European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 1, pp 17–25 | Cite as

Are electronic cigarettes a healthier alternative to conventional tobacco smoking?

  • Jan LöhlerEmail author
  • Barbara Wollenberg
Review Article


Electronic cigarettes (EC) with and without nicotine are used by more and more consumers within the last decade. The long-term risks of vapor inhalation are unknown. This study should describe the state of the art of knowledge with respect to the following four items: (1) ingredients of the vapor and their potential risks, the influence of EC on smoking of combustible tobacco to (2) adults and (3) the youth, and (4) the side effects of passive vaping. The vapor of EC contains, in comparison to tobacco smoke, less harmful substances, qualitatively and quantitatively. But, due to failing standardization of EC, this comparison is difficult. Adults are often using both, EC and combustible cigarettes dually. In addition, EC were used for supporting smoke-quitting. Unfortunately, consuming EC with and without nicotine due later to a higher risk of conventional tobacco smoking for the user. In general, the effects of passive vaporing are unknown. Although the vapor of EC is less harmful than tobacco smoke, EC are not hazard-free lifestyle products. Technical standardization should be desirable. Adult smoker’s benefit using EC is given by completely change to EC only. The rates of success using EC for smoke quitting are not well evaluated. Children and their parents should be informed on the risks of EC use as a precursor of combustible smoking mandatorily. Internet selling EC to any non-adult should be forbidden by law. EC ought not to be allowed to weaken non-smoker’s rights, and third persons should be protected by the potential hazards of EC vaporing.


Electronic nicotine delivery systems e-Cigarette Risks Head and neck cancer Ingredients Gateway hypothesis Smoking Smoking cessation Review 



Electronic cigarette, e-cigarette


Electronic nicotine delivery system


Electronic non-nicotine delivery system


Personal vaporizers


Heat not burn products




Propylene glycol





This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.


