The Future of Electronic Cigarettes: Part 1

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If you keep up with the news surrounding electronic cigarettes, you may have already heard the buzz revolving around the recent release of Public Health England’s Evidence-Based Review on electronic cigarettes and the statements made regarding the potential health benefits they may bring to those in search of an alternative to smoking. You may have even wondered how these findings will affect e-cig regulations in the United States. With this question in mind, we’ve decided to break down the similarities between England and the U.S. with regard to smoking rates and e-cig usage, as well as how PHE’s review could affect the vaping industry in the U.S. First, let’s recap the findings in Public Health England’s Evidence-Based Review. 

Public Health England’s Evidence-Based Review Recap

As the popularity of electronic cigarettes continues to soar, the controversy surrounding their potential as a smoking cessation aid continues to dominate political debates across the globe. With this in mind, policy makers must base decisions on clear scientific evidence when it comes to creating public health policies. Electronic cigarettes are no exception.

Although they have not been not promoted as such, electronic cigarettes have become the number 1 smoking cessation aid in the UK, which is also the number one reason for Public Health England’s Evidence-Based Review, as stated in the review’s foreword, “The role and impact of electronic cigarettes has been one of the great debates in public health in recent years and we commissioned this independent review of the latest evidence to ensure that practitioners, policy makers and, most importantly of all, the public have the best evidence available.”

E-Cig Studies: The Evidence Review

Evidence-based review of e-cig studies

Public Health England’s Evidence-Based Review was compiled from several tobacco and e-cig studies, surveys, and scientific research collected around the globe since 2014. The report covers e-cig policy framework, the prevalence of e-cig use, the knowledge and attitudes towards e-cigs and the impact of e-cigs on smoking behavior, as well as an examination of recent safety issues and nicotine content, emissions and delivery. Since this is such an in-depth report, we’re going to take a look at the key findings regarding how safe e-cigs are in terms of health.

After reviewing several studies on the safety of electronic cigarettes, PHE found many of these studies were either conducted in unlikely scenarios or did not provide a sound case of scientific evidence. The major components reviewed included the presence of aldehydes in e-cig vapor, how e-cig vapor affects the lungs, and the content, emissions and delivery of nicotine via electronic cigarettes.

The Presence of Aldehydes in E-Cig Vapor

The Presence of Aldehydes in E-Cig Vapor

Public Health England reviewed several studies claiming e-cig vapor contains dangerous levels of aldehydes and discovered that many of the studies testing cont e-liquid vapor content were conducted in highly unlikely scenarios, including heating e-liquid to unreasonable (unvapable) temperatures, rather than testing at the average temperature levels produced by the majority of e-cig devices. In previous studies, e-liquid vapor tested under normal circumstances only detected trace amounts of aldehydes, with the highest amount still being six times lower than traditional cigarettes. With these findings, PHE determined the presence of aldehydes in e-liquid vapor to be negligible when compared to traditional cigarettes, which led them to conclude, “There is no indication that EC users are exposed to dangerous levels of aldehydes.”

The Effects of E-Cig Vapor on the Lungs

How vaping affects the lungs

PHE reviewed a study published in February 2015 that claimed e-cigs were linked to lung inflammation, lung infection, and even lung cancer. In this study, mice were separated into two groups: a control group and a test group. The test group was exposed to e-cig vapor for 3 hours a day for 2 weeks, while the control group did not receive the same exposure. Both groups were then infected with either streptococcus pneumonia via intranasal instillation and killed 24 hours later, or with tissue culture influenza to be monitored for weight loss, mortality, and lung and airway inflammation. When compared to the control group, the test group had an increase in pro-inflammatory cytokines, diminished lung glutathione levels and higher viral titre, and were more likely to lose weight and die. The study claimed free radicals in e-cig vapor to be the potential culprit; however, PHE found several problems with the study itself, as well as in the interpretation of the results.

PHE claims the study made no attempts to compare the effects e-cigs have on the lungs in relation to the effects tobacco smoke has on the lungs. This resulted in PHE’s statement, “Even at the very high vapor density generated by the study procedure, the level of free radicals identified in vapor was several orders of magnitude lower than in cigarette smoke.” In addition to suffering repeat nicotine poisoning, the mice in the test group were also exposed to a greater amount of stress than the control group, which made them even more susceptible to infection as stress greatly affects bacterial and viral response. With these findings, PHE concluded that the “accelerated weight loss, reduced immunity and early death in the experimental group were much more likely the result of protracted stress and nicotine poisoning, rather than the result of exposure to free radicals (which were in any case 1,000 times lower than from cigarettes).” In summary, PHE concluded, “the mice model has little relevance for estimating human risk and it does not raise any new safety concerns.”

How Does PHE’s Review Relate to the United States?

Since Public Health England compiled its evidence-based review on electronic cigarettes from several studies conducted both within the UK and internationally, the information presented in the report is more than relevant to the United States. For the portion regarding nicotine content, emissions and delivery via electronic cigarettes, PHE researched and reviewed several studies listed in the U.S. National Library of Medicine to help determine how safe electronic cigarettes are, compared to combusted tobacco. In part 2 of this article, we will take a closer look at the reviewed studies and PHE’s interpretation of the evidence presented.