Contrasting Views And Findings About Vaping And Respiratory Health

Another study highlighted the relative safety of vaping products in comparison to cigarettes on respiratory health.

A recent study published in JAMA Network Open, analyzed the longitudinal association between vaping, smoking and self-reported wheezing among US adults. The research team analysed data from a sample of 17,075 US adults.

The compiled data indicated that exclusive vaping was not associated with an increase in the risk of self-reported wheezing. However, a small increase in the risk between vaping and wheezing was reported among people who smoke. To this effect, the writers concluded that this study highlighted the relative safety of vaping products.

Many health groups remain misinformed about the relative benefits of vaping
In contrast on occasion of World COPD Day on November 16th, New Zealand’s Asthma and Respiratory Foundation (ARFNZ) urged Kiwis to avoid Chronic Obstructive Pulmonary Disease (COPD) by refraining from vaping. AVCA (Aotearoa Vapers Community Advocacy) co-founder Nancy Loucas said that the group should provide some proof to support their claims.

She referred to the internationally published medical studies by Professor Riccardo Polosa, an award winning and renowned expert in respiratory health and tobacco (THR), saying that the ARFNZ should read them. On contacting Dr. Polosa to discuss these findings, he agreed with Loucas in that the ARFNZ should consider scientific papers.

Yes they (the ARFNZ) should accept that a significant and sustained improvement in lung function, symptoms and functional ability is possible in COPD patients who have switched to EC; this is likely to result from the reduction in the harmful effects of continuing smoking.

“Yes they should accept that a significant and sustained improvement in lung function, symptoms and functional ability is possible in COPD patients who have switched to EC; this is likely to result from the reduction in the harmful effects of continuing smoking. Daily solos ECs use elicited a substantial (52%) decrease in annualized COPD exacerbations by the end of the study. That respiratory exacerbations were halved in patients with COPD who ceased or markedly reduced their tobacco consumption after switching to ECs, was a key finding,” said Polosa.

“No significant changes were noted in COPD patients who continued smoking. Another important finding of the study is that only 8.3% patients from the COPD EC user group relapsed to cigarette smoking over the 5-year duration of the study, thus suggesting that relapse prevention may be an important mechanism by which vaping contributes to long-term smoking abstinence.”

Smoking COPD patients switching to vapes or HTPs report improved symptoms
The professor was referring to the study titled “Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up”, which followed 44 patients for a period of three years. The participants were split in two groups, those who switched from smoking to vaping and the ones who kept on smoking. Once again, the compiled data indicated that the COPD patients who switched reported improved respiratory symptoms, while those who continued to smoke, experienced no change.

Similarly, a recent study by Polosa, confirmed that smokers with COPD who switched from smoking to using Heated Tobacco Products (HTPs) reported improved respiratory symptoms, in comparison to those who continued to smoke.

“Vaping is not perfect but it’s considerably less harmful than smoking. Instead of backing up the Ministry of Health’s use of vaping as an effective smoking cessation tool, ARFNZ continues to create hysteria that doesn’t exist. If ARFNZ wants New Zealand to achieve Smokefree Aotearoa 2025 then it needs to acknowledge vaping’s role rather than scare smokers desperate to quit,” said Loucas. She added that sadly the ARFNZ is putting smokers off a safer alternative that could potentially save their lives.

Many anti-vape studies are flawed and biased
Sadly multiple studies have linked vaping with lung disease, most of which are deeply flawed. One such study, titled, “Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis,” had reported that adults who used e-cigarettes at baseline and had never been diagnosed with lung disease, were more likely than non-vapers at baseline, to be told that they have lung disease after a three year of follow-up.

Commenting on the study, renowned anti-smoking and public health expert Dr. Michael Siegel had explained that it “is deeply flawed.” He pointed out that just like most studies making such claims, the study fails to take into account something really obvious. The main reason why most people start vaping, is to quit cigarettes. Therefore vapers who don’t currently smoke are most likely ex-smokers, meaning that they are prone to developing respiratory conditions.

Adding onto Siegel’s comments, Polosa said that there is another factor to consider. “Moreover, there is also the possibility of reverse causality: those with respiratory disease/symptoms are more likely to initiate vaping instead of initiating smoking,” he highlighted.

Another recent study throwing a bad light on vaping, “Molecular imaging of pulmonary inflammation in electronic and combustible cigarette users: a pilot study,” published online in The Journal of Nuclear Medicine. The researchers conducted a PET scan to compare levels of lung inflammation between cigarette and e-cigarette users in vivo.

Lead study author Reagan Wetherill, Ph.D., explained that an enzyme associated with inflammation was found in the lungs of vapers. “iNOS is an enzyme that is overexpressed in e-cigarette users and cigarette smokers and is associated with acute and chronic inflammatory diseases,” said Wetherill. “This makes it a relevant target for molecular imaging of lung inflammation and inflammatory lung disease.”

Explaining this study in more detail, Dr. Polosa informed that the study authors also made a claim they could not accurately prove. “Wetherill et al’s claim that vaping is more harmful than smoking is unsupported by their small pilot study and at variance with clinical evidence showing that ECs may offer some benefits in reducing harm from cigarette smoke and unlikely to warrant significant respiratory concerns.”
“PET imaging showed much greater 18 F-NOS non-displaceable binding potential (BP ND ) in the lung of EC users than cigarette smokers, but contrary to expectations no difference between cigarette smokers and never smokers/vapers controls was found . This renders interpretation of the study’s findings invalid. There would have been more confidence in the results’s interpretation if former smokers had been included in the study design, however this was not done,” said Polosa.
“Important confounders, such as allergies of the upper respiratory tract with iNOS upregulation and high levels of exhaled nitric oxide (eNO) (2) and prior and present exposure to tobacco smoking among EC users – who are typically either ex-smokers or dual users – were not taken into consideration. As it is impossible to dissociate the lung health impact of EC aerosol emissions from prior tobacco smoke exposure, only long-term follow-up of exclusive vapers who have never smoked in their lives would have been a better appropriate study design to prove potential harm caused by EC use,” concluded the Professor.
Finally: Major US medical academy endorses vaping
Meanwhile, a recent report by the National Academy of Sciences, Engineering and Medicine (NASEM), concluded once again that smokers who switch to vapes will reduce their exposure to lethal toxins and carcinogens.
The lengthy report attempted to examine the health consequences of e-cigarettes for the population and as a result presents 47 conclusions categorized by their strength of evidence with “conclusive evidence” being the strongest. It determined that there is reliable evidence that completely switching from smoking to vaping reduces users’ exposure to a multitude of toxicants and carcinogens.
The findings of course add to the already reliable scientific evidence indicating the relative safety of vaping. However, the highlight of this report was the fact that a major U.S. scientific body has finally reiterated what several reputable health bodies in the UK such as Public Health England, have been saying for some time.