New Delhi: The unregulated e-cigarette market is causing health complications in young Indians, with medical practitioners saying they have been witnessing a spurt in illnesses linked to vaping.
Banning these alternative smoking devices was on the 100-days agenda of the Modi government since it returned to power on 23 May but with the efforts stuck in a limbo, the sector is thriving.
There are over 460 brands of e-cigarettes available in India, with over 7,700 vaping flavours. Some of the popular vaping devices include JUUL, KarmaX, Smok Nord and E-leaf, and they cost anywhere between Rs 2,000 and Rs 15,000.
This easy availability of the devices, say medical experts, has led to an increase in the number of patients.
“Patients have doubled in the last year alone,” says Dr Navneet Sood, Consultant, Pulmonology, at Dharamshila Narayana Superspeciality Hospital in Delhi. “In 2018, I had seen around 24-25 patients with around two patients a month who were vaping and had complications. This year, I have already been seeing around four patients a month.”
Dr Puneet Khanna, head of department, pulmonology and respiratory medicine, Manipal Hospitals in Delhi, echoes Sood’s concerns. “In the last five months, I have started seeing two to three patients (on an average) every month who have developed asthma, breathing issues or have worsened existing breathing disorders after vaping,” Khanna says, adding that he only would get one vaping patient in six months till last year.
Vaping in India
Vaping includes inhaling of vapours formed by hand-held electronic devices called e-cigarettes or other devices like hookahs. These devices heat the fixed cartridges full of nicotine to form vapours that are then inhaled.
While there are no confirmed reports of potentially dangerous lung injuries in India due to these e-cigarettes in India, the US is investigating around 100 cases of a “mysterious lung illnesses” linked to vaping and e-cigarette use. “Several young adults and teens have been hospitalised, with some in intensive care and on ventilators,” The Washington Post reported last week.
The American health department has now put doctors and the public on alert to watch out for the symptoms of the potentially dangerous lung injury, symptoms of which include difficulty in breathing, shortness of breath or chest pain.
Back in India, while the Ministry of Health had received the go-ahead to ban e-cigarettes from its apex advisory committee — the Drugs Technical Advisory Board (DTAB) — in June, the Delhi High Court had stayed the order.
According to reports, the government is now planning “various options including bringing an ordinance to enforce a ban on manufacture, sale and import of ENDS (electronic nicotine delivery systems) devices including e-cigarettes”.
Vaping affecting the young
A majority of the patients coming to them are young, doctors say, adding most complain about symptoms such as difficulty in breathing, shortness of breath or cough at night.
“All these new patients are youngsters in the age group of 18-30,” Dr Puneet Khanna says. “Many of them also confess to being hookah users causing them additional harm.”
Other doctors echoed a similar trend.
“When asked if they smoke or vape, some young patients may even feel shy confessing as they are accompanied by their parents,” says Dr Navneet Sood.
Such is the extent of the problem, says Dr Sunil Kumar K, consultant, interventional pulmonology, Aster CMI Hospital, Bengaluru, that doctors have now begun asking patients if they indulge in vaping habits. “Checking a patient’s smoking status was a norm but now, checking if they vape is also an important question for medical history,” says Kumar.
The Delhi-based Sir Ganga Ram Hospital (SGRH) says smokers increasingly want to know if e-cigarettes can be used against tobacco de-addiction.
“Till 2017, we never received such queries. In the last year, we have seen people getting curious about these devices. These are rare people, aged between 25-45 years, who come to us and check if they should use these devices,” says Dr Rajeev Mehta, vice chairman, department of psychiatry, SGRH. “We clearly prevent them. However, the main audience is youngsters who try these devices for fun. They won’t show up at hospitals unless they face serious side-effects.”
However, public hospitals haven’t started noticing the trend yet.
Dr G.C. Khilani, a former professor in the department of pulmonary medicine at the All India Institute Of Medical Sciences (AIIMS) believes he knows why. “Most of these patients who use electronic smoking devices are presumed to come from better economic background. Hence, they mostly visit private healthcare providers with their symptoms and not public hospitals,” says Khilani, who had co-authored the white paper along the Indian Council of Medical Research (ICMR), based on which the government is considering banning e-cigarettes and other ENDS devices.
‘Serious side effects of vaping may take years to show up’
While there are no confirmed reports of potentially dangerous lung injuries in India caused by e-cigarettes, medical experts warn they may take years to show up.
“Till now, only vulnerable patients are coming to us,” says Kumar from Bengaluru. “These patients already have some medical history. For instance, there is an increase in emergency admissions where patients have had a history of asthma and they tried vaping.”
He warns that “the serious side-effects of vaping nicotine will not show up immediately”.
“We have started receiving early symptoms — irritation in breathing, fever and cough — caused due to damage to the lining of the lungs,” Kumar says. “However, the future can be dangerous as several studies suggest severe side effects of vaping including cancer and potential lung damage.”
This report has been updated to reflect the correct name of Dharamshila Narayana Superspeciality Hospital, Delhi.