E-Cigarettes, Where are we at?

A study published on the 13th August in the Journal Thorax has gone some way to helping us understand the effects ‘vaping’ has on our lungs. The research team, based in Birmingham in the UK and led by Aaron Scott, asked the question; “Do e-cigarettes have a negative impact on alveolar macrophage viability and function?”. In other words does vaping affect the inflammatory process within our lungs?

Before we jump into what the research article shows, just a mention about what this Physiospot post is trying to achieve. This was a complex study and to understand the finer details of what was found does require a level high level of understanding. Therefore this post will sum it up in a nutshell and if you would like to understand the study in it’s entirety, then follow the link as it is open access.

Vaping use has increased greatly in the past decade and according to the Office for National Statistics in the UK use is growing for new, current and ex-smokers. This is without knowing what the long-term impact of using these electronic nicotine delivery systems.

It is also interesting to note that a few days after this study was published the UK Government Science & Technology Committee, which was tasked set up to investigate the impact of e-cigarettes, published its report. There was a long list of recommendations as a result of the committees investigation. Here are a select few:

  • e-cigarettes are estimated to be 95% less harmful than conventional cigarettes.
  • The risk of continuing conventional smoking outweighs the risk of long-term use of vaping and therefore should not be overlooked as a stop smoking tool. However the committee was aware that this should be revisited as new evidence comes to light.

Considering the acceptace that if new evidence becomes available the suggestions may be revisited, lets see what this study shows.

What Was the Study?

Within the open access article itself it does not go into the methods used within the study however they are available in supplementary PDF documents. In essence this was an in vitro experiment involving inflammatory cells found within lung tissue, in a controlled environment, using the “normal” puff rate and strength found in typical vaping products used within the UK.

The techniques used within the investigation are complex and it is hard for this author to comment on the strengths and limitations within the set up. If you are reading this and have experience then please get in touch or discuss in the comment section below.

Clearly  as this is an in vitro experiment considerations need to be made about the ‘real world’ impact of the results. The cells and tissue used within the study are out of the normal complex body system, away from blood and other organs. Also in vitro results are notoriously  difficult to replicate.

What Does this Study Tell Us?

This study is one of the fist (that this editor is aware of) to directly investigate and measure the cellular effects of vaping on inflammation. In simple terms, the study suggests that vaping inhibits the innate immune response which means bacteria can be left to cause more serious respiratory infection. The bacteria include E.Coli, S.Aureus and Strep Pneumoniae. In addition to this, depending on which vapour is used, there is potential for toxic chemicals to be inhaled. Not only does this cause damage to the lung tissue itself, but it also disrupts the inflammatory process as well.

In a nutshell this study suggests that vaping may induce many of the same effects caused by smoking conventional cigarettes. The authors of the study suggest caution against assuming e-cigarettes are safe.

Clinical Implications

Even if you patient is vaping instead of smoking it is still wise to provide cessation advice as it is still unclear what the long term implications are. As this study suggests damage still occurs. If you patient has COPD, asthma or other respiratory diseases it is a good idea to stop vaping all together.