Public health

TSANZ takes hard line approach to e-cigarette regulation

Mounting evidence that electronic cigarettes harm the lungs has led the two peak respiratory bodies to conclude they have no place in any setting other than smoking cessation.

In a joint submission to a parliamentary inquiry on vaping, TSANZ and the Lung Foundation argue there is “no good public health claim for an unregulated approach to e-cigarettes and even claim there is “a strong case for a total ban”.

The parliamentary inquiry is investigating the use, marketing and appropriate regulatory framework for e-cigarettes and vaporisers, which can now be bought legally in every jurisdiction, with nicotine e-liquid only lawfully obtained through the TGA under prescription.

The joint submission claims the most compelling argument for e-cigarettes is for use as smoking cessation aids.

But even then, they say evidence is weak, and if vaping devices are to be used as cessation aids they must be regulated by the TGA as therapeutic devices.

“The safety and efficacy standards required by the TGA would be sufficient to determine if the benefits of e-cigarettes and personal vaporisers were effective and worth the known risks and potential future risks from certain levels of use,” the submission states.

The submission goes on to describe a range of health concerns arising from an emerging body of evidence.

“Globally, e-cigarettes and personal vaporisers are being marketed as a harmless life choice, without any cautionary labels or health warnings.

“However, emerging evidence has shown that the use of e-cigarettes and personal vaporisers can deliver an unregulated cocktail of harmful chemicals which contain variable concentrations of nicotine directly to the lungs.”

The document cites research suggesting vaping can harm young lungs – including a 2016 study of 40,000 South Korean teenagers that found e-cigarette use more than doubled the risk of asthma diagnosis, and another study of 45,000 teens in Hong Kong where risk for cough and sputum doubled in both ever-smokers and never-smokers when there was e-cigarette use in the preceding 30 days.

“These adverse events are real, immediate and a cause for action to protect children and young adults from e-cigarettes whether containing nicotine or otherwise.”

The peak respiratory organisations also highlighted the as-yet unquantified risks of inhaling “superheated” toxins contained in vaping fluids – including formaldehyde – and device heating coils made from known carcinogens nickel, chromium and aluminium.

Meanwhile three Australian studies published in the past year make a link between vaping and harm to the lungs.

The TSANZ and the Lung Foundation also worry that the marketing of vaping as a fashion accessory could make smoking socially acceptable again.

They also raise concerns about the marketing of flavoured vaping fluids to a younger market, adding that there is now compelling evidence vaping is a gateway to smoking for teenagers.

If the government decides against a ban, vaping products should carry health warnings, clear labelling of compounds and toxicology data, the submission said.

There should also be rules restricting sales to over 18s, vaping fluid with nicotine must be regulated by the TGA, and ongoing research  and clinical trials are needed.

The inquiry has attracted 332 submissions and has held one public hearing with more anticipated in the coming months.

You can read the full submission here: Sub0332 Thoracic Society of Australia and New Zealand and Lung Foundation Australia 

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