DW: It sound spromising, but is the e-cigarette a suitable aid to help smokers quit?

Dr. Loddenkemper: There are claims that it is, but in Germany a court has ruled that it can't be used as a treatment because there's no proof that e-cigarettes wean people off tobacco. Another question is whether it's helpful to substitute e-cigarettes for tobacco cigarettes or if that will just maintain nicotine addiction. There's no data yet. With the so-called "dual-users“, who smoke and vape, there's evidence that they don't quit using tobacco.

DW: Could e-cigarettes be a gateway drug to nicotine addition and ultimately smoking?

Dr. Loddenkemper: There's a fear that could be the case with young people. They're being targeted by the e-Shisha brands with colorful packaging and attractive flavors. And that young people could start out with e-cigarettes, with or without nicotine, and get used to the smoking ritual and then switch to smoking tobacco.

DW: Experts and even the WHO are warning about possible side effects of ingredients - what exactly is in e-cigarettes?

Dr. Loddenkemper: It's basically a chemical mixture made up of propylene glycol und glycerine that produce the vapor, flavorings, either with or without nicotine, and all three have different side effects. Propylene glycol irritates the eyes and respiratory passages, and breaks down into ultra fine particles that can enter the body's circulation through the lungs. Tests with animals have proved that cellular damage can occur. Nicotine leads to addiction and cancer and is therefore very dangerous, especially during pregnancy and in adoloescence. Flavorings differ widely. There are more than 7,000 on the market and not all have been tested. It's been proved recently that some could break down into cancer-causing agents, so the health dangers definitely exist.

DW: Can flavorings also be addictive?

Dr. Loddenkemper: You can compare that with people who like chocolate, who always need chocolate in stress situations and can't break the habit. It's similar to that. Whether it's a real physical dependence is another question, but in a wider sense it's also an addiction.

DW: Should non-smokers be worried about exposure to e-cigarettes?

Dr. Loddenkemper: There are tests that show that passive vaping is definitely relevant. Aerosols exhaled in a room spread and these emissions could bother or harm others.

DW: The number of consumers, especially among young people is soaring. What do you think about e-cigarettes being marketed and sold as a life-stlye product?

Dr. Loddenkemper: We view the e-cigarette industry and its advertising as very negative. And the advertising has to be banned because it seduces young people. Currently it's not regulated and that's a global problem. There are no uniform laws despite recommendations from WHO. There are countries, for example, where there's a complete ban on e-cigarettes, like Brazil, Uruguay or the Arab countries and then there are countries where only nicotine-free e-cigarettes are legal. The problem is that the tobacco industry is trying to win control of the e-cigarette industry. And its in their interest to lure young people to tobacco to increase sales in their old product. That's pretty obvious, but difficult to prove.

Dr. Robert Loddenkemper is an internist and pneumologist and until 2005 was the chief doctor at the Heckeshorn Lung Clinic in Berlin. In the early 1990s he was president of the German Respiratory Society (DGP) and is still a member. In 2007 he initiated the tobacco prevention working group and since then represents the DGP in Germany's Alliance Against Smoking.(ABNR).
www.pneumologie.de

Interview: Marita Brinkmann