Electronic Cigarette Usage Issues

Electronic cigarette usage issues


1. Dry Throat, Sore Throat 
Tobacco withdrawal produces a sore throat in some people. It is unknown why this occurs but perhaps cigarette smoke ingredients have some sort of preventative or anaesthetic effect, and stop the throat becoming sore during cigarette use, which it is easy to see could cause it.

Some - but by no means all - suffer from a dry throat, or even a sore throat, when starting to use an e-cigarette due to the drying-out effect of PG. 

If a person suffers from both conditions: the tobacco withdrawal sore throat, and the e-cigarette new-user sore throat, then in rare cases a fiercely sore throat can result.

PG is a humectant (attracts, ie 'sucks out' water) and when vaping the back of the throat gets coated. You can find that after sleeping, you wake up with a sore throat. Things that can help are drinking a glass of water before bed, gargling with a mouthwash to cut the PG coating before bed, drinking water throughout the day, using hard candies and drinking liquids with honey liquid through the day to keep your mouth moist - especially if you are a new user.

An alternative for those who experience more throat dryness than normal is to change to a VG-based e-liquid, which normally solves the problem.

2. Cottonmouth
Extra-dry mouth or Xerostomia, commonly called cottonmouth, can be experienced by some. The obvious solution is to sip liquids, especially those that seem to assist the repair of dry buccal tissue such as blackcurrant juice (some acidic fruit juices may not be of much benefit). Of course, this may be problematic when travelling, so a throat lozenge may help. It appears that PG is more likely to cause this than the other two eliquid base materials (VG and PEG), so a change to all-VG liquid, or just a higher percentage of VG, may help.

3. Light phlegm
It is not unusual for ecigarette users who ceased tobacco smoking several months previously to experience light phlegm, coughed up two or three times a day. It may be more pronounced with VG eliquids. This might be regarded as a beneficial effect since it allows the body to expel unwanted inhaled materials.

4. Headache, racing pulse, inability to sleep
Also light-headedness, tinnitus (ringing in the ears), dizziness, slurred speech, hiccups, tingling of the extremities (fingertips, toes), jitters, teeth grinding - all these are reported as nicotine overdose symptoms.

Sometimes we overestimate just how much nicotine we were getting with regular cigarettes, and underestimate how much we are vaping, particularly at the beginning. Racing pulse is the most common, slurred speech less so. Headache can be severe. Light-headedness plus tinnitus is described as the 'just come out of a loud rock concert' effect. Try cutting down the nic dosage in your cartridges or liquids or vaping less frequently. The nicotine strength can be easily reduced by adding some VG (Glycerine, USP - obtained from a pharmacy), although this will also reduce the flavor.

It is said that some people experience one or other of the above symptoms even with a low nicotine liquid and find that switching to VG solves their problems, although such symptoms of PG intolerance are not widely believed to exist never mind be proven. It is more likely that such a reduction of the symptom/s (while staying at the same nic level) would be due to an intolerance to flavorings, colorings or similar used in an eliquid, and changing to a VGliquid simply removed those particular ingredients - see footnote.

Tachycardia and insomnia
A racing pulse and inability to sleep are symptoms of nicotine OD that may be experienced by those who have never before had any symptom of excess nicotine consumption. It is not clear if these symptoms are due to a batch of e-liquid that was considerably stronger than labeled, or an eventual reaction to excess nicotine. The solution might be to reduce the nic strength to a minimum sufficient to produce the required results (removal of cravings, adequate life functionality, stress relief, etc.) and no more.

Note that there is a huge range of tolerance to nicotine: some people report that 12mg liquid causes these types of symptoms for them, while others consume fairly large quantities of 36mg (or even higher) with no effects whatsoever. There are cases of users with 6mg liquid who reported that over-consumption was problematic, compared with a case of one user who vaped 60mg with no effects. There are many reports of people consuming 48mg in order to successfully convert to an e-cigarette. This appears to show that there is a factor-10 variance in nicotine tolerance between individuals - that is, some can tolerate a nicotine intake ten times higher than others.

