“Study finds e-cigarettes affect airways, and quickly”

[Tom09]

The saddest part to me is that there is no outcry from the greater scientific community about this study (that gleefully pronounces itself the first to find a measurable physiologic effect measurable in the parts per billion) because they must admit that this is in fact, "what passes for 'science' these days." ...

I don’t totally disagree, I just don’t think that there is a real problem with the technical part of this paper. The measured changes in the IOS data (respiratory flow resistance, impedance) and in the exhaled nitric oxide ARE significant. The IOS indicates some constriction, and decrease in FeNO does not suggest “inflammation” (Reuters’ falsification). Me thinks that the FeNO finding is possibly also consistent with constriction (endogenic NO acts as a vasodilator and nicotine would decrease the NO concentration). At any rate, results do not mean that users would have had breathing difficulties (no change in airways dynamics, as asessed in spirometry), and all it shows is that an acute physiological effect, without clinical expression on lung function, was measurable. Remains the mystery how a measurable physiological effect translates to an adverse health effect in communications to the general audience.
We all know that e-cig use induces measurable physiologic effects. If not, this practice would be as effective as “puffing from an unlit cigarette” - and there would be no user community (no ECF), for the most part binded together by nicotine. Probably best documented acute physiologic effect is the increased heart beat rate, correlating with / induced by the delivered nicotine. Of course, a well written paper (like this one) is unlikely to end up in an alarmistic headline as if “study finds e-cigarettes affect cardiovascular system, and quickly” (duh, we sort of are about these effects, as we are seeking nicotine without the additional detrimential health effects attached to most common nicotine delivery method).
I think, that there is a huge problem when a scientific author breaks out from the scientific discussion (confined to world of formally published articles) to contribute in activism. There can be no doubt about the intention of the presently discussed paper, as documented in the absence of attempts to set noteworthy but close to trivial findings in relation, and the direct jump from detecting a measurable physiological effect to calling for a ban.
This conflation of science and activism, or the misuse of scientific methods for activism, apparently accepted in parts of the scientific community, is really hurting science.

 

[denali_41]

i wish a mod would lock this thread so it will stop rearing its ugly ignorant,stupid inbred head !!!

 

[jimbill]

Bunch of bull i have copd and in no way has a e-cig affected my airways but the opposite. I don't cough my brains out in the mornings anymore and my breathing is so much better than before where do these study's come from a cracker jack box.

 

[kristin]

Bunch of bull i have copd and in no way has a e-cig affected my airways but the opposite. I don't cough my brains out in the mornings anymore and my breathing is so much better than before where do these study's come from a cracker jack box.

You have COPD? If you haven't already, you should definitely comment here: Facebook and here: E-Cigarettes May Not Be Better Than the Real Thing After All

 

[nopatch]

It's sad that we will all throw out or discount any study that looks negative on ecig use. I've had several smokers try my e-cig and immediatly put it down and start coughing insanely.. Usually they smoke it like a cigarette (direct lung inhale).. That would probably be the reason...

We NEED to know if these are safe.. I think we all had issues in the beginning. And yes, perhaps our bodies have adapted (just like they did to cigarettes), that doesn't mean they are safe..

Human bodies can adapt to lot of things.Even asbestos in lungs cannot effect some people.

Coming back to the study; The carriers of ejuice,PG and Vg, cause inflammation to Lung tissue.I read some abstract on pubmed to that effect.Short term inflammation (Due to Lung irritants) May or May Not cause permanent damage.

 

[nopatch]

You have COPD? If you haven't already, you should definitely comment here: Facebook and here: E-Cigarettes May Not Be Better Than the Real Thing After All

Testimonials are at best anecdotal evidence.We should all be seeing witch doctors if we go by individual testimonies( I ripped off this analogy from some forum).

 

[nopatch]

Someone should tell pulmonary technicians about this. PG fog is used in hospital breathing treatments to deliver medication to the lungs. Most have seen the mask and fog treatment for people with pneumonia. If they only knew that this was just making the problem worse ...

