Myth: Alternative nicotine products are as dangerous as smoking: Difference between revisions

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*Conclusion: "Exclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance."

 

*In this update, 70 new studies were added to the synthesis, making a total of 123 studies included. All combustible tobacco products score between 40 and 100, with bidis and smokeless (rest of world) also in this range. All other products have a combined risk score of 10 or less, including U.S. chewing tobacco, U.S. dipping tobacco, snus, heat-not-burn tobacco, electronic cigarettes, non-tobacco pouches and nicotine replacement therapy.

 

 

 

 

 

*Even if they should not be considered as risk-free products, HTPs and ECs lead to an appreciable risk reduction in comparison to cigarettes, both for cancer and non-cancer diseases. According to the current knowledge, and more specifically to the data presented here, HTPs and ECs might be considered as an acceptable reduced risk substitute for cigarettes for legal-age smokers who would otherwise continue smoking cigarettes.

 

 

 

*The findings of the current study indicate that CS causes discoloration of dental hard tissues and color mismatch of esthetic composite resin restorations. THS 2.2 induces much less discoloration in dental hard tissues and dental composite restorations in comparison with CS. These results are consistent with available evidence that THS 2.2 generates an aerosol with a different chemical composition from CS and with no combustion-related solid particles typically found in CS tar.

 

*The results of this study concorded with evidence that complete switching from combustible cigarettes to vapor products may reduce exposure to key carcinogens and other toxicants known to be associated with tobacco-related diseases.

===2012: [https://www.sciencedirect.com/science/article/abs/pii/S0278691512005030 Acute effects of electronic and tobacco cigarette smoking on complete blood count]===  

 

 

 

 

 

*In summary, e-cigarettes have good evidence to support them as an effective smoking cessation aid for tobacco smokers. Smokers can expect to see substantial improvements in their oral health if they fully switch to an e-cigarette. Longer-term use is a balanced judgement between smoking relapse prevention against the small risk of any detrimental effects from the e-cigarettes themselves.

 

 

 

 

 

 

 

 

 

===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933315/ Effects of tobacco smoke and electronic cigarette vapor exposure on the oral and gut microbiota in humans: a pilot study]===

 

 

===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068504/ Electronic Cigarette: Role in the Primary Prevention of Oral Cavity Cancer]===

*Citation: Franco T, Trapasso S, Puzzo L, Allegra E. Electronic Cigarette: Role in the Primary Prevention of Oral Cavity Cancer. Clin Med Insights Ear Nose Throat. 2016 Oct 17;9:7-12. doi: 10.4137/CMENT.S40364. PMID: 27773997; PMCID: PMC5068504.

 

===2015: Article: [https://web.archive.org/web/20230607145405/https://www.dentalhealth.org/news/british-dental-health-foundation-responds-to-public-health-england-e-cigarette-review Oral Health Foundation: (Formerly known as the British Dental Health Foundation)]===

===2020: [http://Benefits%20of%20e-cigarettes%20in%20smoking%20reduction%20and%20in%20pulmonary%20health%20among%20chronic%20smokers%20undergoing%20a%20lung%20cancer%20screening%20program%20at%206%20months Benefits of e-cigarettes in smoking reduction and in pulmonary health among chronic smokers undergoing a lung cancer screening program at 6 months]===

*Pulmonary health, assessed with self-reported measures, clinical evaluations and the Leicester Cough Questionnaire, improved in participants who stopped smoking compared to their own baseline. Moreover, participants in this group [nicotine e-cigarettes] showed the lowest level of exhaled carbon monoxide, and the lowest level of dependence compared to the nicotine-free e-cigarette and control conditions.

===2020: [https://www.nber.org/papers/w27507 E-Cigarettes and Respiratory Disease: A Replication, Extension, and Future Directions]===

*The statistical associations between e-cigarette use and respiratory disease are driven by e-cigarette users who are also current or former smokers of combustible tobacco.

*A striking feature of the data is that almost all e-cigarette users were either current or former smokers of combustible tobacco.

*Among respondents who had never smoked combustible tobacco, we find no evidence that current or former e-cigarette use is associated with respiratory disease.

