Smart Smoke Inc., an electronic cigarette retailer here that targets longtime tobacco smokers, has enjoyed strong growth in its first year of operation, says Aaron Rollins, director of sales and marketing.

Smart Smoke, which opened its first outlet in the Spokane Valley Mall a year ago, now has four locations, including its corporate office in the Paulsen Center, at 421 W. Riverside, and kiosks in NorthTown Mall and in Silver Lake Mall, in Coeur d'Alene.

Rollins says Smart Smoke currently is negotiating a lease for a storefront in Spokane and plans to open three more storefronts within a 150-mile radius of Spokane by the end of March. The company employs 15 people now and plans to hire a total of 10 more employees at its planned stores.

An electronic cigarette is a tube that contains a cartridge of liquid nicotine solution and a battery-powered heating element called an atomizer. When the user inhales through the tube, the airflow activates the atomizer, which creates a vapor that looks like smoke, although no combustion is involved. Most models are tipped with a diode that glows like a cigarette ember when the atomizer is activated.

Dr. Glen Stream, a family practitioner with Spokane-based Rockwood Clinic PS, says he's fielded a few patient inquiries about electronic cigarettes, and one patient even demonstrated the device in his office.

"The physician community is starting to become aware of patients using them," Stream says.

Stream says he can't recommend electronic cigarettes as a permanent replacement or alternative to smoking, because little research has been done on the long-term health effects of inhaling nicotine alone.

"We're used to relying on research studies, but there isn't much information out there," he says.

Most patients who inquire about the device are interested in using it as a bridge to quitting smoking, although it's not approved as a smoking-cessation device, Stream says.

"If people told me they want to use electronic cigarettes as part of a goal of quitting, I wouldn't try to talk them out of it," he says. "It's certainly less harmful than continuing to smoke, and quitting should be the goal."

The U.S. Food and Drug Administration issued a health warning about electronic cigarettes last July.

"The FDA is concerned about the safety of these products and how they are marketed to the public," said Dr. Margaret Hamburg, FDA director.

Some longtime smokers claim their lungs cleared up after they converted to electronic cigarettes.

Marcia Bowler, of Spokane, says she's converted almost completely to electronic cigarettes over the last two months, after smoking a pack of tobacco cigarettes a day for about 35 years.

"I don't wake up coughing my brains out anymore," she says. "That's the main thing that caused me to give up smoking."

She also says her senses of smell and taste have returned since she cut back on smoking tobacco. Bowler says her husband kicked the nicotine habit altogether with the aid of a prescription drug, but she had an allergic reaction to the drug and sought another alternative.

Bobbi Holmes, who works in the office at Spokane-based Acme Concrete Paving Inc., says she and at least five other people there have converted to electronic cigarettes. Holmes says those who have been using the devices for a while claim they feel healthier than when they were smoking tobacco.

Rollins declines to disclose Smart Smoke's revenues, but says sales have doubled every 90 days since it opened its first outlet. Smart Smoke's competitors here include the Vapor Lounge downtown and BestECiggy, a Hayden-based Internet and retail operation with two outlets, including one in Spokane.

Most electronic cigarettes and nicotine products are manufactured in Asia. Smart Smoke sells its products under its own brand name, Rollins says. A typical electronic cigarette kit that includes two batteries, two atomizers, and a wall charger runs about $170.

Smart Smoke sells refills of the nicotine liquid for about $40 for a half-ounce bottle. Each bottle has enough liquid to refill the cartridge in an electronic cigarette 20 times, and each cartridge holds about the nicotine equivalent of a pack of cigarettes, bringing the equivalent ongoing cost to about $2 per pack, Rollins says. That compares with a typical price of more than $7 for a pack of cigarettes bought here.

Some electronic cigarettes are colored to simulate small cigars or filtered cigarettes. Others look more like thick writing pens and come in blue, red, silver, and black.

Rollins says the product is designed to provide a smoker with the full sensation of smoking, including the taste, feel, and hand-to-mouth motion, in addition to the nicotine hit, but without harmful smoke.

Smart Smoke's marketing literature claims the device is a "smarter alternative" to smoking tobacco, but makes no direct claim that the system is safe or healthy, because such assertions haven't been approved by the U.S. Food and Drug Administration, he says.

Several studies on the use of electronic cigarettes are under way, but it will take many years to determine the long-term health effects of inhaling nicotine vapor, Rollins says. He contends the toxic agents that cause more than 400,000 smoking-related deaths annually in the U.S. are products of combustion rather than the highly addictive nicotine behind the smoking habit.

In its warning in July, the FDA said a sample of cartridges from two brands of electronic cigarettes contained detectable levels of known carcinogens and other toxic chemicals. The FDA also had determined that electronic cigarettes were unapproved drug devices and seized several shipments of the Chinese-made devices as they entered the U.S.

In response to the FDA warning and seizures, the American Association of Public Health Physicians urged the FDA in August to change its stance and approve electronic cigarettes as tobacco harm-reduction products under the modified-risk component of the 2009 Family Smoking Prevention and Tobacco Control Act. In its request the AAPHP estimated that certain smokeless tobacco products carry less than 1 percent of the mortality rate of conventional cigarettes.

A federal judge ruled last month that the FDA overstepped its authority in its attempt to ban sales of electronic cigarettes by classifying them as unapproved drug devices. Washington, D.C.-based U.S. District Judge Richard L. Leon ruled that because the nicotine liquid used in some brands of electronic cigarettes is distilled from tobacco plants, it must be considered a tobacco product. Tobacco products are exempt from regulation as a drug, under the Tobacco Act, Leon's ruling said.

The FDA reportedly appealed the decision last week.

Carrie Nyssen, Seattle-based senior director of advocacy for the American Lung Association in Washington, says the association objects to health claims made by some electronic cigarette distributors.

"We don't know that electronic cigarettes will help people quit smoking, and we don't know that they are safe," Nyssen says. "There have been so very few studies that we can't conclusively say that they are more or less healthy than cigarettes."

The American Cancer Society, American Heart Association, and the Campaign for Tobacco-Free Kids also oppose electronic cigarette sales, in part due to concern they might be marketed to minors.

Rollins says Smart Smoke doesn't seek to create nicotine addicts.

"We don't want anything to do with appealing to a younger demographic," he says. "Most customers are 35 to 60 years old and have been smoking long enough to hate it."

Counter to the FDA's warning, Rollins contends there are no known carcinogens in Smart Smoke's products.

Bowler says money she's saved by converting to the electronic cigarette and that her husband has saved by completely quitting nicotine covers the payments on their sport-utility vehicle.

The electronic cigarette helps improve productivity compared with cigarette smoking, claims Bud Sebens, whom Smart Smoke hired for retail sales after he was a customer for nearly a year.

Because the smokeless product doesn't violate air quality regulations, it can be used indoors, eliminating the need to go outdoors for a time-consuming smoke break, Sebens says.