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Questions abound after reading release associating vaping with reduced harms

The majority of smokers who successfully switch to vaping say they have fewer respiratory infections, according to a study led by Queen Mary University of London

The majority of smokers who successfully switch to vaping say they have fewer respiratory infections, according to a study led by Queen Mary University of London (QMUL).

The on-line survey of 941 respondents assessed subjective changes in respiratory symptoms in smokers who switched to vaping for at least two months. The results, published in the Journal of Addiction Research & Therapy, show that 66 per cent of respondents reported an improvement in respiratory symptoms, 29 per cent reported no change and 5 per cent reported worsening.

Senior author Professor Peter Hajek from QMUL said: “There is no doubt that e-cigarettes are much safer than conventional cigarettes, but smokers are still led to believe that they’re dangerous. This misinformation includes a misreported study on rats that claimed that vaping may increase vulnerability to infections. These new findings from human vapers show that this is not the case.

“The study needs to be interpreted with caution because it is based on self-reported data, and further studies using objective measures are needed. However, the present results provide sufficient information to suggest that vaping does not increase infection rates and may in fact lead to a decrease in infections.”

Some previous cell and animal studies have been interpreted as suggesting that vaping may increase vulnerability to infection, but these studies did not use realistic exposure levels. Human trials have reported no significant adverse respiratory effects associated with e-cigarette use for up to 1.5 years and a follow-up study of smokers with asthma who switched to vaping found significant improvements.

The researchers say that it is not surprising that the survey respondents noticed improvements in their respiratory health. This is because smoking increases susceptibility to respiratory infections and stopping smoking can be expected to have a positive effect. In addition to this, vaping may also provide some antimicrobial protection through the e-liquid ingredient propylene glycol, though further evidence is needed to confirm this.

The main limitation of the study is that the reports are subjective. Future studies should assess respiratory symptoms objectively and on unselected samples of vapers. Despite the limitations, the researchers say that the study provides a reasonable reassurance that vaping does not promote respiratory infections and may in fact reduce them.

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For more information, please contact:
Joel Winston
Public Relations Manager (School of Medicine and Dentistry)
Queen Mary University of London
j.winston@qmul.ac.uk
Tel: +44 (0)20 7882 7943 / +44 (0)7970 096 188

Notes to the editor

* Research paper: ‘Changes in the Frequency of Airway Infections in Smokers who Switched to Vaping: Results of an Online Survey’. Joanna Astrid Miler, Bernhard-Michael Mayer and Peter Hajek. Journal of Addiction Research & Therapy 2016. DOI: 10.4172/2155-6105.1000290
http://www.omicsonline.org/open-access/changes-in-the-frequency-of-airway-infections-in-smokers-who-switched-to-vaping-results-of-an-online-survey-2155-6105-1000290.pdf

About Queen Mary University of London

Queen Mary University of London (QMUL) is one of the UK’s leading universities, and one of the largest institutions in the University of London, with 20,260 students from more than 150 countries.

A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research – in the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014).

We also offer something no other university can: a stunning self-contained residential campus in London’s East End. As well as our home at Mile End, we have campuses at Whitechapel, Charterhouse Square and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln’s Inn Fields.

We have a rich history in London with roots in Europe’s first public hospital, St Barts; England’s first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People’s Palace based at Mile End.

QMUL has an annual turnover of £350m, a research income worth £100m, and generates employment and output worth £700m to the UK economy each year.

Vaping may lead to fewer respiratory infections for ex-smokers

Our Review Summary

e-cigaretteThis news release describes results of an online survey showing that most smokers who switched to e-cigarettes, or vaping, for at least two months reported a drop in respiratory infections. The news release cautions readers about limitations of the survey, which was published in the Journal of Addiction Research & Therapy, though we don’t think it goes far enough in describing those drawbacks. We disagree with its assertion that the survey provides “a reasonable reassurance that vaping does not promote respiratory infections.”

A survey does not equate to scientific evidence that vaping is safe, as the news release suggests. A self reported survey of conventional cigarette smokers might help make a comparison, but it still wouldn’t be a controlled trial with verified findings. There’s no data on the extent of reported improvements, which means vaping could still contribute to lung infections, just not to the extent of regular cigarettes. The news release also should have mentioned that one author of the report has done work for several e-cigarette makers.