  1. 1.
    Ernst A (1889) On the etymology of the word tobacco. Am Anthropologist A 2(2):133–142. CrossRefGoogle Scholar
  2. 2.
    Falgairolle E (1897) Jean Nicot, ambassadeur de France en Portugal au XVIème siècle. ParisGoogle Scholar
  3. 3.
    Gregorii JG (1708) (Melissantes) Geographia Novissima, Teil 1, Frankfurt, Leipzig und Erfurt, S. 1.181Google Scholar
  4. 4.
    Zeissler K (1993) Die “Langen Kerls”. Geschichte des Leib- und Garderegiments Friedrich Wilhelms I. Ullstein, Frankfurt am Main u. a.Google Scholar
  5. 5.
    Spode H (2010) Kulturgeschichte des Tabaks. In: Singer M (eds) Alkohol und Tabak. Grundlagen und Folgeerkrankungen. Thieme, StuttgartGoogle Scholar
  6. 6.
    Müller FH (1940) Tabakmißbrauch und Lungencarcinom. Zeitschrift für Krebsforschung 49:57CrossRefGoogle Scholar
  7. 7.
    Albrecht J (2018) Als die Welt im Fieber lag. Frankfurter Allg. Sonntagszeitung, Nr. 9, S. 59–62Google Scholar
  8. 8.
    Lickint F (1929) Tabak und Tabakrauch als ätiologischer Faktor des Carcinoms. Zeitschrift für Krebsforschung 30:349–365CrossRefGoogle Scholar
  9. 9.
    Proctor RN (1999) Why did the Nazis have the world’s most aggressive anti-cancer campaign? Endeavour 23(2):76–79CrossRefGoogle Scholar
  10. 10.
    Proctor RN (1999) The Nazi war on cancer. University Press, PrincetonGoogle Scholar
  11. 11.
    Doll R, Hill AB (1950) Smoking and carcinoma of the lung. BMJ 2:739–748CrossRefGoogle Scholar
  12. 12.
    Terry LL (1964) Smoking and health: report of the advisory committee to the surgeon general of the United States. U-23 Department of Health, Education, and Welfare. Public Health Service Publication No. 1103, BethesdaGoogle Scholar
  13. 13.
    Deutsches Krebsforschungszentrum. Gesundheitliche Folgen des Rauchens.
  14. 14.
    Doll R, Peto R, Boreham J, Sutherland I (2004) Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 328:1519CrossRefGoogle Scholar
  15. 15.
    Robinson J (1927) Patent “Electric vaporizers”. US 1775947 AGoogle Scholar
  16. 16.
    Gilbert H (1963) Patent “Smokeless non-tobacco cigarette”. US 3200819 AGoogle Scholar
  17. 17.
    Horning L (2016) Die Geschichte der E-Zigarette. In: Die E-Zigarette, Geschichte—Gebrauch—Kontroverse. Stöver H (Hrsg.), Fachhochschulverlag, Frankfurt/ MGoogle Scholar
  18. 18.
  19. 19.
  20. 20.
    Bundesgesetzblatt (2016) Teil I, Nr. 15, Bl. 569 ffGoogle Scholar
  21. 21.
    Henkler F, Tkachenko A, Paschke M, Hutzler C, Luch A (2016) Gesundheitliche Risiken von E-Zigaretten. In: Stöver H (Hrsg) Die E-Zigarette, Geschichte—Gebrauch—Kontroverse. Fachhochschulverlag, Frankfurt/MGoogle Scholar
  22. 22.
    Varlet V (2016) Drug vaping. Toxics 4:29. CrossRefGoogle Scholar
  23. 23.
    Jazbinsek D (2016) Gewinnmaximierung durch Schadensreduzierung? In: Stöver H (Hrsg) Die E-Zigarette, Geschichte—Gebrauch—Kontroverse. Fachhochschulverlag, Frankfurt/MGoogle Scholar
  24. 24.
  25. 25.
  26. 26.
  27. 27.
  28. 28.
  29. 29.
    Kotz D, Böckmann M, Kastaun S (2018) the use of tobacco, E-cigarettes, and methods to quit smoking in Germany. A representative study using 6 waves of data over 12 months (the DEBRA study). Dtsch Arztebl Int 115:235–242Google Scholar
  30. 30.
    Hilliendorf A (2017) E-Shishas und E-Zigaretten, Umsätze weisen steil nach oben. Dtsch Arztebl 114:A68Google Scholar
  31. 31.
  32. 32.
  33. 33.
    Stöver H (2016) Elektronische Dampfprodukte und Harm Reduction. In: Stöver H (Hrsg.) Die E-Zigarette, Geschichte—Gebrauch—Kontroverse. Fachhochschulverlag, Frankfurt/MGoogle Scholar
  34. 34.
    Schaller K, Mons U (2017) E-Shishas und E-Zigaretten: debatte um Schaden und Nutzen. Dtsch Arztebl 114(3):A70Google Scholar
  35. 35.
    Kandel D, Kandel E (2015) The gateway hypothesis of substance abuse: developmental, biological and societal perspectives. Acta Paediatr 104(2):130–137CrossRefGoogle Scholar
  36. 36.
    Deutsches Krebsforschungszentrum (2008) Tabakrauch ein Giftgemisch.
  37. 37.
  38. 38.
    Goniewicz ML, Knysak J, Gawron M et al (2014) Levels of selected carcinogens and toxicants in vapor from electronic cigarettes. Tob Control 23:133–139CrossRefGoogle Scholar
  39. 39.
    Batra A (2011) Pharmakologische Aspekte des Nikotins. In: Singer MV, Batra A, Mann K (eds) Alkohol und Tabak. Grundlagen und Folgeerkrankungen. Thieme, StuttgartGoogle Scholar
  40. 40.
    Haussmann H, Fariss MW (2016) Comprehensive review of epidemiological and animal studies on the potential carcinogenic effects of nicotine per se. Crit Rev Toxicol 46:701–734CrossRefGoogle Scholar
  41. 41.
    Hecht SS (1999) DNA adduct formation from tobacco-specific N-nitrosamines. Mutat Res 424:127–142CrossRefGoogle Scholar
  42. 42.