*Citation: E-Cigarettes and Respiratory Disease: A Replication, Extension, and Future Directions, Donald S. Kenkel, Alan D. Mathios, and Hua Wang, NBER Working Paper No. 27507, July 2020, JEL No. I12

===2020: [https://academic.oup.com/ntr/article/22/Supplement_1/S54/5893624 Exclusive e-cigarette users report lower levels of respiratory symptoms relative to dual e-cigarette and cigarette users]===

*Findings suggest that differences in respiratory symptoms between dual and exclusive e-cigarette users appear to be attributable to combustible cigarette smoking, rather than more intense or frequent e-cigarette use across groups.

*[https://sci-hub.wf/10.1093/ntr/ntaa150 PDF]

*Citation: Rachel N Cassidy, Jennifer W Tidey, Suzanne M Colby, Exclusive E-Cigarette Users Report Lower Levels of Respiratory Symptoms Relative to Dual E-Cigarette and Cigarette Users, Nicotine & Tobacco Research, Volume 22, Issue Supplement_1, December 2020, Pages S54–S60, https://doi.org/10.1093/ntr/ntaa150

===2020: [https://pubmed.ncbi.nlm.nih.gov/31960343/ Vaping effects on asthma: results from a web survey and clinical investigation]===

*Almost all of the asthmatics who previously smoked would recommend switching to e-cig, and vaping did not worsen their asthma symptoms. Furthermore, switching from tobacco smoking to e-cigs showed a significant improvement in asthma control and quality of life, not showing, in the period studied, to affect pulmonary function tests.

*Citation: Solinas A, Paoletti G, Firinu D, Di Pino M, Tusconi M, Mura JF, Del Giacco S, Marongiu F. Vaping effects on asthma: results from a web survey and clinical investigation. Intern Emerg Med. 2020 Jun;15(4):663-671. doi: 10.1007/s11739-019-02247-5. Epub 2020 Jan 20. PMID: 31960343.

===2019: [https://www.tandfonline.com/doi/full/10.1080/17476348.2019.1649146 The effect of e-cigarette aerosol emissions on respiratory health: a narrative review.]===  

*Expert opinion: There is growing evidence to support the relative safety of E-Cigarette (EC) emission aerosols for the respiratory tract compared to tobacco smoke.  

*This review article shows that although some potential effects on respiratory cell types can be shown in vitro, and low levels of chronic irritation of the respiratory tract can be anticipated at certain levels of vaping, these effects are much less than those of smoking. The clinical evidence confirms that ECs are unlikely to raise significant health concerns for the respiratory tract under normal conditions of use.

*Promoting further access to ECs may offer an opportunity to reduce or prevent some of the otherwise inevitable burden of respiratory morbidity and mortality caused by tobacco smoking

*...we are now confident that current vaping products are much less harmful than conventional cigarettes as well as earlier EC designs.

===2018: [https://www.dovepress.com/health-effects-in-copd-smokers-who-switch-to-electronic-cigarettes-a-r-peer-reviewed-fulltext-article-COPD Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up]===   

*The present study suggests that EC use may ameliorate objective and subjective COPD outcomes and that the benefits gained may persist long-term. EC use may reverse some of the harm resulting from tobacco smoking in COPD patients.

===2017: [http://E-cigarettes%20in%20patients%20with%20COPD:%20current%20perspectives E-cigarettes in patients with COPD: current perspectives]===  

*Although ECs are not risk free, they are much less harmful than conventional tobacco smoking. The emerging clinical evidence suggests that ECs are unlikely to raise significant health concerns for the respiratory tract under normal conditions of use, even in smokers with preexisting lung disease. In particular, recent studies in COPD and chronic asthma suggest that substitution of conventional tobacco cigarettes for ECs can ameliorate subjective and objective disease-related outcomes and exacerbation rates as well as improving success in abstaining from smoking long term.

===2017: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429854/ Reduced biological effect of e-cigarette aerosol compared to cigarette smoke evaluated in vitro using normalized nicotine dose and RNA-seq-based toxicogenomics]===   

*Here, we assessed the transcriptional response of a primary 3D airway model acutely exposed to e-cigarette aerosol and cigarette (3R4F) smoke.

*Based on equivalent or higher nicotine delivery, an acute exposure to e-cigarette aerosol had a reduced impact on gene expression compared to 3R4F smoke exposure in vitro.

