To vape or not to vape?

We’ve all experienced it—you’re walking behind someone in the street, when you suddenly find yourself immersed in a fruity-smelling cloud of vapor.

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While this may be preferable to a cloud of cigarette smoke, some argue that e-cigarette vapor can be just as damaging to our respiratory health.1 In recent years, there has been a significant surge in the number of e-cigarette sales across the US2, and there are no signs of this decreasing in the near future.3 While this points positively towards an increase in the numbers of people giving up smoking, the jury is still out on how beneficial ‘vaping’ really is. One clinical trial showed it was slightly helpful in kicking the habit,4 while another study demonstrated its inability to increase cessation rates.5

Besides its success (or lack of) as a quitting aid, a recent landmark study conducted by researchers from the Centers for Disease Control and Prevention, the Roswell Park Cancer Institute, and the University College London, concluded long-term vaping to be ‘far safer than smoking’. This real-world study found significantly lower levels of carcinogens, tobacco specific nitrosamines (TSNAs), volatile organic compounds (VOCs) and toxic chemical NNAL in the urine and saliva samples of former smokers using e-cigarettes, compared with current smokers. Nicotine levels were roughly similar between the two groups; however, this decrease in exposure to toxic chemicals suggests that e-cigarettes can significantly reduce harm to smokers and hopefully to those also exposed to second hand smoke.6

Across the pond, the UK has been recognizing results such as these, and now ubiquitously promotes e-cigarettes as a safer alternative to smoking. So what’s stopping the US from the doing the same? Well, FDA Commissioner Scott Gottlieb argued, “We need to put novel products like e-cigarettes through an appropriate series of regulatory gates to fully evaluate their risks and maximize their potential benefits”.

While there’s no debating that conventional cigarettes are one of the deadliest products available to consumers, e-cigarettes must still be treated with caution.7 Conventional cigarettes date back to over 150 years ago8—yet it took us the first 100 to discover the full extent of their devastating health effects.9

Emerging studies have even suggested that e-cigarettes may pose unique health risks for users. Although toxic gases and tar aren’t being inhaled as with normal cigarettes, the vapor has been shown to trigger immune responses in the lung that can contribute to inflammatory lung diseases. Researchers at the University of North Carolina published these findings, which also demonstrated that e-cigarette use was associated with a significant increase in neutrophil-related proteins. While neutrophils are helpful in terms of fighting pathogens, they are also associated with lung diseases such as COPD and cystic fibrosis,1 so perhaps results such as these are why the US is more cautious to promote vaping.

So is vaping actually healthier than traditional smoking? Despite their constant juxtaposition in the media, some believe comparing the harm of conventional and e-cigarettes is like comparing apples to oranges. Emerging data suggest the impact they have on the lungs is similar in some ways and unique in others, so to truly understand the impact of e-cigarettes, we need to study them in isolation.10

The truth is, the future impact of e-cigarettes on public health remains a big question mark. We currently don’t have enough research to conclude that they have an overall positive impact on public health, so they can’t truly be categorized as either beneficial or harmful. For now, the general consensus seems to be that while they aren’t without health risks, they are likely to be far less harmful than conventional cigarettes.11 Only time will tell whether this truly is the case.

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References

  1. Reidel B et al. Am J Respir Crit Care Med 2018; 197(4): 492–501.
  2. Marynak KL et al. Am J Prev Med 2017; 53(1): 96–101.
  3. U.S. e-cigarette sales seen rising 24.2% per year through 2018. Available at: http://fortune.com/2014/06/10/e-cigarette-sales-rising/. Accessed: June 2018.
  4. Bullen C et al. The Lancet 2013; 382(9905): 1629–1637.
  5. Grana RA et al. JAMA Intern Med 2014; 174(5): 812–813.
  6. Shahab L et al. Ann Intern Med 2017; 166(6): 390–400.
  7. 4 big takeaways from the most comprehensive report on e-cigarettes yet. Available at: https://www.vox.com/science-and-health/2018/1/23/16923070/nas-report-e-cigarettes-health-risks. Accessed: June 2018.
  8. A brief history of tobacco. Available at: http://edition.cnn.com/US/9705/tobacco/history/. Accessed: June 2018.
  9. When was the link between smoking and cancer established? Available at: https://www.theguardian.com/news/2005/jun/02/thisweekssciencequestions.cancer. Accessed: June 2018.
  10. Vaping may cause unique health problems as dangerous as smoking cigarettes, finds study. Available at: https://www.independent.co.uk/news/vaping-health-problems-smoking-e-cigarettes-north-carolina-study-danger-lung-conditions-disease-a8016861.html. Accessed: June 2018.
  11.  Public Health Consequences of E-Cigarettes. Consensus Study Report. The National Academies of Sciences, Engineering and Medicine. 2018.

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