The research, published December 16 in the American Journal of Preventive Medicine, stresses that this danger is substantially greater among those who use both e-cigarettes and conventional cigarettes. Study authors note that the vast majority of those who vape are dual users who also smoke tobacco. “This is the first large-scale study that shows that if you started out with people who didn’t have lung disease and followed them forward in time, the people who used e-cigarettes get more lung disease than the people who didn’t,” says the study’s lead investigator, Stanton Glantz, PhD, a professor of medicine and the director of the University of California in San Francisco (UCSF) Center for Tobacco Control Research and Education.
As Much as Triple the Risk of Lung Disease
The scientists based their findings on an analysis of data from 2013 to 2016 of 32,320 individuals participating in the Population Assessment of Tobacco and Health (PATH) study. PATH tracks e-cigarette and tobacco habits, as well as new lung disease diagnoses, over time with repeated monitoring. Dr. Glantz and his collaborators discovered that current and former e-cigarette users were 1.3 times more likely to develop chronic lung disease than non-users. For tobacco smokers, that potential hazard was 2.6 times greater, and the risk jumped to 3.3 times higher among dual users. “The increase in lung disease experienced by dual users is alarming, since data often show that individuals who use e-cigarettes are often dual users,” says Patricia Folan, RN, the director of the Northwell Health Center for Tobacco Control in Great Neck, New York, who did not contribute to this study. “In the population of smokers we treat at our center, the majority of them report use of e-cigarettes as well as combustible cigarettes.” From the most recent data collected in the study (between 2015 and 2016), 91 percent of e-cigarette users were continuing to smoke combustible tobacco products.
Are E-cigarettes Safer?
Glantz points out that those who exclusively used conventional cigarettes appeared to have a much higher risk for lung illnesses than those using e-cigarettes alone, but more extensive research is needed to better understand this. “It may be if we do this study 5 or 10 years from now, the risks will be more comparable,” he says. “The cigarette users may have had a longer exposure. We don’t know from this analysis.” The significantly higher risk for lung disease among dual users indicates that e-cigarettes may pose their own unique hazards. Compared with cigarettes, these products feature much higher levels of propylene glycol and vegetable glycerin, which may increase lung and airway irritation after concentrated exposure, according to the American Cancer Society. They also may contain flavoring chemicals, formaldehyde, volatile organic compounds, and ultra-fine particles that have been linked to damaging health outcomes. Although Glantz sees a possibility that vaping may be exposing people to lower levels of toxicity, he doubts that they may be less harmful overall based on other research, such as findings presented this year at the American Heart Association Scientific Sessions, suggesting that vaping may pose heart health risks that are equal to or greater than those linked to conventional cigarettes. A recent wave of severe respiratory illnesses and deaths connected to vaping have raised concerns even further. Folan warns that there are so many different types of e-cigarettes and e-liquids (approximately 500, with thousands of different flavors) that it makes it difficult to research and understand their true impact on users. “Plus, with e-cigarette users, it is difficult to quantify how much nicotine and other chemicals they are ingesting, because of the way they inhale the product,” she says. “Many e-cigarette users draw on the products continuously, in contrast to cigarette smokers, who generally smoke a finite number at intervals during the day.”
Casting Doubt on E-cigarettes as a Way to Quit Smoking
Originally, many healthcare providers considered vaping as a possible way for people to stop smoking. Increasingly, however, cessation programs have been turning away from this approach, as evidence mounts demonstrating that e-cigarettes may not only be damaging but also more addictive than conventional cigarettes. “While e-cigarettes have been promoted as a way to quit smoking, in reality they make it harder to quit, so you wind up a dual user with an increased risk of lung disease compared with if you just kept smoking,” says Glantz.
