E-cigarettes 'may damage lungs'

Behind the Headlines

Monday September 3 2012

'Vaping' e-cigarettes: could it damage the lungs?

“Electronic cigarettes could 'damage your lungs' as they cause less oxygen to be absorbed by the blood,” reports the Daily Mail.

The news is based on a press release of preliminary findings of a small study investigating the short-term effects of smoking an ‘e-cigarette’, commonly known as ‘vaping’. The study looked at the lung function of non-smokers and smokers with and without lung conditions.

According to the press release, researchers found that ‘smoking’ a single e-cigarette for 10 minutes caused an increase in airway resistance, blocking the air getting into and out of the lungs.

Electronic cigarettes (e-cigarettes) are devices that mimic real cigarettes. They deliver nicotine through vapour rather than smoke. This method is thought to be potentially less harmful than smoking tobacco. Importantly, e-cigarettes are not regulated medicines so the ingredients and amount of nicotine contained within each e-cigarette may vary. The government’s medicines watchdog will decide next year whether to introduce stricter checks on e-cigarettes.

Limited conclusions can be drawn from the preliminary findings of this small study. The current press release suggests that the study adds weight to the growing evidence of the harmful effects of e-cigarettes.

There are far more well-established methods that can help you quit smoking, such as nicotine patches, gum and inhalers (collectively known as nicotine replacement therapy or NRT).

To order a free NHS QuitKit, visit the NHS Smokefree website.

 

Where did the story come from?

The study was carried out by researchers from the University of Athens in Greece. Sources of funding were not reported.

This story is based on a press release and conference abstract (a short summary of the findings) from the European Respiratory Society’s Annual Congress in Vienna in September 2012 presenting the initial findings of a study on e-cigarettes.

The study has not yet been published in a journal, and therefore has not been subjected to the peer-review process so findings reported should be treated with some caution.

 

What kind of research was this?

With only the press release available it is not possible to conduct a full appraisal of the design and methods of this study. The study is reported to have included 32 people and investigated the short-term effects of a single e-cigarette on their respiratory function.

From the press release it appears that this may be the earliest phase of a clinical trial, a phase 1 trial. These usually include small groups of people who all receive a small dose of the intervention in order to look primarily at its safety and effects on the body. Depending on the findings, phase 1 trials may be followed by further phase 2 trials looking at safety and effectiveness in larger groups of people. Finally, phase 3 trials may be conducted. These are randomised controlled trials which may compare the intervention to other standard treatment options.

 

What did the research involve?

Researchers recruited to their study 32 people. Of these:

  • eight were non-smokers
  • 11 were smokers without existing lung conditions 
  • 13 were smokers with existing lung conditions, either chronic obstructive pulmonary disease (COPD) or asthma

Each participant smoked a single e-cigarette for 10 minutes and had their airway resistance measured using a number of different respiratory tests before and immediately afterwards. Respiratory tests carried out by the researchers included:

  • spirometry (a test looking at various measures of lung function)
  • static lung volume
  • airway conductance (a measure related to airway resistance)
  • single breath nitrogen test (a measure of how adequate inspiration and expiration is)

The abstract did not include details of the type or brand of e-cigarette used in the research, nor did it include the chemical make-up of the product, such as the dosage of nicotine.

 

What were the basic results?

According to the press release the main finding of the study was that smoking one e-cigarette for 10 minutes caused an immediate increase in airway resistance. This lasted for longer than 10 minutes in all of the 32 people, suggesting that air was not passing so easily through their airways.

When looking at the particular groups included in the study the findings were:

  • participants who were non-smokers (considered healthy subjects), had a significant increase in airway resistance from an average of 182% to 206% 
  • participants who were smokers without lung conditions had a significant increase from an average of 176% to 220% 
  • participants who were smokers with existing lung conditions (COPD or asthma), appeared to have no immediate effects on their airway resistance

 

How did the researchers interpret the results?

In discussing the study, one of the researchers, Professor Christine Gratziou said “we found an immediate rise in airway resistance in our group of participants, which suggests e-cigarettes can cause immediate harm after smoking the device”. She added that “more research is needed to understand whether this harm also has lasting effects in the long-term”.

Professor Gratziou who is also Chairman of the European Respiratory Society (ERS) Tobacco Control Committee also said, “the ERS recommends following effective smoking cessation treatment guidelines based on clinical evidence which do not advocate the use of such products”.

