One million NHS patients to get free vapes – was the headline-grabbing policy first announced by the Conservative Government in 2023. And, at the time, it was one of the most revolutionary anti-smoking measures taken anywhere in the world.
A £45 million scheme, called Swap To Stop, it involved giving free reusable e-cigarettes to patients who were trying to give up smoking. And it came at a time when many countries – including Australia, Singapore, Thailand and Mexico – had chosen to ban the products over safety fears. Many experts argued that more research was needed before vapes could be considered low risk.
Britain, in contrast, was betting on vapes – in all their brightly coloured and sweetly flavoured varieties – to be safe enough to hand out on prescription.
But today there is growing evidence that vapes – while undoubtedly safer than cigarettes – are still dangerous.
Perhaps most concerning are the studies that show people who vape are more likely than non-vapers to develop chronic obstructive pulmonary disease, or COPD – a chronic lung condition that which can trigger organ failure.
Most patients live no more than ten years after a COPD diagnosis.
Research also suggests that regular vaping can weaken the lung’s protection against potentially serious infections and can even damage the teeth.
The Government has already begun to take action to clamp down on the number of Britons taking up vaping.
Perhaps most concerning are the studies that show people who vape are more likely than non-vapers to develop chronic obstructive pulmonary disease, or COPD – a chronic lung condition that which can trigger organ failure
Last week it was announced that vaping could be banned in cars carrying children and in playgrounds, over concerns about the health risks of second-hand vapour from the devices
Last year, faced with a concerning rise in teenagers taking up the habit, disposable vapes were banned in the UK – a decision based on the logic that these cheap and easy-to-use products are appealing to young people.
And, last week, it was also announced that vaping could be banned in cars carrying children and in playgrounds, over concerns about the health risks of second-hand vapour from the devices.
However, some experts believe the Government should go further in its crackdown, and question whether it is right that the NHS continues to hand them out.
‘There’s lots of emerging evidence that vaping can be damaging to the body,’ says Dr Aran Singanayagam, a consultant in respiratory medicine at OneWelbeck and Guys’ and St Thomas’ Hospital in London.
‘Of course, smoking is much more dangerous. But we really need to consider whether switching smokers to vapes is the right approach. It would be much safer if they just stopped completely.’
How a daily habit nearly killed Kyla
When she first began vaping, 17-year-old Kyla Blight believed the habit to be ‘harmless’.
But when the occasional social vape puff eventually became an addiction – with Kyla’s habit equivalent to smoking 400 cigarettes a week – it came with devastating consequences.
After collapsing and turning blue at a friend’s house, Kyla, from West Cumbria, underwent a five-hour surgery to fix a hole in her lung. Medics discovered that a small air blister – known as a pulmonary bleb – had developed on the top of her lungs and burst due to her excessive vaping, causing her lung to collapse.
After her surgery, Kyla had to spend two weeks in hospital, pictured right, before she could return home.
Now she says the ordeal has frightened her off disposable vapes for the rest of her life. ‘When I was 15 it started becoming a popular thing. All my friends were doing it,’ she said.
‘I just thought it would be harmless and that I would be fine.
‘Every day I would use the 4,000 puff ones, and I would go through them in about a week.
‘I honestly thought they were harmless and wouldn’t do anything to anyone, even though I had seen so many things about it. I just feel like everyone has that same view.
‘But now I won’t touch them. I wouldn’t go near them. The situation has really scared me out of them. I was terrified.’
Recent figures show that one in five British children aged 11 to 17 have tried vaping, despite it being illegal for under-18s, with the number of them using vapes tripling in the past three years alone.
So what exactly are the dangers of vaping? And is the habit ever worth the risk?
The need for more ways to help patients quit smoking is clear. The number of smokers in Britain has fallen precipitously since the 1970s, when more than four in ten adults smoked. Today, that figure is closer to one in ten.
However, even with this decline, lung cancer – which is primarily triggered by smoking – kills 33,000 every year. This makes it the nation’s most deadly cancer.
Smoking is also the leading cause of incurable COPD, which affects around 1.7 million people in the UK, killing around 30,000 a year.
Cigarettes contain dozens of toxic chemicals, including addictive nicotine, but the most dangerous ingredient within them is tar. The sticky residue is what damages the lungs and leads to cancerous changes in the cells.
Vapes, in contrast, do not contain tar, carbon monoxide or many of the other potentially hazardous chemicals found in cigarettes. Instead, they are primarily made using a combination of propylene glycol and vegetable glycerin (two ingredients used to create the distinctive vape ‘clouds’) as well as flavourings and, of course, nicotine.
Studies suggest vapes can also contain low levels of toxic chemicals, including formaldehyde, which has been linked to cancer, as well as small metal particles. However, experts say that the amount of these ingredients used in vapes is mostly too low to have any significant impact on the body.
