Smokers should be confident that vaping with e-cigarettes is much less harmful to the lungs than smoking cigarettes, according to a new review of the relevant science. A new article published in the Expert Review of Respiratory Medicine journal contends that there is growing evidence showing that electronic cigarette (EC) emission aerosols are relatively safe compared to tobacco smoke. Led by Dr. Riccardo Polosa, director of CoEHAR, the Center of Excellence for the Acceleration of HArm Reduction at the University of Catania, The effect of e-cigarette aerosol emissions on respiratory health: a narrative review provides a critical assessment of the research published on the effects of ECs on respiratory system.

"For smokers who want to do something about their health, our review shows that switching to vaping is a very good option if they don't want to or can't quit completely.  No-one can prove that e-cigarettes are one hundred percent safe, but all the science points to vaping being very much safer than smoking," said Dr. Polosa.

Polosa added: "We agree with Public Health England and the Royal College of Physicians of London that it is reasonable to proceed on the basis that vaping is at least 95% less risky than smoking, and probably even less risky than that."

The findings indicate that the lack of clear and accurate reporting of experimental studies has resulted in confusion about the respiratory health risks of ECs.

"The millions of deaths resulting from cigarette smoking illustrate an ongoing, immediate and preventable tragedy that should be fully factored into a rational risk-benefit analysis," said Dr. Polosa. "In our view, there is a growing body of evidence that suggests substituting ECs for cigarettes is an effective method of curbing the use of tobacco cigarettes. Unfortunately, consumer understanding of the relative risks is distorted and in the past few years fewer adult smokers have perceived e-cigarettes as less harmful than tobacco cigarettes. These misperceptions have real consequences and require corrections." 

The article by Polosa et al. is the first attempt to correct most of these misperceptions and to provide authoritative reference when communicating to the public how to improve personal and public health of smokers. Former smokers currently using ECs and smokers intending to use ECs as a substitute for smoking have the right to know the factual information about the potential risks and benefits of these products. Improvement in risk communication can promote more switching among smokers who do not want or cannot quit and eventually reduce or prevent some of the respiratory deaths and disease caused by tobacco smoking.

The authors of the review also found that smokers who substituted cigarettes with ECs experienced improvements in smoking symptoms (cough, phlegm) and exhibited lower levels of exhaled carbon monoxide. These results were even more beneficial for smokers who completely replaced cigarettes with ECs.

For smokers with diseases such as asthma and chronic obstructive pulmonary disease (COPD), EC use may have a beneficial effect on symptoms, though additional data is needed to determine the complete effect ECs may have on lung function.

Dr. Donald Tashkin, pulmonologist and professor at the David Geffen School of Medicine at the University of California, explains: "Yielding accurate findings for determining the respiratory health risks and benefits of e-cigarette use requires substantial improvement of current research designs. Obviously, only large, long-range prospective studies of vapers who have never smoked can provide definitive data to demonstrate any potential impacts regular use of vaping products may have on long term health."

Dr. Polosa concludes: "Challenging uninformative or even misleading research due to problem with methodology and interpretation of these studies is not enough. It is urgent to address common mistakes and to develop robust and realistic methodological recommendations in order to adequately assess the impact of EC use on human health under normal condition of use. The adoption of standardised methods can enable better tobacco harm reduction science."

Notes to Editors - Authors' Biographies:

Riccardo Polosa, MD, PhD, is full Professor of Internal Medicine at the University of Catania (Italy), and Director of the Center of Excellence for the Acceleration of HArm Reduction (CoEHAR) within the same University. He is convenor for the European Working Group on "Requirements and test methods for emissions of electronic cigarettes," within the European Committee for Standardization (CEN/TC 437). Dr. Polosa is also Coordinator of the "Scientific Committee on electronic cigarettes research" promoted by the Italian Antismoking League (LIAF).

Renée O'Leary, PhD, is a literature review consultant (21st Century Literature Reviews) and tobacco control researcher, and a research affiliate with the Canadian Institute for Substance Use Research (Victoria, Canada).  She is the author of the evidence report, Clearing the Air: A systematic review on the harms and benefits of e-cigarettes and vapour devices (2017), and an EC policy article, Claims in vapour device(e-cigarette) regulation: A Narrative Policy Framework analysis. 

Dr. Donald Tashkin, MD, is a pulmonologist in Los Angeles, California and Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles. In the past 2 decades, he has been a leading voice in the clinical assessment of marijuana's effect on users' lung health and has led efforts into understanding marijuana's effects and associations with other pulmonary conditions including chronic obstructive pulmonary disease.

Dr. Rosalia Emma, M.Sc., PhD, is a researcher at the University of Catania. She is currently conducting a study involving the toxicological assessment of liquids of electronic cigarettes at the Department of Biomedical Sciences and Biotechnologies of the same University.

Dr. Massimo Caruso, M.Sc., PhD, is a researcher and contract Professor of Immunopathology at the University of Catania, with expertise in biological aspects of asthma and other respiratory diseases. He is conducting a study to verify the quality of the methodology used in many toxicological assessments conducted on ECs by the tobacco industry.

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