*Therefore, we can conclude that the data strongly supports the adverse effect of acute exposure to cigarette smoke on MucilAir™ cells with functional enrichment for cancer, inflammation and fibrosis genes. In contrast, RNA-seq-based toxicogenomics showed a reduced impact of e-cigarette aerosols acute exposure on MucilAir™ cells compared with 3R4F reference cigarette at equivalent or higher dose of nicotine exposure.

*Citation: Haswell LE, Baxter A, Banerjee A, Verrastro I, Mushonganono J, Adamson J, Thorne D, Gaça M, Minet E. Reduced biological effect of e-cigarette aerosol compared to cigarette smoke evaluated in vitro using normalized nicotine dose and RNA-seq-based toxicogenomics. Sci Rep. 2017 Apr 18;7(1):888. doi: 10.1038/s41598-017-00852-y. PMID: 28420881; PMCID: PMC5429854.

===2017: [https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0676-9 Electronic cigarette vapor alters the lateral structure but not tensiometric properties of calf lung surfactant]===  

*While both e-cigarette vapor and conventional cigarette smoke affect surfactant lateral structure, only cigarette smoke disrupts surfactant interfacial properties. The surfactant inhibitory compound in conventional cigarettes is tar, which is a product of burning and is thus absent in e-cigarette vapor.

===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5162097/ Evidence for harm reduction in COPD smokers who switch to electronic cigarettes (EC’s)]===   

*These findings suggest that ECs use may aid smokers with COPD reduce their cigarette consumption or remain abstinent, which results in marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes.

===2016: [https://www.omicsonline.org/open-access/changes-in-the-frequency-of-airway-infections-in-smokers-who-switched-to-vaping-results-of-an-online-survey-2155-6105-1000290.php?aid=77944 Changes in the Frequency of Airway Infections in Smokers Who Switched to Vaping: Results of an Online Survey]===   

*941 responses were received. Overall, 29% of responders reported no change in respiratory symptoms, 5% reported worsening, and 66% reported an improvement.

===2016: [https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12651 Changes in breathomics from a 1‐year randomized smoking cessation trial of electronic cigarettes]===   

*Smokers invited to switch to electronic cigarettes who completely abstained from smoking showed steady progressive improvements in their exhaled breath measurements and symptom scores. FeNo and eCO normalization is highly supportive of improved respiratory health outcomes and adds to the notion that quitting from tobacco smoking can reverse harm in the lung.

===2016: [https://pneumonia.biomedcentral.com/articles/10.1186/s41479-016-0001-2 Respiratory infections and pneumonia: potential benefits of switching from smoking to Vaping]===  

*Also, given that the propylene glycol in EC aerosols is a potent bactericidal agent, switching from smoking to regular vaping is likely to produce additional lung health benefits.

*In conclusion, smokers who quit by switching to regular ECs use can reduce risk and reverse harm from tobacco smoking.  

*Innovation in the e-vapour category is likely not only to further minimise residual health risks, but also to maximise health benefits.

===2016: [https://www.discoverymedicine.com/Riccardo-Polosa/2016/02/persisting-long-term-benefits-of-smoking-abstinence-and-reduction-in-asthmatic-smokers-who-have-switched-to-electronic-cigarettes/ Persisting long term benefits of smoking abstinence and reduction in asthmatic smokers who have switched to electronic cigarettes]===

*This prospective study confirms that EC use ameliorates objective and subjective asthma outcomes and shows that these beneficial effects may persist in the long term. EC use can reverse harm from tobacco smoking in asthma patients who smoke. The evidence-based notion that substitution of conventional cigarettes with EC is unlikely to raise significant respiratory concerns, can improve counseling between physicians and their asthmatic patients who are using or intend to use ECs.

*Citation: Polosa R, Morjaria JB, Caponnetto P, Caruso M, Campagna D, Amaradio MD, Ciampi G, Russo C, Fisichella A. Persisting long term benefits of smoking abstinence and reduction in asthmatic smokers who have switched to electronic cigarettes. Discov Med. 2016 Feb;21(114):99-108. PMID: 27011045.

===2014: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053879/ Effect of Smoking Abstinence and Reduction in Asthmatic Smokers Switching to Electronic Cigarettes: Evidence for Harm Reversal]===     

*The e-cig may help smokers with asthma to reduce their cigarette consumption or remain abstinent and hence reduce the burden of smoking-related asthma symptoms. The positive findings observed with e-cigs allows us to advance the hypothesis that these products may be valuable for smoking cessation and/or tobacco harm reduction also in asthma patients who smoke.

