Is Heat-Not-Burn Vaping Safer Than Smoking Cigarettes?

What Is Heat-Not-Burn Vaping?

Dear Dr. Mahler:

I keep reading about a “tobacco unit” that heats tobacco instead of burning it. The information states that the tobacco is heated just enough to release a flavorful vapor that contains nicotine. What do you think?

I am desperate to quit smoking because I have severe COPD. I have tried everything including the patch, gum, spray, and Chantix. My friend told me that hypnosis helped her quit, but my insurance does not cover this. Should I consider trying IQOS as a safer alternative to cigarettes? 

Andrew from Peterborough, Ontario, Canada

Dear Andrew:

I appreciate your situation as many others in my practice continue to struggle with quitting smoking. I am sure that Canada has some Help Quit phone numbers to assist you to give quitting another try.

Unfortunately, there is no published research by independent universities to answer your question.

Here is a brief review of different tobacco products –  cigarettes, electronic cigarettes, and heat-not-burn – to help you and other viewers understand your choices.

Tobacco Cigarettes

Lighting a cigarette creates a fire that burns tobacco at a temperature of more than 600 degrees Centigrade. This creates smoke that contains nicotine and other toxic chemicals as well as ash. The latest statistics in the United States is that 15% of adults smoke cigarettes daily – an all-time low.

A cigarette sits in an ashtray

Electronic Cigarettes

E-cigarettes do not contain any tobacco, but instead vaporize a liquid that usually contains nicotine and possibly favoring. Apparently, many smokers are not satisfied with e-cigarettes because they do not provide the “throat-hit” that smokers are used to with cigarettes.

Vaping e-cigarette may cause e-cigarette explosion

A person vaping e-cigarette.

Heat-Not-Burn Tobacco Products

These products heat tobacco at temperatures about 350 degrees Centigrade which releases a vapor containing nicotine without burning the tobacco. Because the tobacco is heated and not burned, tobacco companies claim that there are lower levels of harmful chemicals compared with cigarettes.

IQOS is a product for heat-not-burn vaping

A heat-not-burn product called IQOS which means “I quit ordinary smoking.” Image shows charger and holder.

There are several different heat-not-burn vaping tobacco products called 3T, Glo, IQOS, iSmoke OneHitter, Pax 2, Ploom Tech, and V2 Pro. Many of these are currently available in about 30 countries including Canada (where you live), the United Kingdom, and Japan.

Once again, there is no independent research to support the claims that these products are safer than cigarettes.

The United States Food and Drug Administration (FDA)

The FDA has announced plans to cut nicotine levels in cigarettes to become less or non-addictive. For those who can’t or won’t quit, the FDA plans to allow lower-risk products that deliver nicotine without the deadly toxic chemicals.

At a two day meeting next week before the FDA, scientists from Philip Morris International and its US partner Altria will try to convince government experts that IQOS is less harmful than cigarettes. If successful, IQOS could then be advertised as the first “reduced risk” tobacco product sanctioned by the FDA. 

Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.


Donald A. Mahler, M.D.

Vaping To Help Quit Smoking: Is It Safe? Is It Effective?

Is Vaping OK to Help Quit Smoking?

Dear Dr. Mahler:

I have a question about vaping. Is it ok to use a vape when you have COPD when trying to quit smoking?

Daniel from Albuquerque, NM

Dear Daniel:

Your question is a frequent one that I have been asked in my practice. Please read my March 1, 2016, post in response to a question similar to yours, “Can e-cigarettes help to quit smoking?” At the time I wrote that, “The World Health Organization takes the view that there is not enough evidence to recommend e-cigarettes for quitting smoking. In one review, there was no difference in quit smoking rates between those using e-cigarettes and those using nicotine replacement products (as examples, gum and patches).”

Vaping e-cigarette may cause e-cigarette explosion

A person vaping e-cigarette.

To provide an up-to-date answer to your question, I searched PubMed, the online search site for published medical articles. Here is what I found:

Current Perspectives of E-cigarettes in Patients with COPD

A recent review was published in the November 2017 issue of the International Journal of COPD (volume 12; pages 3202-3210) on the topic of your question. The battery of an e-cigarette heats an element that vaporizes a solution of glycerol, propylene glycol, and flavoring with and without nicotine.The authors emphasize that e-cigarettes do not contain tobacco and do not rely on combustion to operate.  However, they can deliver nicotine that closely matches the rate and level of tobacco cigarettes.

Of interest, the US Food and Drug Administration consider both glycerol and propylene glycol as Generally Recognized as Safe.

In one study, those with COPD who stopped smoking  or considerably reduced tobacco consumption by using e-cigarettes were followed for two years. Over this time period, flare-ups of COPD were reduced by 50% and there was an improvement in general health status.

The authors concluded that although e-cigarettes are not risk free, they are much less harmful than smoking tobacco cigarettes.

