Outstanding article summarizing the respiratory effects of e-cigarettes

Jeff Gotts, Sven-Eric Jordt, Rob McConnell, and Robert Tarran recently published “What are the respiratory effects of e-cigarettes?” in BMJ.  This article provides an extensive (and readable) comprehensive assessment of the evidence on the pulmonary effects of e-cigarettes, covering the population, clinical, animal, and cellular evidence on the effects of e-cigarettes.  (The paper has 193 citations.)  While dealing with technical matters, the authors do a remarkably good job of explaining their findings in a way that normal people can understand.

Everyone one following the e-cigarette debate should read this paper, especially the FDA and other regulatory authorities because it shows that the situation is a lot more complex than the idea that getting rid of combustion is all that is needed to make a product that is substantially safer than a cigarette.

Another favor that the authors do for readers (and regulators) is to include the tobacco industry-funded studies and make the point that most of the industry studies – unlike the rest of the literature – do not find lung problems with e-cigs.

Here is the abstract:

Electronic cigarettes (e-cigarettes) are alternative, non-combustible tobacco products that generate an inhalable aerosol containing nicotine, flavors, propylene glycol, and vegetable glycerin. Vaping is now a multibillion dollar industry that appeals to current smokers, former smokers, and young people who have never smoked. E-cigarettes reached the market without either extensive preclinical toxicology testing or long term safety trials that would be required of conventional therapeutics or medical devices. Their effectiveness as a smoking cessation intervention, their impact at a population level, and whether they are less harmful than combustible tobacco products are highly controversial. Here, we review the evidence on the effects of e-cigarettes on respiratory health. Studies show measurable adverse biologic effects on organ and cellular health in humans, in animals, and in vitro. The effects of e-cigarettes have similarities to and important differences from those of cigarettes. Decades of chronic smoking are needed for development of lung diseases such as lung cancer or chronic obstructive pulmonary disease, so the population effects of e-cigarette use may not be apparent until the middle of this century. We conclude that current knowledge of these effects is insufficient to determine whether the respiratory health effects of e-cigarette are less than those of combustible tobacco products.

The citation for the paper is  Gotts Jeffrey E, Jordt Sven-Eric, McConnell Rob, Tarran Robert. What are the respiratory effects of e-cigarettes? BMJ 2019; 366 :l5275.  It is available here.