September 6, 2019

expert reaction to paper and commentary on recent cases of harm through vaping in the US

Research and commentary, published in The New England Journal of Medicine (NEJM), reports on recent cases of lung harm through vaping in the US.

Prof Paul Aveyard, Professor of Behavioural Medicine at the University of Oxford, said:

“The New England Journal of Medicine reports a cluster of 53 people from central USA who developed severe and sudden lung injury after vaping.  This is an acute reaction to something toxic and not the kind of lung damage that comes on after years of smoking.  The cause is unknown, but more than 8 in 10 had vaped cannabis. 

“People who vape will be asking themselves if it’s safe to vape.  They can be reassured by other data we have.  The best data on the effectiveness, tolerability, and safety of e-cigarettes comes from randomised trials and the largest of these was published recently, also in the New England Journal of Medicine.  This trial enrolled 886 people and half tried to stop smoking by vaping and half by using nicotine replacement treatment.  Most of those who stopped smoking by vaping continued using the e-cigarette for the whole year, but most of those using nicotine replacement stopped using it.  At the end of that year the scientists found that people who were vaping had less cough, and produced less phlegm than those who were not vaping, while there was no difference in wheeze or breathlessness.  This study added to other good quality studies that show no evidence that vaping causes short-term serious harms. 

“We must also remember that for nearly every person who vapes, the alternative to vaping is smoking.  While vaping does produce some toxins, those are at significantly lower levels than seen in cigarette smoke.  If vaping typically caused severe lung damage, we’d have seen many more cases in people who smoke, which we have not.  These cases are worrying and need investigating, but advice from all official bodies in the UK is that it is always preferable to vape than to smoke.  Today’s reports should not change that advice.”

Dr Sarah Jackson, Senior Research Fellow, UCL Tobacco and Alcohol Research Group, University College London (UCL), said:

“The recent cluster of vapers developing lung problems follows a decade of widespread e-cigarette use without reports of similar adverse effects. The majority of cases appear to have been vaping illicit e-liquids containing THC. E-cigarettes are the most popular quitting aid used by smokers – and among the most effective. Advice to discourage people from vaping legal, regulated e-liquids appears to be unwarranted and risks pushing people back to smoking.”

Prof Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London (QMUL), said:

“The mystery seems to have been resolved now, with cases being traced to a contaminated marijuana extract. Although the scare is being used to put smokers off switching from cigarettes to much less risky vaping, it has nothing to do with e-cigarettes as they are normally used in this country.  

“E-cigarettes have been around for over a decade now and are used by millions of people, with no such cases occurring. The outbreak is similar to methanol poisonings that kill people every now and then when contaminated alcohol is sold.”

Original Article: Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report
Jennifer E Layden, M.D., Ph.D., Illinois Department of Public Health, Chicago, IL and Editorial: Vaping-Induced Lung Injury
David C. Christiani, M.D., M.P.H., the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA were published in NEJM at 6pm UK time on Friday 6 September 2019. 

Declared interests

None to declare.