Advice From Former-Smoking E-cigarettes Users to Current Smokers  

4,192 individuals who quit smoking using e-cigarettes were surveyed online. They were asked to provide advice to current smokers who were considering vaping as a way to help them quit. Their advice covered four themes: 1. Find a combination of vaping device, flavor of e-liquid, and nicotine strength that “works for you”; 2. It is OK to continue to smoke for a while after starting to vape; 3. It is common for people to fail to quit smoking using approved aids (like nicotine patch) before success with e-cigarettes; and 4. Many respondents noted an awareness of improved health and hygiene since switching to vaping.

This reports was published online on August 3, 2017, in the journal Nicotine Tobacco Research (doi: 10.1093/ntr/ntx176

My Comments

As your have COPD, the most important thing that you do is to quit smoking cigarettes. I advise patients in my practice to quit any way possible. This includes quitting “cold turkey,” use of nicotine patch or gum or lozenges, acupuncture, hypnosis, and prescription medications.

I also support the use of e-cigarettes as a substitute for tobacco cigarettes. Why? Cigarette smoke contains over 4,000 chemicals, including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. In contrast, vape smoke contains only three (nicotine, glycerol, and propylene glycol) along with possible flavoring.

Good luck on quitting. Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.

Donald A. Mahler, M.D.

Quitting Smoking: “I Need Help To Stop”

Ways for Quitting Smoking

Dear Dr. Mahler: 

I have COPD and breathe hard with most activities. I was in the hospital two months ago for a chest infection and had to quit smoking then. I did great for about 3 weeks, but then started smoking 1 – 2 cigarettes a day. Gradually, it increased to about 10 per day. It is frustrating because I know that I should quit. I try to stay busy, but a friend may come over to visit and we both enjoy smoking together. It helps me relax. 

My doctor has told me that I have Stage 3 COPD, and take Spiriva and Advair inhalers. I make sure to get a flu shot each year.

Is there any advice can you give me?

Miriam from Corpus Christi, TX

Dear Miriam:

It is great that you want to quit smoking. Here is some general information on smoking in the US followed by recommendations to help you quit.

General Information on Tobacco Use In The United States

According to the Centers for Disease Control and Prevention, in 2015, 20% of adults (49 Million) use a tobacco product either every day or some days. That includes cigarettes (15%), e-cigarettes (3.5%), cigars or cigarillos (3.4%), smokeless tobacco (2.3%), and regular pipes, water pipes, or hookahs (1.2%).

Smokers need help quitting smoking

Cigarette Smoking

Current use of tobacco is higher in men (25% versus 15% in women), those less than 65 years of age, persons living in the Midwest; persons of annual household income of less than $35,000 per year (28% versus 13% with income of at least $100,000 per year); persons who were single, never married, or not living with a partner; persons insured through Medicaid; persons with a disability, and those who identified as lesbian, gay, or bisexual (27% versus 20% in heterosexuals).

Ways For Quitting Smoking

I have provided information on ways for quitting smoking in Chapter 3 (Can You Help Me Quit Smoking?) of COPD: Answers to Your Questions published in 2015 (for more information see heading Books on my website). Various websites and phone numbers are listed in a Table on page 23.

In addition, QuitNow offers a FREE program which will help you create an easy-to-follow Quitting Plan that will show you how to get ready, take action, and then live the rest of your life as a non-smoker. The website is, and the phone number is 1-800-784-8669.

According to the website, you get: Quitting Aids including FREE nicotine replacement products (patches or gum) if it is part of your personalized Quitting Plan; Quit Guide – an easy to use workbook; Quit Coach – assistance over the phone from someone who specializes in helping people quit; Web Coach – a private online community where you can complete activities, watch videos, and track your progress; and Text2Quit – text messages allows you to connect with your Quit Coach, interact with your Web Coach, use medications correctly, manage urges, and avoid relapse.

Finally, Miriam, I encourage you to discuss your desire to quit smoking with you health care professional. He or she can offer suggestions based on knowledge about your specific situation.

Mark Twain has a famous quote about quitting smoking

Mark Twain

I often quote Mark Twain about quitting smoking: “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.”

Best wishes on success on quitting smoking.

Donald A. Mahler, M.D.

Can e-cigarettes Help to Quit Smoking?

Use of e-cigarettes to Quit Smoking

Dear Dr. Mahler:

My husband wants to quit smoking. He has tried just about everything, but none of them have worked for more than a week or two. Now he wants to try smoking electronic cigarettes. What do you think?  

His doctor has told him that he has early emphysema. He is fairly active in the community and works 25 hours a week at Home Depot. 

Joan from Columbus, OH

Dear Joan,

I congratulate your husband on wanting to quit smoking.  E-cigarettes are a $2.2 billion industry in the United States, and use is increasing rapidly among adults and teenagers. 4% of US adults are regular users.


Electronic cigarettes are battery-powered devices that simulate the feeling of smoking, but without tobacco. Smoking an e-cigarette is called vaping. There are four parts.  The battery powers the e-cigarette and is usually rechargeable.

