There remains considerable controversy about e-cigarettes and vaping, with some studies suggesting benefit in terms of smoking cessation, others reporting signals of harm and unknown long-term effects.1 Professor Bals discussed the findings of the ERS task force report in the context of public health strategy1
Professor Bals began summarising current knowledge on the use of e-cigarettes in 2014 in response to a marked increase in the development and use of electronic nicotine delivery systems.1,2 The task force specifically looked at e-cigarettes and excluded devices such as heated tobacco products.1,2
E-cigarettes are known to contain various substances which are vaporised and delivered to the lungs including: nicotine, water, alcohol, propylene glycol and/or glycerine and also flavouring (> 8000 different types are available) – for which there is little toxicity information.1,2
The task force conducted a literature review of 2,271 original publications with empirical data including experimental, preclinical and observational studies, case reports, clinical trials and systemic reviews.1,2 The group identified that e-cigarette use among teenagers and young adults had increased over the past few years in many countries.1,2
In vitro toxicology studies in cells found that e-cigarettes mediated adverse changes in markers of oxidative stress, inflammatory mediator production and host defence against infection but did not generate the cytotoxic effects of tobacco cigarette products.1,2
These results were not always translatable giving consideration to the fact that exposure conditions such as puffing regime and deposition efficiency are not simple to simulate in a short-term in vitro study.1,2 Conclusive answers regarding the safety of e-cigarettes will only be obtained with carefully conducted long-term studies in users.1,2
Some, limited evidence from the literature review on smoking cessation suggested that smokers who used e-cigarettes were significantly more likely to quit successfully than those who did not use e-cigarettes.1,2 There was also some evidence to suggest that e-cigarettes may be particularly useful for hard-to-reach patients who find it particularly difficult to quit smoking.1,2 Currently, it is not known whether e-cigarettes can be used as cessation tool to finally quit smoking or nicotine use.
Overall, the task force conclusions were that the risks of e-cigarettes have not been adequately studied, the potential benefit should be weighed against the potential harm and that e-cigarettes should be used with caution.1,2
Professor Bals reiterated that it is difficult to judge from the available evidence whether the e-cigarette is a good smoking cessation tool.2
Professor Dr Robert Bals is director of the department of pulmonology at Saarland University, Saarbrücken, Germany
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