-cigarette, reported that TSNA was detected in a very small amount. Interestingly, TSNA was also detected on other FDA approved NRT products. Recent study comparing several e-cigarette brands noted that a certain brand significantly increased plasma carbon monoxide level and heart rate of user.
Conclusion. Available data showed that e-cigarette is not yet proven as a safe alternative to NRT and further studies are still needed to evaluate the health impact of e-cigarette on long term use.
Keywords: tobacco, nicotine, tobacco cigarette, nicotine repacement therapy, electronic cigarette.