Australia has about 2.7 million people with asthma, and some 464,000 with chronic obstructive pulmonary disease (COPD). Most of both groups use puffers for relief, sometimes in lifesaving attacks.

But none of the asthma drugs which are inhaled come in flavours which might make them more palatable. And respiratory medicine colleagues tell me that many users do not enjoy the medicinal taste. So you’d imagine that the manufacturers of inhaled medicines would jump at the opportunity to have flavours available if this would encourage more people to use their puffers when needed.

Here’s an example of someone enquiring to an on-line forum about whether puffer flavours are available. The advice back? “We still do not know the long-term consequences of inhaling concentrated flavourants, but I suspect that many are pretty bad for you… Also, many aromas (perfumes) are known to induce asthma attacks in people who are sensitive. So all-in-all probably not the best idea for people who are already at risk of reduced lung function.”

People who use puffers are advised that it’s safe to use them 4-6 times a day maximum. Contrast this with the number of times that the average vaper fills their lungs with propylene glycol, nicotine and flavouring chemicals, all vaporised from the liquid that is heated by the metal coil heated by the e-cigarette  battery.

This recent study monitored people vaping and found those who were exclusive vapers pulled this cocktail deep into their lungs 173 times a day — a mere 63,188 times a year. Those who were dual users (ie who smoked and vaped) took 72 lung-basting inhalations. The average 12 a day smoker takes about 96 puffs.

So the average exclusive vaper is inhaling vaporised flavours into their lungs at a rate some 35 times more than a person with asthma takes a blast from their puffer. And that’s before we even begin to count the secondhand vape that vapers (and the rest of us) also get when they vape around others.

Way back in 2014, there were 7764 unique vaping flavour names available online. It is likely there are many, many more in 2020.  So these flavouring agents have all been cleared as safe to inhale, right?

Errrm .. no, actually.

The peak flavour manufacturers association in the USA Flavor and Extracts Manufacturers Association (FEMA) stated earlier this year:

1. There is no apparent direct regulatory authority in the United States to use flavors in e-cigarettes.  In this context, it is important to note that the “generally recognized as safe” (GRAS) provision in Section 201(s) of the Federal Food, Drug, and Cosmetic Act (FFDCA) applies only to food as defined in Section 201(f) of the Act.

2. None of the primary safety assessment programs for flavors, including the GRAS program sponsored by the Flavor and Extract Manufacturers Association of the United States (FEMA), evaluate flavor ingredients for use in products other than human food.  FEMA GRAS status for the uses of a flavor ingredient in food does not provide regulatory authority to use the flavor ingredient in e-cigarettes in the U.S

3. E-cigarette manufacturers should not represent or suggest that the flavor ingredients used in their products are safe because they have FEMA GRAS status for use in food because such statements are false and misleading.

So in summary, flavouring chemicals likely to be used in e-juice may have been assessed as safe to injest, but not to inhale.

83% of New Zealand vapers name flavouring as a main reason they took up vaping. We know that flavours are a big factor that attract kids to vaping. And e-juice manufacturers have taken note. Here are a few examples of flavours that would be a big hit at any 5 year old’s birthday party.

Vaping advocates argue that regulators should keep their hands away from flavours because they are a major factor attracting smokers to try and keep vaping. Those worried about the dramatic rises in regular vaping by teens in several nations which have opened the e-cigarette access floodgates should get their priorities right, apparently.

By contrast, the pharmaceutical industry, which almost certainly would like to flavour its inhalable asthma drugs, has not gone down that road. One of the big reasons for this is undoubtedly that its asthma products have to go through therapeutic goods regulation. The two considerations there are efficacy (does a drug do what it is supposed to do? Answer with vaping: very, very poorly) and safety. The pharmaceutical industry knows it would struggle to demonstrate that inhaling flavours are acceptably safe.

This is why the vaping industry and its urgers are desperate to avoid therapeutic regulation and instead have its products avoid the safety standards that they would try in vain to demonstrate.

People living with asthma don’t abandon their unflavoured puffers in great numbers because they don’t taste the best. But undoubtedly, many who vape would not do so if they could not get flavoured e-juice.

But it is very wrong to imply that all who are vaping today are former and current smokers who are vaping to quit smoking and need support.  The just-published paper from the ITC-4CV four country (Australia, USA, UK, Canada) cohort survey found that “among smokers who also vaped, 46% planned to quit smoking within 6 months, 30% planned to quit in the future, but beyond 6 months, with the remaining 24% reporting that they did not know or did not plan on quitting, suggesting low motivation to quit smoking among many of the concurrent [both smoking and vaping] users.” 

Many dual users who vape are not at all desperate to quit smoking. Regulatory policy which fails to appreciate this and puts the flavour experimenting interests of vapers with no interest in quitting ahead of policies that keep beguiling flavoured vapes totally out of the reach of the great majority of kids, needs strong opposition. The Greg Hunt prescription access barrier is an obvious way to ensure this.