E-cigarettes: Studies presented at the ERS Congress
Munich, Germany: The latest evidence on the potential benefits and risks of e-cigarettes has been presented this week at the European Respiratory Society’s International Congress in Munich.
Electronic cigarettes have received much attention in recent years as their use has increased across Europe. As the devices are relatively new, there is little long-term evidence detailing the potential harm or benefit that these devices can cause.
During the ERS Congress, a number of abstracts will be presented on the topic. The key outcomes are revealed here:
Research into the short-term effects of e-cigarettes has established a link between the devices and asthma and emphysema in a mouse model
E-cigarettes were found to cause similar changes to the cells in the lungs that are seen with normal cigarettes
Research found that the devices could be used as a successful quitting aid
Study shows a lack of consensus among doctors advising patients
ERS position on e-cigarettes
The ERS agrees with the recent report from the World Health Organization (WHO) and is opposed to the use of unregulated e-cigarettes. While the short-term negative impact on health appears not as great as tobacco cigarettes, the long-term effects of e-cigarettes are not known. As a Society grounded in scientific principles, ERS believes that the precautionary principle should be applied when scientific evidence is inconclusive and insufficient.
E-cigarettes: miracle or health risk?
More than two million people in the UK get their nicotine hit via electronic cigarettes. But as ‘vaping’ replaces smoking - and is enthusiastically marketed by the beleaguered tobacco giants - no one is yet sure how safe it actually is.
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The World Health Organisation (WHO) calls the devices’ safety “illusive”, noting that the chemicals they contain are often not disclosed and have not been properly tested. The US Federal Centers for Disease Control (CDC) has said there is “enough evidence” to say that switching to electronic cigarettes would “likely be healthier” than smoking. But mainly because of the near complete lack of regulatory oversight, and because e-cigarettes do, after all, contain nicotine, which is far from being a “benign substance”, the CDC will not go so far as to pronounce them safe either.
The British Medical Association (BMA) has also warned it is worried by the lack of peer-reviewed studies on e-cigarette safety, and public health officials elsewhere have expressed concerns about the purity of the products’ ingredients, the precise dose of nicotine delivered by different devices and liquids, inaccurate product labelling and an overall lack of quality control in the manufacturing process. “The real truth,” says Gilmore, “is that we just do not know. We cannot say e-cigarettes are risk-free. We cannot yet be sure what impact they will have on smoking rates or population health, whether they’ll be the miracle product or not.”
Nor is there unanimous agreement among public health experts that e-cigarettes even help people to give up smoking. WHO has said their efficacy as an aid in giving up smoking is “yet to be demonstrated”, adding that it “strongly advises” consumers not to use them until national regulatory bodies have declared them both effective and safe. Similarly, the BMA currently encourages doctors to recommend other nicotine replacement therapies ahead of e-cigarettes (although it says that for patients who are unwilling to use nicotine gum or patches, or tried them unsuccessfully, the devices can be presented as a lower-risk option than smoking tobacco).
Many experts, including Ash’s former director, Clive Bates, feel strongly that any risks associated with e-cigarettes are outweighed by their capacity to dramatically take the harm out of using nicotine. Others, equally strongly, disagree, arguing that even if e-cigarettes turn out to be perfectly safe, they risk re-normalising what is now, in most developed countries, a pariah habit: a “lifestyle product” that is actually a way to get, or keep, people hooked on the real thing.
UK studies seem to suggest little evidence that e-cigarettes might have this effect. But in a study of 40,000 young Americans unambiguously entitled E-Cigarettes: Gateway to Nicotine Addiction for US Teens, the University of California’s Center for Tobacco Research and Education found that using e-cigarettes was likely to increase the probability of experimenting with traditional cigarettes.
ERS agrees with the WHO proposal and believes that a strong regulatory framework is required in particular to protect children, young people and non-smokers. Furthermore, there is a clear need for more independent research to find out both potential benefits and risks of these products.
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For more information on this ERS position, read an editorial on e-cigarettes published in the European Respiratory Journal: http://erj.ersjournals.com/content/current
Studies Reveal Health Risks Of E-Cigarettes
Modern electronic cigarettes have been available for a decade and have been booming in popularity. Unlike traditional cigarettes, e-cigs don’t burn dried tobacco leaves doused in nearly 600 additives; 69 of which are carcinogenic. Instead, a battery-powered device heats a liquid solution (called e-liquid) of nicotine and flavors, creating an aerosol that is inhaled to simulate the physical sensation of smoking in a process known as “vaping”.
Higher end models of e-cigs allow the user to adjust the voltage from the battery, which regulates the intensity of the heating element. As the solution gets hotter, it intensifies the effect of the nicotine hit. Unfortunately, these higher temperatures also affect the glycerin and propylene glycol used as solvents within the e-liquid, converting them to carbonyls found in cigarettes such as formaldehyde and acetaldehyde.
Earlier this year, a study found that increasing an e-cig’s voltage from 3.2V to 4.8V while using an e-liquid with both solvents produced almost as much formaldehyde as a traditional cigarette. While the human body produces formaldehyde as a byproduct of normal metabolic activity in the cells, it is suspected of being carcinogenic when inhaled. The same study also found that at lower voltages, e-cigs produced up to 800 times less formaldehyde than a cigarette. While this might sound a lot safer, the size of the vapor particles and the delivery method into the lungs heavily impact the risk of disease.
Particles found in inhaled cigarette smoke have a median size of 0.3-0.5 microns. Testing has found that the e-cigarette particles have a median of 0.18-0.27 microns. About 40% of these particles can travel deep into the lungs and become embedded in the alveoli, where gas exchange occurs. Even if the particle itself isn’t toxic, the size alone places a burden on the lungs and can cause disease.
As vaping is still fairly new, there just has not been enough time to do the necessary long-term studies regarding health risks. Though these early studies do hint that e-cigs are a better option than traditional smoking, that isn’t really saying a lot, because cigarettes are pretty terrible. Even if vaping is better than smoking, it doesn’t mean it’s safe. As its popularity continues to grow, it is important to understand the full risk associated with vaping for both the user and those exposed to the vapor secondhand.
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