E-cigarettes: banning flavours is better than an outright ban.

Introduction:
This text is a correspondence published in The Lancet Respiratory Medicine, discussing the US government's intention to ban all flavored e-cigarettes and India's decision to ban the production, sale, and import of all e-cigarettes. The authors discuss the potential implications of these policies and propose a more balanced approach. Readers will learn about the reasons for and against e-cigarette bans, the impact of flavored e-cigarettes on teenage use, and the potential risks associated with e-cigarette aerosols.

Key points:

* The US government plans to ban all flavored e-cigarettes, while India has approved a ban on the production, sale, and import of all e-cigarettes.
* Teenage initiation into e-cigarette use is often triggered by enticing flavors and the belief that vaping is safer than smoking.
* Banning flavored e-cigarettes could reduce teenage vaping, as it targets the primary lure to adolescent use.
* The exact aetiology of the recent outbreak of vaping-associated lung injury is under investigation, but certain e-cigarette flavorings have been found to impair airway epithelium ciliary function.
* Manufacturers' listed constituents in e-cigarettes might not be the only chemicals present in the aerosols, as some flavorings can form potentially toxic compounds when mixed with other components.
* The impact of e-cigarettes on smoking cessation is unclear, and a ban on e-cigarettes could drive nicotine-addicted vapers back to tobacco cigarettes.
* The authors suggest banning flavored or adulterated e-cigarettes while allowing unflavored, unadulterated nicotine-containing e-cigarettes as prescription products for smoking cessation.

Main message:
The main message of this correspondence is the importance of finding a balanced approach to e-cigarette regulation. While banning flavored e-cigarettes could help reduce teenage use, a complete ban on e-cigarettes could have unintended consequences, such as driving nicotine-addicted vapers back to tobacco cigarettes. By allowing unflavored, unadulterated nicotine-containing e-cigarettes as prescription products, regulators can maintain the option as an alternative to smoking while enhancing the safety profile of e-cigarettes. The authors emphasize the need for adequate safety profiles, health risk descriptions, and guidelines for healthcare providers to manage patients who use e-cigarettes as smoking cessation aids.

Rambaran K, Sakhamuri S, Pereira LP. E-cigarettes: banning flavours is better than an outright ban. The Lancet Respiratory medicine. 2019;7(12):1. doi:10.1016/S2213-2600(19)30359-5