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.

Vaping Electronic Cigarettes Help People Quit Smoking

Two Reports Show Vaping Electronic Cigarettes Helped People Quit Smoking

Background: E-cigarettes heat liquid laced with nicotine into a vapor. The global market for vaping products is estimated at around $7 billion in 2015. Vaping electronic cigarettes have been used by some individuals as a way to help quit smoking tobacco products. How effective e-cigarettes are for this purpose is unknown.

There are numerous types for vaping electronic cigarettes.

E-cigarettes are displayed in a store.

 Study 1. Researchers at University College London analyzed results on smokers who participated in the Smoking Toolkit Study – a survey of households of those 16 years of age and older in England. Information was collected on about 170,490 smokers between 2006 and 2015.  21% were current smokers. The authors estimated that in 2015 e-cigarettes alone may have helped about 18,000 smokers quit cigarettes who would not otherwise have quit. The study was published in the British Medical Journal on September 13, 2016, volume 354 (doi: 10.1136/bmj.i4645)

Person vaping electronic cigarette

A person vaping e-cigarette.

Study 2: A Cochrane review evaluated 11 new studies about electronic cigarettes published since 2014. The review found that electronic cigarettes that contain nicotine can help people stop smoking. The Cochrane committee stated, “There was no evidence of serous side effects form e-cigarette use over a two year period.” 

Comments: Dr. John Britton, Director of the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham, commented about the Cochrane report, “The evidence is clear, smoking kills. If you can’t stop smoking, if you can switch to another form of nicotine and that lets you stop smoking, then that is great.”

Ms. Deborah Arnott, chief executive of the health charity Action on Smoking and Health, said, “Taken together, the Cochrane review and the BMJ article provide further reassurance that e-cigarettes are not undermining quitting. Indeed, the evidence from England, where smoking prevalence is continuing to decline, is the e-cigarette use is associated with a higher rate of successful quit attempts by smokers.”

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.