    Knezevich A, Muzic J, Hatsukami DK, Hecht SS, Stepanov I (2013) Nornicotine nitrosation in saliva and its relation to endogenous synthesis of N′-nitrosonornicotine in humans. Nicotine Tob Res 15:591–595CrossRefGoogle Scholar
  43. 43.
    Lisko JG, Tran H, Stanfill SB, Blount BC, Watson CH (2015) Chemical composition and evaluation of nicotine, tobacco alkaloids, pH, and selected flavors in E-cigarette cartridges and refill solutions. Nicotine Tob Res 17:1270–1278CrossRefGoogle Scholar
  44. 44.
    Jazbinsk D, Gießelmann K (2018) Tabakerhitzer—Streit um rauchfreie Alternative. Dtsch Arztebl 115:A130–A136Google Scholar
  45. 45.
    Zhu SH, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, Lee M (2014) Four hundred and sixty brands of e-cigarettes and counting: Implications for product regulation. Tob Control 23(Suppl 3):iii3–iii9CrossRefGoogle Scholar
  46. 46.
    Barrington-Trimis JL, Urman R, Leventhal AM, Gauderman WJ, Cruz TB, Gilreath TD, Howland S, Unger JB, Berhane K, Samet JM, McConnell R (2016) E cigarettes, cigarettes, and the prevalence of adolescent tobacco use. Pediatrics 138(2):e20153983CrossRefGoogle Scholar
  47. 47.
    Kreiss K (2017) Recognizing occupational effects of diacetyl: What can we learn from this history? Toxicol 388:48–54CrossRefGoogle Scholar
  48. 48.
    Behar RZ, Luov W, Lin SC, Wang Y, Valle J, Pankow JF, Talbot P (2017) Distribution, quantification and toxicity of cinnamaldehyde in electronic cigarette refill fluids and aerosols. Tob Control 25(Suppl 2):ii94–ii102CrossRefGoogle Scholar
  49. 49.
    Kosmider L, Sobczak A, Prokopowicz A, Kurek J, Zaciera M, Knysak J, Smith D, Goniewicz ML (2017) Cherry-flavored electronic cigarettes expose users to the inhalation irritant, benzaldehyde. Thorax 71(4):376–377CrossRefGoogle Scholar
  50. 50.
    Stratton K, Kwan LY, Eaton DL (2018) Public health consequences of E-cigarettes. Nat Acad Science Engineering Medicine, Washington, DC. CrossRefGoogle Scholar
  51. 51.
    Schneider S, Göring T, Herr R, Herth FJ, Bauer-Kemény C, Huerkamp R, Diehl K (2016) Die E-Zigarette—Verbreitung, Konsummuster und Nutzermotive bei Siebt- und Achtklässlern. Sucht 62:153–162CrossRefGoogle Scholar
  52. 52.
    Werse B, Müller D, Stöver H, ichtl A, Graf N (2017) Der Konsum von elektronischen Dampferzeugnissen unter Jugendlichen—Konsummuster in einer repräsentativen Stichprobe aus Frankfurt/ Main. Sucht 18:1–6Google Scholar
  53. 53.
    Morgenstern M, Nies A, Goecke M, Hanewinkel R (2018) E-Cigarettes and the use of conventional cigarettes. A cohort study in 10th grade students in Germany. Dtsch Arztebl Int 115:243–248Google Scholar
  54. 54.
    Dutra LM, Glantz SA (2018) E-cigarettes and national adolescent cigarette use: 2004–2014. Pediatrics. Google Scholar
  55. 55.
  56. 56.
    Schraufnagel DE, Blasi F, Drummond FB, Lam DCL, Latif E, Rosen MJ, Sansores R et al (2014) Electronic cigarettes. A position statement of the international forum of respiratory societies. Am J Resp Crit Care Med 190:611–618CrossRefGoogle Scholar
  57. 57.
    Nowak D, Gohlke H, Hering T, Herth FJF, Jany B, Raupach T, Welte T, Loddenkämper R (2015) Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP) zur E-Zigarette. Pneumologie 69:131–134CrossRefGoogle Scholar
  58. 58.
    Bundesamt für Risikobewertung (2015) Gesundheitliche Bewertung von Zusatzstoffen für Tabakerzeugnisse und elektronische Zigaretten.
  59. 59.
    Welte T (2018) Ein Déjà-vu—warum man dieselben Fehler nie zweimal machen sollte. Dtsch Arztebl 115:223–224Google Scholar
  60. 60.
    Glasser AM, Katz L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC (2017) Overview of electronic nicotine delivery systems: a systematic review. Am J Prev Med 52:e33–e66CrossRefGoogle Scholar
  61. 61.
    Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P (2016) Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev (9):Art. No.: CD010216.
  62. 62.
    Matthews-King A (2018) NHS hospitals should sell e-cigarettes, says Government agency. Independet.
  63. 63.
    Dhalwani NN, Szatkowski L, Coleman T, Fiaschi L, Tata LJ (2015) Nicotine replacement therapy in pregnancy and major congenital anomalies in offspring. Pediatrics 135:859–867CrossRefGoogle Scholar
  64. 64.
    Dhalwani NN, Szatkowski L, Coleman T, Fiaschi L, Tata LJ (2018) Stillbirth among women prescribed nicotine replacement therapy in pregnancy: analysis of a large UK pregnancy cohort. Nicotine Tob Res. (Epub ahead of print)Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Wissenschaftliches Institut für angewandte HNO-Heilkunde (WIAHNO, Scientific Institute of Applied ENT Medicine) of the Deutscher Berufsverband der HNO-Ärzte e. V. (German Professional Association of ENT Surgeons)Bad BramstedtGermany
  2. 2.Schleswig-Holstein University Hospital, Lübeck Campus, ENT ClinicLübeckGermany

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