Components of an e-cigarette

Components of an e-cigarette

The battery connects to atomizer which turns nicotine liquid into vapor. Next in line is the cartridge where the nicotine liquid is stored before vaporization and where new liquid is refilled. Many newer e-cigarettes combine the cartridge with the atomizer into one component. The final part is the mouthpiece or tip. This funnels vapor from the cartomizer into the vapor’s mouth. The user activates the e-cigarette by taking a puff.

There are many types of e-cigarettes as shown.

Battery charger with USB port.

Battery charger with USB port.

Hand grenade type e-cigarette

Hand grenade type e-cigarette







Quitting Smoking with e-cigarettes

There is controversy about using e-cigarettes to help people quit smoking. However, the benefits and the health risks are uncertain, and the long-term health effects are unknown. Compared to smoking tobacco, e-cigarettes are safer for both users and bystanders.There is tentative evidence that they can help people quit smoking. They have not been proven to work better than nicotine replacement products such as the patch or gum.

Woman vaping an e-cigarette.

Woman vaping an e-cigarette.

The World Health Organization takes the view that there is not enough evidence to recommend e-cigarettes for quitting smoking. In one review, there was no difference in quit smoking rates between those using e-cigarettes and those using nicotine replacement products (as examples, gum and patches).


The vapor contains flavors, propylene glycol, formaldehyde, nicotine, carcinogens, heavy metals, and other chemicals. Overall, e-cigarettes reduce exposure to carcinogens and other toxic substances compared with smoking tobacco in cigarettes. The nicotine in the vapor is associated with heart disease and potential birth defects. There is inadequate research to demonstrate that nicotine is associated with cancer in humans.

One main concern is that e-cigarettes are unregulated. There are risks from misuse or accidents such as fires by vaporizer malfunction and explosions from battery failure. A recent article in the Seattle Times described four young adults who experienced injuries to the face, hand, and arm due to exploding e-cigarettes. In October 2015, one 24 year old man lost front teeth and suffered cuts to his lips and gums due to blast injury from an explosion.

In summary, I encourage your husband to use whatever method to help him quit smoking. If he decides to use e-cigarettes, he should hopefully do this to quit smoking and then to quit using e-cigarettes. He may consider using nicotine patch or gum instead of electronic cigarettes.

Also, I encourage your husband to discuss his plans with his health care provider.

Best wishes to both of you for success in your husband quitting,

Donald A. Mahler, M.D.

I Want to Quit Smoking: Can e-cigarettes Help Me Give Up Tobacco?

Should I try e-cigarettes to quit smoking?

Dear Dr. Mahler:

What are your thoughts about e-cigarettes? I want to quit smoking cigarettes and have tried the patch, gum, and Chantix without success. Do they work? Are they safe? I am 59 and have “moderately severe” COPD according to my doctor. She says electronic cigarettes do not have all of the chemicals that are in cigarettes.

Cam from Kingston, Ontario, Canada

Dear Cam:

Your question is important and timely. Before I answer it, here is some brief information on electronic cigarettes.

There are numerous types for vaping e-cigarettes.

Various electronic cigarettes displayed in a store.

Electronic cigarettes contain no tobacco. The burning of tobacco produces smoke (combustion) which makes particles and gases that can cause cancer (carcinogens). Thousands of toxins have been identified in tobacco smoke.


With electronic cigarettes, the vapor contains only trace or no toxins and no carbon monoxide gas. The vapor usually includes flavorings and  a chemical called propylene glycol. Current evidence shows that e-cigarette vapor is much less toxic then cigarette smoke. Nicotine is the major chemical in e-cigarettes and is highly addictive as everyone knows.

Experts state that the greatest potential but unproven benefit of e-cigarettes is to help people quit smoking cigarettes. So far, there are two studies that have examined the success of e-cigarettes in helping someone quit smoking. Overall, about 10% of individuals using e-cigarettes were able to quit tobacco smoking, which was similar to use of nicotine patch.

Although many young people are experimenting with vaping e-cigarettes, most of these are already smoking regular cigarettes. Studies in animals show that the developing brain is vulnerable to the effects of cigarettes. Thus, preventing sales of electronic cigarettes to youth as proposed by the FDA is important.

Person vaping e-cigarette

A person vaping e-cigarette.

Finally, most experts suggest that e-cigarettes should meet safety standards and be regulated. Right now, there is no regulation as to what additives or how much nicotine is actually in electronic cigarettes.

When someone in my practice asks the same question as you have, I provide a brief explanation, and then state that vaping electronic cigarettes appears to be safer then smoking cigarettes. Ideally, someone might use e-cigarettes as a way to quit smoking cigarettes, and then eventually quit vaping.

Of course, you should discuss this with you health care provider.

For more information, see Point and Counterpoint: Does the Risk of Electronic Cigarettes Exceed Potential Benefits? in the journal CHEST, September 2015.

Best wishes on quitting,

Donald A. Mahler, M.D.