Can you please show a reference regarding usage of PG for pneumonia?..

 

[nopatch]

Another, different, article from late last year: Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation Medscape: Medscape Access

"...Combined sustained 50% reduction and smoking abstinence was shown in 22/40 (55%) participants, with an overall 88% fall in cigs/day. Mouth (20.6%) and throat (32.4%) irritation, and dry cough (32.4%) were common, but diminished substantially by week-24. Overall, 2 to 3 cartridges/day were used throughout the study. Participants' perception and acceptance of the product was good."

Note the next to the last sentence, referencing the fairly typical early vaper issues, diminshing a great deal over time.

From the full report: "These events were most commonly reported at the beginning of the study and appeared to wane spontaneously by study visit 5....side effects commonly recorded during smoking cessation trials with drugs for nicotine dependence were absent (i.e. depression, anxiety, insomnia, irritability, hunger, constipation were not reported)."

This is a very useful study.Hopefully the subjects are tracked for a longer period of time .

Full text is here at http://www.biomedcentral.com/content/pdf/1471-2458-11-786.pdf

Page 9 of the pdf gives some data.

 

[Thulium]

Human bodies can adapt to lot of things.Even asbestos in lungs cannot effect some people.

Coming back to the study; The carriers of ejuice,PG and Vg, cause inflammation to Lung tissue.I read some abstract on pubmed to that effect.Short term inflammation (Due to Lung irritants) May or May Not cause permanent damage.

Except that this study did not show any inflammation of lung tissue. This study actually found a statistically significant DECREASE in exhaled Nitric Oxide (an indicator of inflammation) ninety seconds after using the e-cigarette. There was no effect on respiration as measured by spirometry.

 

[nopatch]

Except that this study did not show any inflammation of lung tissue...

Did the paper made any claims about measuring inflammation?.People are going on and on for about 13 pages about inflammation while the paper never claimed to measure inflammation.

This study actually found a statistically significant DECREASE in exhaled Nitric Oxide (an indicator of inflammation) ninety seconds after using the e-cigarette.

Then why people(including that Asch guy) are getting agitated about Inflammation?.

Regarding exhaled NO (Feno) i find this in wikipedia:
Low levels have been found in primary ciliary dyskinesia, bronchopulmonary dysplasia, and pulmonary arterial hypertension. In the latter condition, inhaled NO is used as a diagnostic test of the response of the pulmonary arteries to vasodilators (agents that relax the blood vessels). Exposure to air pollution has been associated with decreased,^[21] and increased eNO levels.<sup>[22][23].

Not so clear; is it Not?.</sup>

There was no effect on respiration as measured by spirometry.

Then let us all go home and be happy .


Now, can somebody tell what is the problem with the actual report?.

 

[yvilla]

Did the paper made any claims about measuring inflammation?.People are going on and on for about 13 pages about inflammation while the paper never claimed to measure inflammation.

Then why people(including that Asch guy) are getting agitated about Inflammation?.

Now, can somebody tell what is the problem with the actual report?.

You seem to be deliberately not getting it. The problem is that all the news reports about this study, following on the original Reuters article, ARE touting this erroneous bit about inflammation being found to result from e-cig use:

"The researchers found that after five minutes, users showed signs of airway constriction -- as measured by several types of breathing tests -- and of inflammation".

Are E-Cigarettes Bad For Health? Study Shows They Quickly Affect Airways

Study finds e-cigarettes affect airways, and quickly

Study finds e-cigarettes affect airways, and quickly: MedlinePlus

SP Clinic : Cosmetic Plastic Surgery Thailand

Study Finds E-Cigarettes Affect Airways, and Quickly

Ottawa SUN

Believe me - I could keep going and going and going with links to articles that repeat that inflammatory bit of misinformation about the findings of this study!

For the vast majority of people, all they see are the misleading and fear mongering media accounts, they do not have access to, much less read, the actual study pdf.