*By substantially reducing number of cigarettes smoked per day and exposure to their hazardous toxicants, e-cigs may not only improve asthma symptoms and pulmonary function but may also confer an overall health advantage in smokers with asthma. Therefore, e-cig use in asthmatic smokers unable or unwilling to quit should be exploited as a safer alternative approach to harm-reversal (i.e., specific reversal of asthma-related outcomes) and, in general, to harm-reduction (i.e., overall reduction of smoke-related diseases).

*Citation: Polosa R, Morjaria J, Caponnetto P, Caruso M, Strano S, Battaglia E, Russo C. Effect of smoking abstinence and reduction in asthmatic smokers switching to electronic cigarettes: evidence for harm reversal. Int J Environ Res Public Health. 2014 May 8;11(5):4965-77. doi: 10.3390/ijerph110504965. PMID: 24814944; PMCID: PMC4053879.

==Toxicity Vaping vs Smoking==

*Citation: Goniewicz ML. Addict Neurosci. 2023 Jun;6:100077. doi: 10.1016/j.addicn.2023.100077. Epub 2023 Feb 26. PMID: 3708924

*Citation: Emma, R., Fuochi, V., Distefano, A., Partsinevelos, K., Rust, S., Zadjali, F., Al Tobi, M., Zadjali, R., Alharthi, Z., Pulvirenti, R., Furneri, P. M., Polosa, R., Sun, A., Caruso, M., & Li Volti, G. (2023). Cytotoxicity, mutagenicity and genotoxicity of electronic cigarettes emission aerosols compared to cigarette smoke: The REPLICA project. Scientific Reports, 13(1), 1-12. https://doi.org/10.1038/s41598-023-44626-1

*All analytes were significantly higher in cigarette smokers than in either e-cigarette users or nonsmokers.

*Citation: Chen M, Carmella SG, Lindgren BR, Luo X, Ikuemonisan J, Niesen B, Thomson NM, Murphy SE, Hatsukami DK, Hecht SS. Increased Levels of the Acrolein Metabolite 3-Hydroxypropyl Mercapturic Acid in the Urine of e-Cigarette Users. Chem Res Toxicol. 2023 Apr 17;36(4):583-588. doi: 10.1021/acs.chemrestox.2c00145. Epub 2022 Jul 20. PMID: 35858275; PMCID: PMC9852357.

===2021: [https://www.sciencedirect.com/science/article/abs/pii/S0273230021001598 Screening of different cytotoxicity methods for the assessment of ENDS toxicity relative to tobacco cigarettes]===

*[https://sci-hub.ru/10.1016/j.yrtph.2021.105018 PDF]

*Citation: Caruso M, Emma R, Rust S, Distefano A, Carota G, Pulvirenti R, Polosa R, Li Volti G. Screening of different cytotoxicity methods for the assessment of ENDS toxicity relative to tobacco cigarettes. Regul Toxicol Pharmacol. 2021 Oct;125:105018. doi: 10.1016/j.yrtph.2021.105018. Epub 2021 Jul 24. PMID: 34314750.

*Citation: Margham J, McAdam K, Cunningham A, Porter A, Fiebelkorn S, Mariner D, Digard H, Proctor C. The Chemical Complexity of e-Cigarette Aerosols Compared With the Smoke From a Tobacco Burning Cigarette. Front Chem. 2021 Sep 30;9:743060. doi: 10.3389/fchem.2021.743060. PMID: 34660535; PMCID: PMC8514950.

 

===2020: [https://www.sciencedirect.com/science/article/abs/pii/S0946672X2030167X?via%3Dihub Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016]===

*In this study, blood lead levels, and urinary cadmium, barium, and antimony levels were similar between participants who ever-used e-cigarettes and participants who did not, and therefore, e-cigarette use was not a major source of heavy metals.