 

Why This Matters

E-cigarettes are heralded as a way to get a nicotine fix without the risk of smoking traditional cigarettes, but the jury is still out on just how safe they are and whether they actually help people quit smoking altogether.

There is much that is unproven about e-cigarettes and similar new nicotine delivery devices. It is biologically plausible that they may be less harmful than smoking cigarettes, since they contain fewer harmful chemicals. Some studies have found a modest portion of established smokers stop smoking when they switch to e-cigarettes, similar to the success rates of nicotine patches. But the overall harms and potential benefits remain unclear.

In the absence of definitive evidence, the U.S. public health community has traditionally taken a stronger stand against e-cigarettes than the British medical community has, but health groups are becoming more divided on their use as an alternative to tobacco use. UK health policy experts tend to see vaping as a likely harm reduction strategy against the number one cause of premature death. The current news release is from London, and may be received differently there than here.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

Vaping is a lot cheaper than smoking, but it still isn’t cheap, running into the hundreds or even thousands of dollars per year. The cost of vaping isn’t mentioned. Nor is the cost of other smoking cessation methods. The health costs of e-cigarettes are still unknown.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The news release says of 941 respondents, 66 percent reported an improvement in respiratory symptoms, 29 percent reported no change and 5 percent reported worsening. However, respondents were not required to quantify the extent of changes in their symptoms, so it’s hard to tell how significant these reported improvements are.

We disagree with a researcher’s conclusion that the survey results “provide sufficient information to suggest that vaping does not increase infection rates and may in fact lead to a decrease in infections.” That’s something that requires a controlled trial.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release quotes a researcher saying it’s “misinformation” to tell smokers that vaping is dangerous. That’s just not true. E-cigarettes contain nicotine, which can harm fetuses and adversely affect brain development. They also contain a host of other chemicals, including some potential carcinogens and lung irritants, which have not been adequately studied. The relative amount of harm from vaping versus smoking remains uncertain.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The news release does some things right. It stresses in the fifth paragraph that the study “needs to be interpreted with caution because it is based on self-reported data, and further studies using objective measures are needed.”

But more detail should have been provided. For one thing, the news release should have explained that the survey was posted in two large online German vape forums. Responses were invited from e-cigarette users who had stopped smoking or reduced smoking by at least 95%.

The news release does not mention that it’s possible some vapers “were trying to portray vaping in a positive light to counteract the general anti-vaping ethos of public health and media coverage,” according to the published report. The report says it’s possible some respondents reported improvements in infection resistance “even when the actual change was small or none.” Another potential problem cited in the study and left out of the news release is that people who experienced adverse effects from e-cigarettes and stopped using them would have been left out of the survey.

Does the news release commit disease-mongering?

Satisfactory

The news release does not exaggerate the severity or extent of nicotine addiction.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The news release does not mention that one of the study authors has financial ties to e-cigarette makers and another to pharmaceutical companies making smoking cessation medications.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

Smoking cessation programs that incorporate counseling, nicotine replacement therapy such as patches or gum, and antidepressants are considered to be cost-effective and relatively safe. The news release does not mention this.

The healthiest and most cost-effective strategy is to avoid both smoking and e-cigarettes.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Applicable

E-cigarettes are widely available at nearly every drug store and gas station convenience store in the United States and are widely available in the  UK where the study was conducted. The release could have mentioned that, in the U.S. at least, new rules require buyers to be at least 18 years old to purchase them.

Does the news release establish the true novelty of the approach?

Satisfactory

The news release is not the novelty of e-cigarettes but the novelty of the research. We give it a satisfactory for including this statement which puts the research in context:

“Some previous cell and animal studies have been interpreted as suggesting that vaping may increase vulnerability to infection, but these studies did not use realistic exposure levels. Human trials have reported no significant adverse respiratory effects associated with e-cigarette use for up to 1.5 years and a follow-up study of smokers with asthma who switched to vaping found significant improvements.”

Total Score: 4 of 9 Satisfactory

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