 

[nopatch]

You seem to be deliberately not getting it. The problem is that all the news reports about this study, following on the original Reuters article, ARE touting this erroneous bit about inflammation being found to result from e-cig use:

I do get it to the extent that the report is NOT positive about ecigs.What i don't get is the basis for the acsh scientists atttack on the scientists involved in the study.I find it Bizarre that these scientists are blasting the study based on their assumptions and what they gleaned from Journalistic interpretations and abstract.

The "so what" statement reads like a political statement.Can somebody forward the full report to these guys.

"The researchers found that after five minutes, users showed signs of airway constriction -- as measured by several types of breathing tests -- and of inflammation".

The report talks about air way constriction and not about inflammation.

quote:
To our knowledge this is the first study to find a physiological response after inhaling on
231 an e-cigarette. According to our findings 5 minutes of use was sufficient to lead to an increase in
232 lung flow resistance over a range of frequencies and was related to a decrease in FeNO
233 concentrations.
234 Impulse oscillometry as a methodological approach, has been previously used in clinical
235 trials and can be used to sensitively diagnose obstructive lung disease and has been shown to be
superior to spirometry measurements during pulmonary assessment18-21236 . This is verified by the
237 fact that that e-cigarette usage was associated with increased flow resistance even though
238 spirometry assessed lung function was deemed normal, a finding that is corroborated by the fact
239 that IOS can detect oncoming pathophysiological changes of the respiratory system, before
spirometry is able to20240 .

unquote

Are E-Cigarettes Bad For Health? Study Shows They Quickly Affect Airways

Study finds e-cigarettes affect airways, and quickly

Study finds e-cigarettes affect airways, and quickly: MedlinePlus

SP Clinic : Cosmetic Plastic Surgery Thailand

Study Finds E-Cigarettes Affect Airways, and Quickly

Ottawa SUN

Believe me - I could keep going and going and going with links to articles that repeat that inflammatory bit of misinformation about the findings of this study!

For the vast majority of people, all they see are the misleading and fear mongering media accounts, they do not have access to, much less read, the actual study pdf.

Other than inflammation the rueters report is fairly accurate.The study did find problems with regards to Air way resistance with ecig usage for 5 minutes. It is the gall of the researchers casting bad light on ecig usage which is disturbing

 

[Bill Godshall]

Tom09 wrote:

I think, that there is a huge problem when a scientific author breaks out from the scientific discussion (confined to world of formally published articles) to contribute in activism. There can be no doubt about the intention of the presently discussed paper, as documented in the absence of attempts to set noteworthy but close to trivial findings in relation, and the direct jump from detecting a measurable physiological effect to calling for a ban.
This conflation of science and activism, or the misuse of scientific methods for activism, apparently accepted in parts of the scientific community, is really hurting science.

Tom has hit the nail on the head.

Except for tobacco industry scientists, the vast majority of tobacco/nicotine researchers are abstinence-only tobacco prohibitionists whose underlying goal is to ban, excessively regulate, excessively tax, and/or demonize tobacco companies, products and users.

While much of their research is objective, the titles, abstracts and press releases (and comments to the news media, elected officials and government health agencies) focus on advancing their abstinence-only prohibitionist policy agenda. That's not science, but rather policy activism disguised as science.

But a larger problem is that NCI, RWJF, Legacy, FAMRI and many other funders of tobacco/nicotine research in the US have adopted abstinence-only tobacco prohibition policies, and they give the money to like minded abstinence-only tobacco prohibiton advocates who request funding.

If NCI, RWJF, Legacy, FAMRI or other funders adopted policies supportive of risk reduction products and behaviors for smokers, there would be funding for objective tobacco/nicotine product research and researchers.

 

[TonyTT]

They're commenting on short term irritation and inflammation of the lungs. When I first started, this did happen due to my body adjusting to the new method, as well as the fact that you vape, differently then you smoke. You don't inhale vape as directly as you smoked a cig.