*Citation: R. Constance Wiener, Ruchi Bhandari, Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016, Journal of Trace Elements in Medicine and Biology, Volume 62, 2020, 126602, ISSN 0946-672X, doi: 10.1016/j.jtemb.2020.126602

 

===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432690/ Urinary Biomarkers of Exposure to Volatile Organic Compounds from the Population Assessment of Tobacco and Health Study Wave 1 (2013–2014)]===

*Citation: De Jesús VR, Bhandari D, Zhang L, Reese C, Capella K, Tevis D, Zhu W, Del Valle-Pinero AY, Lagaud G, Chang JT, van Bemmel D, Kimmel HL, Sharma E, Goniewicz ML, Hyland A, Blount BC. Urinary Biomarkers of Exposure to Volatile Organic Compounds from the Population Assessment of Tobacco and Health Study Wave 1 (2013-2014). Int J Environ Res Public Health. 2020 Jul 28;17(15):5408. doi: 10.3390/ijerph17155408. PMID: 32731321; PMCID: PMC7432690.

 

 

 

===2018: NASEM report on E-Cig Health Effects evaluates the available evidence of health effects related to the use of E-cigarettes: [http://Public%20Health%20Consequences%20of%20E-Cigarettes Public Health Consequences of E-Cigarettes]=== 

**There is moderate evidence that risk and severity of dependence are lower for e-cigarettes than combustible tobacco cigarettes.

**There is moderate evidence from randomized controlled trials that e-cigarettes with nicotine are more effective than e-cigarettes without nicotine for smoking cessation.

**While the overall evidence from observational trials is mixed, there is moderate evidence from observational studies that more frequent use of e-cigarettes is associated with an increased likelihood of cessation.

**There is limited evidence for improvement in lung function and respiratory symptoms among adult smokers with asthma who switch to e-cigarettes completely or in part (dual use).

 

 

*Of the 51 toxicants tested, eight were detected in the e-cigarette aerosols but at substantially lower levels than reported in cigarette smoke.

*Link above to the PDF form of the information presented at: 1st Scientific Summit, Tobacco Harm Reduction, Kallithea, Greece, June 2018

 

 

 

 

*In this study, we have demonstrated that no clinically relevant, product-related safety findings were observed for smokers of Combustible Cigarettes (CCs) switching to an [[Special:MyLanguage/Abbreviations|Electronic Vapor Product (EVP)]] for 12 weeks under real-life settings. [[Special:MyLanguage/Abbreviations|AEs]] reported by subjects switching to the EVP occurred primarily within the first week after switching, and only 1.3% of all AEs reported were considered to be almost definitely related to the product. Up to a third of all reported AEs in the EVP group were related to nicotine withdrawal symptoms, which were observed to decrease after the first two weeks from product switch. EVP use was associated with significant decreases in exposure to nicotine and other chemicals such as benzene and acrolein, typically found in CC smoke. Changes were also observed in the level of WBC, haemoglobin, RBC and LDL cholesterol, which although minor, were consistent with those observed after smoking cessation. The data presented in this study shows the potential that EVPs may offer to smokers looking for an alternative to CCs.

 

*Smokers using [[Special:MyLanguage/Abbreviations|EC]]s over 4 weeks maintained cotinine levels and experienced significant reductions in carbon monoxide, [[Special:MyLanguage/Abbreviations|NNAL]], and two out of eight measured [[Special:MyLanguage/Abbreviations|VOC]] metabolites. Those who switched exclusively to ECs for at least half of the study period significantly reduced two additional VOCs.

*Citation: Pulvers, K., Emami, A. S., Nollen, N. L., Romero, D. R., Strong, D. R., Benowitz, N. L., & Ahluwalia, J. S. (2016). Tobacco Consumption and Toxicant Exposure of Cigarette Smokers Using Electronic Cigarettes. Nicotine & Tobacco Research, ntw333. doi:10.1093/ntr/ntw333

 

 

 

 

 

 

 

*Citation: Russo C, Cibella F, Mondati E, Caponnetto P, Frazzetto E, Caruso M, Caci G, Polosa R. Lack of Substantial Post-Cessation Weight Increase in Electronic Cigarettes Users. Int J Environ Res Public Health. 2018 Mar 23;15(4):581. doi: 10.3390/ijerph15040581. PMID: 29570695; PMCID: PMC5923623.

 

===2017: [http://Could%20Vaping%20be%20a%20New%20Weapon%20in%20the%20Battle%20of%20the%20Bulge? Could Vaping be a New Weapon in the Battle of the Bulge?]===

*Citation: Glover M, Breier BH, Bauld L. Could Vaping be a New Weapon in the Battle of the Bulge? Nicotine Tob Res. 2017 Nov 7;19(12):1536-1540. doi: 10.1093/ntr/ntw278. PMID: 27798086.