Status:
Active
Health advisory:
190009
Date Issued:
13 Sep 2019
Issued by:
Dr Brett Sutton, Chief Health Officer, Victoria
Issued to:
Health professionals and consumers

Key messages

  • All Australian governments are united in maintaining a precautionary approach to the marketing and use of e-cigarettes. There is growing evidence implicating e-cigarettes in a range of harms to individual and population health.  E-cigarettes are relatively new products and the long-term safety and health effects associated with their use and exposure to second-hand vapour are unknown.
  • International evidence is emerging of a possible link between the use of e-cigarettes and lung disease. This includes severe lung disease requiring intensive care support and, as at 11 September 2019, at least six fatalities being linked with vaping in the United States.
  • Liquids used in e-cigarettes (e-liquids), even when labelled ‘nicotine free’, can contain harmful and widely varying substances such as nicotine, heavy metals, volatile organic compounds and cancer-causing chemicals. In some cases overseas, the use of cannabinoids has also been reported. 
  • At a population level, there continues to be insufficient evidence to promote the use of e-cigarettes for smoking cessation. Unlike any e cigarette product, all smoking cessation products lawfully available for sale in Australia have been evaluated for safety and efficacy and have been registered with the Therapeutic Goods Administration (TGA). To date, the TGA has not approved any e-cigarette product as a therapeutic good to help smokers quit.
  • Individuals who use e-cigarettes presenting with unexplained respiratory symptoms (cough, shortness of breath, chest pain), sometimes associated with gastrointestinal and other non-specific symptoms, should seek medical advice. 
  • Clinicians should ask patients whether they are using e-cigarettes (commonly known as ‘vaping’) in the same context as encouraging smoking cessation and should reiterate that no e-cigarette product has been evaluated for safety.
  • Health professionals and consumers can report adverse events following e cigarette exposures to the Victorian Poisons Information Centre by phoning 13 11 26 (24 hours a day, seven days a week).

What is the issue?

E-cigarettes are battery-operated devices that allow the user to inhale nicotine or other chemicals in a vapour form (known as vaping). The liquids used in e-cigarettes can contain nicotine, but also flavourings and harmful substances such as heavy metals, volatile organic compounds and cancer-causing chemicals.

International evidence is emerging of a possible link between the use of e-cigarettes and lung disease. On 30 August 2019, the US Centers for Disease Control and Prevention (CDC) issued a health advisory to clinicians, which reports over 200 cases of lung disease across multiple states in patients with a history of recent e-cigarette use. This work is ongoing, and Australian health authorities will continue to closely monitor these developments.

No single substance or product has been consistently associated with illness, although many patients have reported use of cannabinoids, such as tetrahydrocannabinol (THC). Further investigations are underway. E-cigarettes are relatively new products and further research is needed to understand their long-term impacts. However, increasing evidence reinforces the need to maintain, and where appropriate, strengthen the controls. 

Who is at risk?

Anyone using e-cigarette products or who are exposed to e-cigarette emissions and/or e liquids is potentially at risk. This includes  but is not limited to young people, pregnant women and their unborn children.  

Symptoms and transmission

Patients identified in the United States reported experiencing respiratory symptoms (cough, shortness of breath or chest pain) and some have reported gastrointestinal symptoms (nausea, vomiting, or diarrhoea). Some patients also reported non-specific symptoms such as fatigue, fever or weight loss. They all had a history of e-cigarette product use within the past 90 days. 

Recommendations

Individuals who use e-cigarettes presenting with unexplained respiratory symptoms (cough, shortness of breath, chest pain), which are sometimes associated with gastrointestinal and other non-specific symptoms, should seek medical advice.

Clinicians should ask individuals presenting with respiratory symptoms of unclear cause whether they use e-cigarettes (commonly known as ‘vaping’). Health professionals and consumers can report adverse events following e-cigarette exposures to the Victorian Poisons Information by phoning 13 11 26 (24 hours a day, seven days a week).

If e-cigarette product use is suspected as a possible cause of a patient’s lung symptoms or disease, the patient should be advised to cease their use of e-cigarettes.

Smokers or Vapers attempting to quit should use evidence-based treatments. Smoking cessation medication (approved by the Therapeutic Goods Administration) combined with behavioural intervention provides smokers with the best chance of quitting for good.

If you are concerned a child has drunk liquid nicotine, call the Poisons Information Centre on 13 11 26.

For evidence-based smoking cessation support, contact Quit on 13 78 48.

More information

Clinical information

NHMRC – Insufficient evidence for the safety of e-cigarettes    
Australian Government Department of Health – Principles that underpin the current policy and regulatory approach to e-cigarettes in Australia
Victorian Department of Health and Human Services – Electronic cigarettes containing nicotine
Centers for Disease Control (US) – Severe Pulmonary Disease Associated with Using E-Cigarette Products

Quit Learning Hub – Smoking cessation resources for health professionals 

Consumer information

Better Health Channel – e-cigarettes