 

[nopatch]

They're commenting on short term irritation and inflammation of the lungs. When I first started, this did happen due to my body adjusting to the new method, as well as the fact that you vape, differently then you smoke. You don't inhale vape as directly as you smoked a cig.

Actually the report stresses that it is a study on short term effects and their results give no indication on longterm effects.

 

[deluxe]

If the study was sound, then it's useful information to know... except that e-cigs are not used by non-smokers. It would be far better to have a direct comparison between e-cig vapor and cigarette smoke and how they affect airflow, along with some good information about what airway constiction means in the real world for a person's health - short and long term.

 

[Vocalek]

Actually the report stresses that it is a study on short term effects and their results give no indication on longterm effects.

...however the long term health effects of e-cigarette use are unknown but potentially adverse and worthy of further investigation.

The phrase in bold is inflammatory and unwarranted.

Would it not have been sufficient to state "the long term health effects of e-cigarette use are unknown and worthy of further investigation"? Sure, they might be adverse, but then again, there is no existing data that would indicate that the long term health effects would be any more adverse than continuing to smoke.

So I disagree that the report stressed that their results give no indication on long term effects. The last line of the abstract (quoted above) speculated that the effects are potentially adverse. And news outlets tend to not differentiate between evidence and speculation.

 

[Vocalek]

The following letter provides additional information to help us evaluate what the research did and did not establish scientifically.

To the Editors:

The findings by Vardavas and colleagues are not conclusive due to the small number of subjects studied, the choice of study outcomes of unclear clinical relevance, together with the lack of appropriate study controls. [1] The small changes in FeNO and peripheral flow resistance (IOS) reported may be non specific. A possible explanation for the small decrease in FeNO and the trivial increase in peripheral flow resistance (IOS) is that the mist generated by the e-cigarette per se might have contributed to these changes. In a series of pilot studies aimed at optimizing the distribution of several respiratory investigations within a protocol for the detailed characterization of the asthma phenotype (U-BIOPRED), researchers discovered that nebulization of saline can reduce FeNO up to 25% from baseline (personal observation). For this reason baseline assessment of induced sputum has to follow measurement of FeNO. Therefore, authors should have included a different control (e.g. saline mist generated by a ultrasonic nebulizer) for their study. Also, another reasonable comparator that should have been used as control was participants’ own brand cigarette.

In the Summary, the authors state that the e-cigarettes tested in their study "have immediate adverse physiologic effects after short term use that are similar to some of the effects seen with tobacco smoking". The reported 16% decrease in FeNO (i.e. 2.1 ppb in absolute term!) and 11% increase in peripheral flow resistance (IOS) (i.e. 0.025 kPa/L/s in absolute term!) after e-cigarette use from baseline are so small and well within tests variability [2,3] that it is highly unlikely to have meaningful adverse effects.

Of note, no changes were detected by canonical pulmonary function testing after e-cigarette use. Detailed toxicology characterization of the components contained in the e-cigarettes tested in the study demonstrates that their primary components (i.e. water, propylene glycol, and nicotine) are not harmful, and this is in agreement with the detailed analysis of e-cigarette toxicology by Cahn and Siegel [4]. Moreover, a recent clinical safety assessment of one such product in 40 smokers showed that mouth and throat irritation and dry cough were commonly reported in the initial few weeks of use, but all appeared to wane spontaneously by the end of the study, after 24 weeks of regular use [5]. Thus the authors’ conclusions are not fully supported by the data, and the accumulating evidence is rather strongly supportive of a good safety profile for the e-cigarettes.


References

1. Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Acute pulmonary effects of using an e-cigarette: impact on respiratory flow resistance, impedance and exhaled nitric oxide. Chest. 2011 Dec 22. [Epub ahead of print].
2. Oostveen E, MacLeod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J 2003; 22:1026-1041.
3. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, Olin AC, Plummer AL, Taylor DR; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO)
for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-15.
4. Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? J Public Health Policy. 2011;32(1):16-31.
5. Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011;11:786.

