Current Long-Term Study On E-Cigarettes Consumption

We have often reported on new studies and findings on e-cigarettes in recent years, always with the reference that meaningful long-term studies are still pending. Politicians and the media always use this argument when it comes to electronic cigarettes, when they categorically reject vaping and put it on the same level as tobacco cigarettes. Health consequences for the lungs and respiratory tract have been conjured up again and again, but never well-founded. At the same time, however, the opposite could never be proven, i.e. that vaping has no consequences for the health of the consumer, since such long-term studies were also lacking.

Hopefully that is over now, because a current long-term study on e-cigarette consumption and any associated health impairments of the body, especially the lungs and respiratory tract, has now been published. What opponents of e-cigarettes have always been demanding, a long-term study of the alleged dangers of vaping, is now available. And the findings are groundbreaking, the results clear. At the same time, they underpin the demands of the German medical profession for tobacco prevention and even the first attempt at a U-turn by the federal government on the subject of harm reduction. Mrs. Mortler, the federal government’s drug commissioner, had repeatedly called for long-term studies. It is all the more astonishing that the long-term study on the effects of vaping on the lungs hardly receives any media attention, while previously every rumor, no matter how hair-raising, was spread in the media (see: Exploding e-cigarettes & Gateway effect). One might think that the results of the study are not what the tobacco lobby and nicotine replacement advocates, like their mouthpieces, were hoping for.

“It’s a well-known fact that bad news dominates the headlines and vaping stories are no exception. So I am not very surprised that, despite the important public health implications, this study has received very little media attention. The irony is that if our data showed signs of lung damage, the news would have been all over the place (and we probably have a better chance of securing funding for a larger study!). Riccardo Polosa interviewed by Ashtray UK

The author of the study is Prof. Dr. Riccardo Polosa, Director of the Institute of Internal Medicine and Clinical Immunology at the University of Catania, Italy. A detailed evaluation of the study and its methodology can be found in the respected journal Nature.

The most exciting findings of the long-term study on e-cigarette use

• Even with intensive use over 3.5 years, neither damage to the respiratory tract nor cardiovascular problems could be detected
• Prof. Dr. Polosa, the author of the study, confirms that there are “no significant changes” in the health of the test subjects
• The methodology and design of the study are very innovative and open the door to further investigations

Methodology and experimental setup of the e-cigarette study

One of the biggest problems that previous studies have faced is that only a tiny percentage of people who vape (0.01%) have never smoked before. Almost all vapers are ex-smokers and have therefore often suffered lung damage. To get around this problem, vapers were sought who had never smoked. The final outcome consisted of a group of nine daily vapers who had never smoked tobacco and a reference group of twelve neither smokers nor vapers (mean age 29.7 (± 6.1) years).

Why it is so important that the e-cigarette users who participated in the study had never smoked tobacco before: When examining the health effects, it is important to consider that it is difficult (if not impossible) to predict reactions , caused by chronic exposure to the aerosol emissions of an e-cigarette, from those related to previous smoking history. If vapers who have never smoked a tobacco cigarette were found to have no health effects, one can hypothesize that the aerosol vapors are much less harmful than tobacco smoke. Such a study has never been conducted before. The experimental setup, i.e. the study design, as well as the composition of the participants, were very complex, scientifically precise and well thought out.

The vapers and a control group that neither vapes nor smokes were monitored for 3.5 years and examined regularly. The main focus of the investigations was:

• lung function
• blood pressure
• heart rate
• body weight
• respiratory symptoms
• Carbon monoxide (eCO) & nitric oxide (eNO) in exhaled air
• HRCT – high-resolution computer typography (image of a lung slice)

Based on these regular examinations over the study period of 3.5 years, long-term data from the real world of a vaper and a control group could be collected, which show that even intensive vaping does not damage the lungs. No pathological findings could be found for the HRCT of the lungs, nor were respiratory symptoms observed.

Although of course it cannot yet be ruled out that damage to the lungs could occur at later stages or over longer periods of time, this study did not show any health concerns associated with long-term use of electronic cigarettes in relatively young users who had never smoked tobacco . But the modern design of the study and the long observation period opened a door in a completely new direction, so hopefully other researchers and long-term studies will follow, which could then also prove the lack of health impairments over even longer periods of time.

Just the way Prof. Dr. Polosa has found its participants is trend-setting. From June to September 2013, the e-cigarette shops and branches conducted surveys of their customers, including their own consumer behavior and previous experience with tobacco cigarettes. From the pool of these regular customers of the respective shops, those who vape regularly but had never smoked were then selected. And there weren’t many. Users who consume dual, i.e. both tobacco and liquids, were excluded from the study. Incidentally, as defined by the study, “Never smoked tobacco” simply means that fewer than 100 cigarettes have been smoked in a lifetime.

Criteria for study participants:

• smoked fewer than 100 cigarettes in a lifetime
• E-cigarette use daily for at least three months
• Control group: neither vaping nor smoking

Further data that were scientifically cleanly logged:

• Morning medical check-ups (three times a year)
• Subjects who reduced or stopped vaping during the 3.5-year study period were excluded
• Nicotine content of the liquids
• E-cigarette model used

Results of the long-term study in detail

“In a small group of young adult, never-smoking, daily e-cigarette users who were followed very carefully for approximately 3.5 years, we did not find any decrease in lung volume, development of respiratory symptoms, changes in markers of inflammation of lungs in exhaled air or signs of early lung damage on CT scan; compared to a carefully matched group of non-smokers and non-users of e-cigarettes. Even the most intense e-cigarette users showed no evidence of incipient lung damage on physiological, clinical, or inflammatory measures. In addition, no changes in blood pressure or heart rate were measured.” – Prof. Dr. Riccardo Polosa, et al., Health impact of E-cigarettes.

There really aren’t that many details. Because nothing was found during the study that indicated a change in the health of the test subjects. Not even if they steamed intensely. Nevertheless, the author himself notes that further investigations are necessary, because there are definitely controversial questions that cannot yet be answered conclusively. What is certain, however, is that the health of the vapers had not deteriorated after 3.5 years of normal use. Not even in comparison to the non-vaping and non-smoking control group of 12 people.

Also exciting: None of the vapers switched to cigarettes during the 3.5 years. However, from the non-vaping and non-smoking control groups, two people started smoking.

Who is behind the long-term study?

The author of the study is Prof. Dr. Riccardo Polosa, Director of the Institute of Internal Medicine and Clinical Immunology at the University of Catania, Italy. The name should be familiar to long-time vapers, as he is one of the best-known European scientists who have long been positive about the e-cigarette. Before the study, which the respected scientific journal “Nature” presented in detail in the article “Health Impact of E-Cigarettes“, Prof. Dr. Polosa already has 250 other scientific papers. Among other things, he is also in charge of the Center for Tobacco Research at the same university and Honorary Professor of Medicine at the University of Southampton. One can therefore assume that this is a meaningful and carefully conducted long-term study that does not lack objectivity.

Together with his team, he examined possible long-term effects of vaping on the body and managed to find reliable data that primarily proves that vaping or the aerosol does not cause any health problems for the lungs. An exciting interview with Prof. Dr. Incidentally, Riccardo Polosa published the study on the “Ashtray” blog.

Recommended read:

• Why Do More People Choose Disposable E-cigarettes?
• Long-term study proves: E-cigarettes are less harmful than tobacco consumption
• E-cigarette Studies