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Are e-cigarettes more harmful than we think?

E-cigarettes have effects similar to those seen in regular smokers and patients with chronic lung disease.  This is the conclusion of authors of a new report published online in the journal Thorax.

E-cigarette vapour boosts the production of inflammatory chemicals and disables key protective cells in the lung that keep the air spaces clear of potentially harmful particles.

Impaired lung defences

The vapour impairs the activity of vital protective cells in the tiny air sacs of the lung,  the alveolar (air sac) macrophages.

These macrophages are the 'big eaters',  or the scavengers,  of the respiratory tract. They are cells of the immune system whose role is to engulf debris, removing dust particles, bacteria, and allergens that get through the mechanical defences of the respiratory tract.  They are a crucial line of defence.

Without them, our respiratory systems would become choked with detritus and pathogens, and our lungs would be more readily infected.

E-cigarettes may be more harmful than we think

The findings of this small experimental study prompt the researchers to suggest that while further research is needed to better understand the long term health impacts of vaping on people, e-cigarettes may be more harmful than we think, as some of the effects were similar to those seen in regular smokers and people with chronic lung disease.

Vaping is increasing in popularity, but most of the current body of research has focused on the chemical composition of e-cigarette liquid before it is vaped.

To find out how vaping might change this chemical soup, and what impact this might have, the researchers devised a mechanical procedure to mimic vaping and produce condensate from the vapour.

They extracted alveolar macrophages from lung tissue samples provided by eight non-smokers who had never had asthma or chronic obstructive pulmonary disease (COPD).

A third of the cells were exposed to plain e-cigarette fluid, a third to different strengths of the artificially vaped condensate with and without nicotine, and a third to nothing for 24 hours.

Condensate significantly more harmful

Vapourised e-cigarette fluid is cytotoxic, pro-inflammatory and inhibits phagocytosis in alveolar macrophages.
The results showed that the condensate was significantly more harmful to the cells than e-cigarette fluid and that these effects worsened as the ‘dose’ increased.

After 24 hours of exposure, the total number of viable cells exposed to the vaped condensate was significantly reduced compared to the untreated cells, and condensate containing nicotine exaggerated this effect.

Exposure to the condensate increased cell death and boosted production of oxygen free radicals by a factor of 50, and it significantly increased the production of inflammatory chemicals–more so when the condensate contained nicotine.

What’s more, the ability of cells exposed to vaped condensate to engulf bacteria was significantly impaired, although treatment with an antioxidant restored this function and helped lessen some of the other harmful effects.

The researchers conclude that the vaping process itself can damage vital immune system cells, at least under laboratory conditions.

Importantly, exposure of macrophages to [e-cigarette vapour condensate] induced many of the same cellular and functional changes in [alveolar macrophage] function seen in cigarette smokers and patients with COPD.  

In an accompanying podcast, lead author Professor David Thickett explains that many e-cigarette companies have been bought up by the tobacco giants, and he says

 there’s certainly an agenda to portray e-cigarettes as safe.

While e-cigarettes are safer than traditional cigarettes, they may still be harmful in the long term, he says, as the current body of research is in its infancy and not able to answer that question yet.

Safer in terms of cancer risk

“In terms of cancer causing molecules in cigarette smoke, as opposed to cigarette vapour, there are certainly reduced numbers of carcinogens. They are safer in terms of cancer risk, but if you vape for 20 or 30 years and this can cause COPD, then that’s something we need to know about,” he states.

I don’t believe e-cigarettes are more harmful than ordinary cigarettes, But we should have a cautious scepticism that they are as safe as we are being led to believe.
This study comes at a time when more people are turning to e-cigarettes, not solely as a substitute for tobacco, but as a fashion itself, and branding has targeted the young.

Regulators concerned about packaging

In May regulators in the United States issued warnings to 13 companies selling e-cigarette liquids for using child-friendly images in the packaging. The exotic flavours and the colourful packaging present them as being some kind of candy.

In 2016, a survey showed that more than 2.1 million US middle and high school students reported using e-cigarettes. That same year, an estimated 20.5 million were exposed to e-cigarette ads.



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