 

[nopatch]

but potentially adverse and worthy of further investigation.

The phrase in bold is inflammatory and unwarranted.Would it not have been sufficient to state "the long term health effects of e-cigarette use are unknown and worthy of further investigation"?

I am afraid that is how scientific investigations are reported.When you have some short term effects that mimic actual cigarette smoking the researcher can warn about potential longterm effects.

Sure, they might be adverse, but then again, there is no existing data that would indicate that the long term health effects would be any more adverse than continuing to smoke.

That could be quite correct.The report should be useful for people who think ecigs are absolutely safe so much so that they give them to their 60 year old mother who remained smokefree for a decade.And for those who think nobody should object to inhaling PG?Vg laced air in a closed room.

So I disagree that the report stressed that their results give no indication on long term effects. The last line of the abstract (quoted above) speculated that the effects are potentially adverse. And news outlets tend to not differentiate between evidence and speculation.

Well, the short term results gave no indication about the nature of longterm effects.It is reasonable to presume and warn that there would be longterm effects the nature of which will be difficult to extrapolate based on the results of the short term study.

 

[nopatch]

The following letter provides additional information to help us evaluate what the research did and did not establish scientifically.

To the Editors:

The findings by Vardavas and colleagues are not conclusive due to the small number of subjects studied, the choice of study outcomes of unclear clinical relevance, together with the lack of appropriate study controls. [1] The small changes in FeNO and peripheral flow resistance (IOS) reported may be non specific. A possible explanation for the small decrease in FeNO and the trivial increase in peripheral flow resistance (IOS) is that the mist generated by the e-cigarette per se might have contributed to these changes. In a series of pilot studies aimed at optimizing the distribution of several respiratory investigations within a protocol for the detailed characterization of the asthma phenotype (U-BIOPRED), researchers discovered that nebulization of saline can reduce FeNO up to 25% from baseline (personal observation). For this reason baseline assessment of induced sputum has to follow measurement of FeNO. Therefore, authors should have included a different control (e.g. saline mist generated by a ultrasonic nebulizer) for their study. Also, another reasonable comparator that should have been used as control was participants’ own brand cigarette.

In the Summary, the authors state that the e-cigarettes tested in their study "have immediate adverse physiologic effects after short term use that are similar to some of the effects seen with tobacco smoking". The reported 16% decrease in FeNO (i.e. 2.1 ppb in absolute term!) and 11% increase in peripheral flow resistance (IOS) (i.e. 0.025 kPa/L/s in absolute term!) after e-cigarette use from baseline are so small and well within tests variability [2,3] that it is highly unlikely to have meaningful adverse effects.

Of note, no changes were detected by canonical pulmonary function testing after e-cigarette use. Detailed toxicology characterization of the components contained in the e-cigarettes tested in the study demonstrates that their primary components (i.e. water, propylene glycol, and nicotine) are not harmful, and this is in agreement with the detailed analysis of e-cigarette toxicology by Cahn and Siegel [4]. Moreover, a recent clinical safety assessment of one such product in 40 smokers showed that mouth and throat irritation and dry cough were commonly reported in the initial few weeks of use, but all appeared to wane spontaneously by the end of the study, after 24 weeks of regular use [5]. Thus the authors’ conclusions are not fully supported by the data, and the accumulating evidence is rather strongly supportive of a good safety profile for the e-cigarettes.


References

1. Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Acute pulmonary effects of using an e-cigarette: impact on respiratory flow resistance, impedance and exhaled nitric oxide. Chest. 2011 Dec 22. [Epub ahead of print].
2. Oostveen E, MacLeod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J 2003; 22:1026-1041.
3. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, Olin AC, Plummer AL, Taylor DR; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO)
for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-15.
4. Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? J Public Health Policy. 2011;32(1):16-31.
5. Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011;11:786.

There are a couple of studies on tobacco cigarette smoking that measured these same parameters which also resulted in small but significant changes.Whether these parameters are relevent or not is something the medical community has to apply their mind and educate people.