SINGAPORE — People who use "energy stick" inhalers can progress to smoking or vaping, and it can also lead to respiratory problems and long-term health damage, said healthcare experts.

The flavoured additives found in these nasal inhalers, such as mango, grape and watermelon, are added to the product and marketed as "healthier" and "more natural", but there are limited studies to substantiate these claims, said Dr Sewa Duu Wen, head and senior consultant of respiratory and critical care medicine at Singapore General Hospital.

"In fact, there is broad literature suggesting some of these flavouring compounds contribute to airway toxicity, impaired respiratory immune cell function and cause cellular damage," said Dr Sewa.

He added that while these flavours are not addictive, their use in other products such as cigarettes and vaping products have been associated with increased use by adolescents, and may pose uncertain long-term health hazards.

Senior Minister of State for Health Janil Puthucheary told Parliament on March 4 that the ministry and the Health Sciences Authority are closely monitoring the use of energy sticks.

He was responding to questions from MPs about the dangers of such products.

Yip Hon Weng (Yio Chu Kang) had asked about the effects of the inhalers and whether there is a need to treat them like vaporisers and e-cigarettes.

Zhulkarnain Abdul Rahim (Chua Chu Kang GRC) had asked about the use of such products among the youth here, and the dangers of such inhalers as gateway devices for potential drug abuse.

Dr Janil noted that energy sticks are being marketed on social media with a range of flavours to target the young.

He said that such inhalers claim to give users an energy boost and contain ingredients that are similar to the conventional nasal decongestant inhaler.

But he added that steps may be taken if they are found to contain harmful ingredients such as nicotine.

He said: "We will continue to evaluate these products to ensure that they are not adulterated with harmful ingredients such as nicotine as they evolve, and we will take the necessary actions to protect public health."

The nasal inhalers, which tout health benefits such as clearing nasal congestion, helping to reduce anxiety and improving sleep quality, have become widely popular among school-going children in Malaysia and China.

Checks done by The Straits Times found that these inhalers can be bought on e-commerce websites at prices as low as $1.50.

Similar to vapes, these products come in endless flavours such as mango, grape, watermelon, guava and mojito.

One listing on Shopee had more than 4,200 buyers, and had a 4.8 star average review for the product.

In February, Malaysia's Health Ministry said enforcement action will be taken against sellers of these nasal inhalers.

Malaysian Pharmacists Society president Amrahi Buang said such energy sticks could be a gateway to developing smoking or vaping habits among children and teenagers, Malaysian newspaper The Star reported.

He added that inhalers sold at pharmacies for medicinal purposes are different from these energy sticks, which are sold online, mainly through social media platforms.

One reporter from ST was able to buy the inhaler from a store on Shopee, with the product taking about two weeks to be delivered from China.

According to the product packaging, ingredients in the inhaler include menthol, borneo camphor, and food flavouring.

These ingredients are found in certain regulated health products that have been approved by the US Food and Drug Administration to be used for relieving symptoms in nasal congestion, said Dr Sewa.

However, he added that other marketed health benefits such as improving sleep quality and reducing fatigue are not established.

"Some of these products found online are produced by companies with unclear quality control standards and may not be subjected to the same rigorous regulations placed in more established companies," said Dr Sewa.

"When these ingredients are absorbed in large quantities in children, the potential to cause side effects may be more evident as compared to the adult population."

He added: "Hence, it is advisable to avoid using these products in very young children less than six years old."

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This article was first published in The Straits Times. Permission required for reproduction.