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E cigarettes: Tar Wars: The (Tobacco) Empire Strikes Back
  1. Andy Bush1,
  2. Jayesh Bhatt2,
  3. Jonathan Grigg3
  1. 1 Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 Respiratory Paediatrics, Nottingham Children’s Hospital, Nottingham, UK
  3. 3 Academic Division of Paediatrics, Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK
  1. Correspondence to Professor Andy Bush, Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney, London SW3 6NP, UK; a.bush{at}imperial.ac.uk

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Students of mythology will recollect that the second Labour of Hercules was to fight Lernaean Hydra, a nine-headed monster with the endearing habit of growing two ferocious heads to replace each one that was cut-off. Autres temps—conventional cigarettes may be on the way out as legislators (although some rather reluctantly) have tightened the noose, with a rich yield of health benefits for children,1 2 but the new Hydra-head of vaping and other means of inhaling nicotine have come on the scene. Far from being given the Hercules treatment (a burning firebrand on the neck stump of the severed head), they have been enthusiastically embraced by Public Health England,3 Members of Parliament and others as ‘at least 95% safer than cigarettes’,4 and proposals to allow vaping in public places are being advanced. By contrast, the European Respiratory Society5 and the Federation of International Respiratory Societies6 among others7 have come out strongly against their use. How should those who care for the respiratory health of children react? Are e-cigarettes the health benefit that their protagonists suggest, or an emerging and sinister threat to lung health?

The first question is, how safe really are e-cigarettes? That they do not produce tar and carbon monoxide is both indisputable and unequivocally better than cigarette smoke. Equally indisputable is that they contain nicotine, which is a drug of addiction and which, in animal models, is highly damaging to the developing fetal lung8–11 and brain.12 It is also a fact that there are literally thousands of different combinations of compounds and flavourings that can be vaped. These fluids are currently lightly regulated. In one study, all 122 vaping refill liquids studied contained substances having some level of hazard/risk of danger according to the globally harmonised classification system for respiratory irritants. …

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