Current treatment guidelines recommend the use of NRT, such as nicotine patches and gum. There are also two types of medication, Zyban (bupropion) and Champix (varenicline), that can help people quit smoking.

 

Conclusion

The preliminary findings of this small study suggest the potential harmful effects of e-cigarettes on a person’s lung function. However, limited conclusions can be drawn from this press release and conference abstract. Scientific research is often presented first at conferences. It gives researchers a chance to speak about their results and discuss them with their peers. However, the results they present are often preliminary, and don’t have to go through the same peer-review quality assurance process that is needed for publication in a journal. Also, as conference presentations are summarised in very brief “abstracts” for the public, very limited details are usually available on the study’s methods and results. This makes it difficult to judge the study’s strengths and limitations.

However, the fact that the study included only 32 participants, all of whom were given a single e-cigarette in order to examine the effects upon lung function, suggests that this was the earliest stage of clinical research – a phase 1 trial. To draw further conclusions, larger studies will be required that include a large number of healthy participants as well as those with a range of lung conditions other than COPD and asthma. Also, according to the press release, each person’s respiratory function was only measured at two time intervals – before and immediately after the e-cigarette was used. Further studies would need to include longer follow-up and examine the effects of more than one e-cigarette in order to make any firm conclusions.

Some of the research presented at conferences never makes it to full publication. This could be for a number of reasons. For example, initially promising findings may not be confirmed in further study, or the research may not be accepted by peer reviewers or journal editors.

This doesn’t mean that all research presented at conferences isn’t reliable – just that it’s best to reserve judgement until the research has been completed and published in a peer-reviewed journal.

Given the growing popularity of ‘vaping’ as a perceived ‘safer’ option than smoking, it is notable that the newspapers – some of which carry large advertisements for these products – are highlighting the potential dangers of these products.

Read more about treatment and support to quit smoking.

 

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on twitter.

Links to the headlines

Electronic cigarettes could 'damage your lungs' as they cause less oxygen to be absorbed by the blood. Daily Mail, September 3 2012

E-Cigarettes 'Can Damage Your Health'. Daily Express, September 3 2012

Links to the science

Gennimata SA, Palamidas A, Kaltsakas G, et al. Acute effect of e-cigarette on pulmonary function in healthy subjects and smokers. Presented at the European Respiratory Society’s Annual Congress. September 2 2012

Further reading

Press release

European Respiratory Society. Experts warn that e-cigarettes can damage the lungs. Published online September 2 2012

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Comments

The 9 comments posted are personal views. Any information they give has not been checked and may not be accurate.

wellmoon said on 18 May 2014

I came to this page during some brief research. I am a long-term asthma sufferer (30+ years), I would describe my suffering as low to moderate, e.g. use my inhaler 4/5 times a week - not quite daily.

I'm also a long-term smoker (20+) years, and again, would describe my smoking as low to moderate, e.g. between 10 and 15 roll-ups per day.

Over the last five years or so I've noticed my asthma has been worsening, have used inhaler more frequently and more regularly, e.g. 5 years ago I would use my inhaler once every 3 months or so.

So in light of worsening asthma (and mounting costs, smell, etc, etc) I have switched to the vapor trails brand of ecigs as I tried a friends and found it most smoking-like and I like the flavors.

I've been using it for about a month now, and I've found that my asthma has been much worse. Very often after using the ecig, even just for a few minutes, I feel like I need to use my inhaler, whereas cigarettes has never triggered the asthma symptoms immediately, and in fact sometimes smoking a cigarette would actually improve asthma symptoms in the immediate term.

I very much prefer using the ecig, but it's interesting/worrying

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maccydee said on 16 March 2014

Have used ecigs now for over 2 years to stop tobacco intake and I have successfully stopped smoking..

Benefits I have noticed for myself are:
I do not cough anymore.
I have my sense of smell back.
My stamina is back
My skin is better.
My sleep pattern is better.
I can run without getting out of breath.
I eat better.

I tried to quit smoking previously on patches, gum. spray and none worked for me ( I was previously a 20 a day smoker) This little device worked for me. I even tried champix that had all sorts of side effects.

I agree on age restriction being put in place for under 18s.

I am happy to be the guinea pig on the long term look into ecigs . My partner has also successfully stopped smoking using this device for over two years.....and others too are successfully stopping smoking.