As a general policy, it is probably best to reduce the nicotine strength to the minimum needed. It will often be impossible to equate this to the amount smoked as for some reason there is no direct relationship, for many/most people. Also, the nicotine strength of the liquid can be reduced over time, for most people.

5. Intolerance to e-liquid ingredients
A small number of people find they are intolerant to an ingredient and need to change the refill liquid they use.
a) The most common source of minor intolerance issues is PG, the most common base or carrier liquid component. A large number of symptoms have been reported, from sore throat, dry skin, and itching - though since there has been no research of such topics, all statements are guesses/opinions. If you find that you are experiencing some sort of issue then the first thing to try is a higher percentage of VG in the liquid (i.e. less PG), or an all-VG liquid, to see if the problem disappears.
b) A very small number or people report the reverse: an intolerance to VG. However, it should be carefully noted that not all glycerine can be used for e-liquid purposes. In particular it has been reported more than once that buying a cheap brand resulted in an adverse reaction. Note that only 'Glycerin, USP' bought from a pharmacy is recommended. VG can be made for industrial purposes and a cheap brand bought in a general store is unlikely to be of the best quality. If a reaction to VG is experienced, it would be worth trying another brand.
c) Some are intolerant to other ingredients, and these are most likely flavorings or colors. The answer is to change to a different liquid or even a different supplier, and see if the problem persists.
d) If you experience a strong reaction to a new liquid then don't use it any more - change to another liquid from another supplier. Some flavorings are obviously going to cause a reaction in a percentage of people because of the type of flavor and its known issues - cinnamon is an example. Some will have a reaction to it and this must be expected.

Here is a post on PG vs VG issues:
Ecig VG health question

6. 'Menthol Mouth'
It is reported that the use of large amounts of menthol-containing e-liquids can result in the deadening of taste for a period, with the result that all refills become tasteless for a while or until menthol use is reduced or ceased. Cinnamon is also implicated.

Menthol may or may not be the cause since many report that all eliquids lose their flavor for a period. Another factor is the change in taste perception, mainly a loss of taste, caused by smoking, together with its return after tobacco cessation, and a possible period when taste goes dead for a time during the first few months off cigarettes even for those who have not used menthol.


CAUTION: E-Cigarettes and Emphysema

Persons with emphysema are at increased risk of pneumonia, and there is a possibility that e-cigarette use may increase this risk further. We have only heard of one case where this may, possibly, have been a factor, after many millions of ex-smokers using e-cigarettes for 7 years, so it is clearly not a major issue.

Nevertheless, emphysema patients are at risk of pneumonia, so any increased risk is not advisable. Smokers with emphysema (or stage 3, stage 4 COPD) should switch to Snus, not an e-cigarette, since inhalation of anything that might negatively affect an existing, serious lung disease is not advisable. 

The pulmonary consultant MUST be informed of any decisions in this area. 

Some advice is: 
(a) Snus would seem a better choice, in the circumstances.
(b) You must consult your doctor about these issues because some patients with serious lung diseases caused by smoking are at risk of pneumonia.
(c) This is one of the very few areas where 100% VG e-liquid does not seem advisable. A percentage of PG seems preferable as it it has a bactericidal and virucidal action, which seems desirable here. The use of all-VG does not seem the optimum choice by persons with emphysema.

Conclusion
Snus is the best choice for smokers with emphysema who cannot give up tobacco/nicotine. 
An all-VG e-liquid does not seem the best choice, some proportion of PG seems advisable. 
Consult your doctor - there is an increased risk of pneumonia with emphysema, and it is not yet clear if e-cigarette use may, rarely, exacerbate this.

Note that pneumonia developing in an emphysema patient is not unusual and has absolutely nothing to do with lipoid pneumonia. This has a completely different pathology.