E-cigarette Summit hears details of major new study into long-term vaping effects on non-smokers
The public sphere is awash with competing studies on controversial matters, many of them cited and defended fiercely for partisan reasons. Vaping has been no exception, and a newcomer to the subject could be forgiven for getting confused; popular media’s relationship with vaping has been fraught with doom-saying headlines backed by single, often misread studies.
A common thorn in the side of allies and defenders of the vape industry has been the argument that the effects of vaping on the body in the long term are a “known unknown” – that no conclusive investigative studies have been conducted. All that may be about to change. Not only has this study followed its subjects over a long period of time, but it has dealt with a category never analysed in detail before: vapers who have never smoked. Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked can tell us new things about the effects of e-cigarettes on the body, and how they play out in the long term.
The study was formally unveiled by its head, Professor Ricardo Polosa at the E-Cigarette Summit in London. It was co-authored by Fabio Cibella, Pasquale Caponnetto, Marilena Maglia, Umberto Prosperini, Cristina Russo and Donald Tashkin.
Professor Polosa has established himself as a formidable advocate of e-cigarette use for smoking cessation, citing its untapped public health potential as his main motivation. This study is already making waves throughout the e-cigarette industry. But how was it conducted, what does it prove, and what does it mean?
1. E-Cigarettes, harm and harm reduction
The study opens by clearly defining its terms, laying out how health outcomes are collected, and what the main health concerns typically cited over vaping are. For this study, changes in “…blood pressure, heart rate, body weight, lung function, respiratory symptoms, exhaled breath nitric oxide [eNO], exhaled carbon monoxide [eCO], and high-resolution computed tomography [HRCT] of the lungs) from a prospective 3.5-year observational study of a cohort of nine daily EC users (mean age 29.7 (±6.1) years) who have never smoked and a reference group of twelve never smokers.”
2. Who were the subjects and how were they chosen?
“Subjects were recruited from June 2013 to September 2013 and data collection completed in March 2017.
“Adult EC users (≥18 years old) were identified amongst a pool of regular Vape Shops customers. Vape shop owners who helped in a previous study were instructed to ask their regular clients a few questions about smoking history and EC use patterns. Customers who had never smoked or who reported having smoked less than 100 cigarettes in their lifetime were defined as never smokers.”
3. How exactly were the subjects tested?
“Participants came in the mornings for their check-up visits during which vital signs (blood pressure – BP, heart rate – HR, body weight) as well as measurements of lung function, respiratory symptoms, and airway inflammation (eNO and eCO levels) were recorded.”
In order to keep results on neutral ground and untainted by external factors, participants were discouraged from vaping or consuming caffeine up to an hour before their measurements were recorded. Check-ups were taken with a diverse range of medical devices and (upon being identified at baseline levels) any new, noteworthy changes in respiratory symptoms were obtained by asking the following questions:
“Have you had any cough in the previous 2-weeks?”
“Have you heard any wheeze when breathing?”
“Have you been short of breath in the previous 2-weeks?”
“Have you had difficulty in breathing like a sensation of pressure on your chest?”
4. What exactly did the study find?
The initial findings give us in the industry good reason to be cautiously optimistic, but mindful of this project as a mere beginning, and open to future findings in this field.
“…no pathological findings could be identified on HRCT of the lungs and no respiratory symptoms were consistently reported in the EC user group. Although it cannot be excluded that some harm may occur at later stages, this study did not demonstrate any health concerns associated with long-term use of EC in relatively young users who did not also smoke tobacco.
“This small study, the first of its kind to date, found no detectable changes in lung health in never smokers who have been regularly vaping for at least 4 years. Daily exposure to ECs aerosol emissions caused no significant changes in any of the health outcomes investigated, including measures of lung function and lung inflammation.”
5. Where do we go from here?
As the very first study of its kind – factoring in the vaper who has never smoked, a neglected and often invisible category in vaping – this will hopefully prove a trailblazer, inviting further inquiry and opening more minds. The best we can hope for now is the encouragement of more research. Looking ahead, there may now be a solid foundation to defend the relative safety of e-cigarette use as a smoking cessation tool over a mid to long term period, and even new discussions on marketing to non-smokers.