‘Since 2016, the UK has regularly monitored the amount of these chemicals in vapes,’ says Professor John Britton, a respiratory medicine expert at the University of Nottingham.
‘And, in almost all cases, these levels have been considered safe for consumption.’
Experts say there are also a number of popularised, but mistaken, beliefs about the contents of vapes.
One of the most prevalent of these is that vaping can trigger a severe, irreversible scarring condition in the lungs called bronchiolitis obliterans, or popcorn lung. The story has become so popular that the NHS now devotes a section on its website to debunking the myth.
In fact, the disease was only ever found in a group of factory workers who were exposed to a chemical, diacetyl, used to flavour popcorn. Diacetyl is found in some e-cigarette products abroad, but is banned in the UK.
It’s for these reasons that, since 2023, vapes have been offered on the NHS to patients attempting to kick cigarettes. However, evidence now suggests that, while vaping is unlikely to lead to cancer like cigarettes, the habit can damage the body in other ways.
Last year, a study published in the journal Primary Care Respiratory Medicine concluded that, over time, vaping significantly increases the risk of developing COPD. It analysed the health records of more than 4 million vapers and, after excluding those with a long history of smoking, found that vapers were almost 50 per cent more likely to get COPD.
Smoking cigarettes is still markedly more likely to trigger the lung problem than vaping, as the habit raises the risk of COPD by as much as 1,000 per cent.
But experts warn that lung damage is a real risk for vapers.
‘If you’re regularly inhaling chemicals then it’s fairly obvious that this can lead to inflammation and potentially lasting damage,’ says Dr Singanayagam. ‘There’s not a lot doctors can do to treat COPD, so it should be avoided at all costs.’
Moreover, there is also evidence that vaping can weaken the immune system – raising the risks of a dangerous lung infection.
In a 2019 University of California study, published in the journal Cell Physiology, mice were exposed to vape smoke and then the cells inside their lungs were analysed. Researchers found that the mice were less able to produce crucial white blood cells which are needed to fight off infections.
Last year, Mamma Mia star Lily James revealed she’d had a filling in her teeth as a result of her vaping habit
‘There’s a lot of emerging evidence that vaping can dampen the immune system,’ says Dr Singanayagam. ‘We’re unsure which chemical or flavouring could be causing this problem. Cigarettes have a similar effect although, of course, much more severely.
‘But it’s troubling because, currently, we’re telling people with COPD to switch to vapes in order to protect them from infections. But it does seem that vapes weaken the immune system too.’
And it’s not just the lungs that appear to be affected by vaping – growing research shows that users appear to have worse dental health too.
Last year, a medical paper, published in the International Dental Journal, concluded that e-cigarette users were significantly more likely to develop gum problems than non-vapers – though much less than cigarette smokers. Experts say the reason for this might be because vaping dries out the mouth, creating an environment that is less hostile for potentially damaging bacteria.
One person whose oral health was affected by vaping is the actress Lily James. Last year, the Mamma Mia star, 36, revealed she’d had a filling – a procedure to fix tooth decay – as a result of her vaping. ‘I prided myself that I’d never had a filling,’ she said. ‘I did recently get one – I was so upset. Apparently it’s from flavoured vapes. They f***ed my teeth.’
However, despite a growing list of serious risks, experts still disagree over whether vapes should be offered on the NHS to those who want to quit cigarettes. Some, like Dr Singanayagam, argue that the NHS needs to come up with better alternatives.
Research shows that vaping is more effective than other methods of quitting smoking.
In 2019, a Queen Mary University of London study found that a fifth of patients who began using vapes were cigarette-free a year later – twice as many as those using nicotine patches or gum.
However, patients who switched to vapes tended to then become addicted to their new habit, while those who used nicotine replacement products eventually weaned themselves off them.
‘It’s not enough to just hand people vapes and claim the problem is solved,’ says Dr Singanayagam. ‘Switching from one bad thing to one less-bad thing isn’t a solution.’
But Prof Britton does not agree. ‘Vaping is the most popular way that smokers choose to quit, and it often works,’ he says. ‘Yes, it’s true that it’s not harmless. In 50 years’ time, I’m sure we will be able to pinpoint people who got COPD from vaping. But they are so much safer than smoking that getting patients to make the switch can only be beneficial.’
However, he adds this argument only applies to people who already smoke – non-smokers who take up vaping, particularly young people, are putting their health at risk.
In recent years there has been an alarming rise of young people who have never smoked taking up vaping.
Studies show that around a fifth of children aged between 11 and 17 have tried it. Of those, around four in ten admit to vaping every day.
Studies also show that young people who start vaping are around three times more likely to start smoking cigarettes.
‘It is madness to take up vaping if you don’t already smoke,’ says Prof Britton. ‘It will only do you harm.’
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