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JustinJeffries said on 06 November 2013

I think a more worthwhile study should be which s more damaging tobacco products or e-cigarettes? That way it could really show consumers what most people already know that e-cigs are no where near as bad as smoking tobacco.
I like this infographic here about cigarettes compared to vaping products http://www.s-ecigarette.co.uk/article/things-you-should-know-about-electronic-cigarettes/ which in my opinion gives a better account of both than the above study!

Personally i love using my vaporizer aand atomizer and saving money a lot of money on nicotine i just think its a shame these products are now being demonized in the way they are in this article. but it will not stop me from using my electronic cigarette and eliquid.

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essamcom said on 05 March 2013

From a researchers point of view , the aim of this study appears to be orientated more at promoting NRT than conducting a coherent study.

Firstly it has'nt been established weather the rise in airway resistance is due to nicotine or electronic cigarettes. Nicotine alone will cause airway resistance which has absolutely nothing to do with electronic cigarettes.

The level of nicotine in the e-cigarettes has not been tested , although its EXTREMELY easy to test. It appears they have omitted anything which isolates the effect of nicotine from the actual e-cigarette itself.

As others have pointed out , there are many more flaws regarding the research techniques used to conduct this study.

Secondly I am absolutely disgusted that the NHS , a body designed to provide us with accurate information and help , is publishing a story which is clearly motivated by financial incentives rather than health incentives.

However I shouldn't be too harsh , the NHS actually pays me.....



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wilsonsss said on 04 March 2013

I do not believe the study is accurate in that they tested someone who "vapped" for ten minutes. E-cigs are not meant to be used in this way; you have 5/6 puffs lasting 2-4 seconds and that is the equivalent of one cigarette.

If the test subject vapped for three seconds and took a break for five seconds they would have taken 75 puffs and smoked the equivalent of 15 cigarettes.

More tests definitely need to be carried out, correctly. Aspirin can help for many things but if you took 10 times the dosage they could be hazardous to health too.

I will stick to my e-cigs for the time being. They may be an unknown quantity but compared to the known dangers of cigarettes they can only be an improvement.

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dawn1967 said on 23 February 2013

have just switched to electric cigarettes after 35 years of smoking more than 20 roll ups a day, I haven't had a cigarette for 3 days. I have tried the usual plaster/chewing gum/cold turkey etc before to no avail (I have the breaking strain of a kit kat!) however I have instantly been able to stop!!! Of course I am concerned about using these e-cigs especially as I already have asthma through smoking, however once I have broke the cycle of smoking cigs I will stop smoking these too - I think in about 5 - 7 days. This article and the result of the brief test is, to be frank, a total waste of time - people should be thinking about how these can benefit smokers not hurt them. But then again we all know the pharmacueticals are in control, and of our NHS - hence why it's in such a mess. If you're a heavy smoker give these a try - on the basis they are only a short term fix whilst the craving for real cigs resides.

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Amercian said on 26 January 2013

A worthless study, but one that will be used by those with a vested interest in opposing these devices. As a smoker for over 40yrs I had no problem switching to an atomiser. Within a few days my lungs opened up and my appetite began to increase, just as they had when I tried to quit completely some years ago. The patches I tried at that time were of little or no use. I smoked 13 hand rolled unfiltered cigarettes a day and recently switched effortlessly to an atomiser. Over the first fortnight I smoked one and a half cigarettes in total, the half because it now tasted so foul. They are not perfect, but with very little further development they could take a massive slice out of the tobacco market. I certainly haven't heard any reports of side effects such as those linked to others. There are huge interests and amounts of revenue involved here. Be prepared for more mud slinging.

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Alpinenewt said on 21 November 2012

Doesn't the same thing happen after a hot shower or a facial steaming?
I've been informed that this 'study' was conducted by someone with financial connections to the company that produces Champix. Hardly impartial.
An Italian study found that side effects such as this cease within a few months. Seeing as how regular cigarettes have the same side effect for a longer period than ten minutes (three hours I believe) which doesn't go away no matter how many years you smoke for, this should be seen as a positive.
I haven't smoked for 2 months thanks to e cigs. If these get banned then it will be back to regular cigarettes for me as patches and gums are pretty useless.
http://www.biomedcentral.com/1471-2458/11/786

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rongraves said on 04 September 2012

This research is hardly worth the effort taken to write it up.

It is quite impossible for a test population of a mere 32 people to yield statistically meaningful results.

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Analysis by Bazian

Edited by NHS Choices

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