We all know that smoking is not a health conscious choice, the evidence is quite clear that lighting up and inhaling the smoke from burning tobacco leaves exposes our bodies to a plethora of different compounds, many with carcinogenic (cancer causing) effects, among other things. [1]

However, people don't smoke cigarettes for the cancer causing compounds of tobacco combustion (great job stating the obvious there, pats self on back), they do it for the nicotine buzz, they do it because it looks cool, they do it as a social function, they do it because it makes them feel good.

As such, in modern times, we have the technology to provide that same smoking experience with out needing to actually burn tobacco. This is done with E-cigarettes. E-cigarettes are small devices which heat a liquid (polypropylene glycol, glycerin, water, maybe a flavoring or two, probably some liquid nicotine... or not), to create a vapor that can be inhaled. So instead of smoking, here people are "vaping." (I am sure this is not new information for any of you, but what would a post of mine be with out a long drawn out boring introduction :D )

Interestingly enough, electronic cigarettes are thought to be safer (a study done in the UK indicates they are upwards of 95% safer) than traditional cigarettes (after all, you aren't inhaling all of the byproducts of combustion of the tobacco leaf). [2]

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In continuing with my attempts to present recent data on topics, today we will be discussing an article pertaining to the safety of these E-cigarettes that everyone has been indicating are so much safer then traditional smoking. The article was recently published in the journal Nature: Scientific Reports and is titled "Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked."

This is an article which looks at the changes in biochemistry that may or may not occur after someone has been smoking E-cigarettes for a while. One of the benefits of this studie's data-set is the people they studied had never smoked traditional cigarettes. One of the downsides of the study we will discuss is the sample size; just NINE participants (not very many at all!). Nevertheless, why don't we begin!?

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Relevant Information About Their Methods

Participants in the study were chosen because they were regulars at vape shops, and they were required to have been vaping for at least 3 months prior to the start of the study. The participants were also required to be "never smokers" meaning that they had smoked less than 100 cigarettes ever in their lifetimes.

What Parameters Were Measured?

Of course the authors measured your favorite physicians greatest hits: Blood pressure, heart rate, body weight. However they also performed a spiometric test (this sort of test measures lung function).

They explored the amount of Nitric Oxide which was exhaled by the participants, as release of Nitric Oxide is a part of our bodies inflammatory response and as such people with higher Nitric Oxide concentrations in their exhaled breath have more inflammation in their lungs (something a study on vaping would be interested in!).

Finally they measured the amounts of Carbon Monoxide exhaled, as it is, much like Nitric Oxide, a good marker for inflammation in the lungs (and its nice to have a second method to confirm results when it comes to lung inflammation), [4] as well as took some scans of participants lungs using High Resolution Computed Tomography (HRCT)

The participants involved in the study (all 9 of them) underwent these tests once per year to monitor the effect that vaping had on their lungs.

What Did They Find?

Well first off we can cross out a change in body weight, blood pressure, and heart rate as the researchers observed no difference between the vape users and control participants who were not vaping.

Okay, how about those lung tests? Well, they turned out interesting and if by interesting I mean, it is interesting to me just now much nothing they showed. What we are looking at to the left is a parameter from a lung test called FEV (Forced Expiratory Volume) AKA the amount of air you can blow out of your lungs. We are looking at the vapers (blue) versus non vaping no smoking control (red), the points at the bottom are at the start of the study, and after one, two and three years.

What we can see is that there is little to no change over the course of the three year study between the control participants and the daily vapers. Interestingly smokers of regular cigarettes are known to show a decline in this parameter (and that decrease is also known to correlate to lung cancer). [5]

Yeah, okay but how about those Nitric Oxide levels, surely the vapers lungs must still be showing some signs of inflammation... right?

UH, Well... No. To the right we are looking at the concentration of exhaled nitric oxide between the control group and the vapers, again showing the start, one year, two years and three years into the study. There is (among the noisy error bars ... yeah yeah something something physics 5 sigma... okay lemouth) no significant difference between these groups over the course of the study.

In case you were wondering, the plot for Carbon Monoxide exhalation looks pretty similar. These two plots show little evidence for inflammation in the lungs of the daily vapers. Which again, is surprising to me. Not that vaping is safer then smoking, but just how much NOTHING this studies data shows.

What Do The Authors Think Their Data Means?

Well they observed basically no change in the health of the lungs of the participants in the study who had been vaping for at least 4 years (and had never really smoked traditional cigarettes). I didn't discuss it above but the authors also didn't find any difference in the lungs structurally by the HRCT scans either. So truly, no real effect on the lungs from vaping.

The authors are careful in their discussion, pointing out the limitations of the study's small sample size (as I mentioned above) as well as the possibility for damage becoming apparent down the road longer as it is thought that the aerosols produced (the vapors mannnnn) and breathed in, can really penetrate deep into our lungs (IE they could accumulate and cause longer term damage that is not detectable in this short term study).

The authors point out their strengths as well which include the 3 year follow up period of the study (they didn't just do one year and call it a day) and their use of a variety of parameters to gauge lung health.

The authors make a point to state that the group studied in this publication (vapers that never smoke) are in the minority population of people and that people who vape also usually smoke standard cigarettes at times as well, so the data generated here may not be relevant to a good portion of the vaping population. Finally the participants in the study were young (they state 27-28) and as such these results may not represent what happens to older vape users.

All of that said, their data provides some mildly convincing evidence that use of vaping solutions and electronic cigarettes, at least in younger people, does NOT result in damage to the lungs. Which honestly, was quite surprising to me.

A Question That I have Which Was Not Addressed By This Study?

Are there any other metabolic changes in the vaping participants? I don't have any reason to suspect their would be considering the components of Vape solution, but it would have been interesting to see a yearly metabolic profile screen done to look for any effects that the inhalation of the solution may have caused (clearly it doesn't cause lung damage on this scale).

What do you think about this study? Do you vape? Do you feel more comfortable knowing these results? If you smoke, do these results make you consider changing to vaping?

I am more curious then anything else. I do not smoke or vape so these results don't affect me one way or the other, but I know people who do and it certainly makes me worry less for their health seeing this.

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Sources

Image Sources

Image 1

Text Sources

1. https://www.ncbi.nlm.nih.gov/pubmed/28956852
2. https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update
3. https://www.nature.com/articles/s41598-017-14043-2.pdf
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651886/
5. https://tobaccoinduceddiseases.biomedcentral.com/articles/10.1186/s12971-017-0122-2

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