E-Cigarettes – Not Without Risk

Published: Sep 9, 2013 | Updated: Sep 10, 2013

By  Ed Susman , Contributing Writer, MedPage Today

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

BARCELONA — Individuals who smoke e-cigarettes appear to have decreased in lung function and other adverse effects irrespective of tobacco smoking history, researchers said here.

About 90% of individuals with asthma and 63% of patients with chronic obstructive pulmonary disease (COPD) reported a sore throat and/or cough when they were smoking e-cigarettes, Sofia Vakali, MD, resident in pulmonary medicine at Sotiria Hospital of the University of Athens, toldMedPage Today at her poster presentation at the European Respiratory Society (ERS) meeting.

“Our study shows that even a single use of an e-cigarette increased heart rate and symptoms like cough and sore throat,” Vakali said. “Claims that electronic cigarettes can help smokers quit need to be backed up by clinical studies and toxicity analyses and operate within the proper regulatory framework.”

The researchers recruited 16 smokers with COPD, 12 smokers with asthma, 29 smokers with no symptoms and 11 nonsmokers and then asked about various symptoms as well as their enjoyment factor.

Following e-cigarette use, sore throat was experienced by 74% of the nonsmokers; 65% of smokers; 91% of asthmatics and 62% of those with COPD.

Cough was experienced by 54% of nonsmokers, 69% of smokers, 66% of asthmatic smokers, and 69% of those with COPD.

Other symptoms reported by all participants included dry mouth and eye irritation.

Despite the adverse events, 51% of smokers and 18% of the non-smokers said they did get pleasure from smoking the e-cigarettes. One in four asthmatics and 44% of those with COPD also said the e-cigarette provided a pleasurable experience.

Vakali also found that oxygen saturation was reduced among those smoking the e-cigarettes, reaching a significant reduction among smokers (P>0.001).

In a second paper, Vakali divided subjects into those smoking an e-cigarette free of nicotine and a second group that smoked e-cigarettes laced with 11 mg of nicotine.

“An increase in exhaled carbon monoxide was detected in all subjects,” she said. “Increased heart rate and palpitations are related to the use of a nicotine containing e-cigarettes but airway symptoms such as sore throat and cough and other inflammatory markers are independent of nicotine use.”

In a third study from the Athens group, Georgios Kaltsakas, MD, a respiratory physician at the hospital, found that smoking e-cigarettes increased airway resistance and decreased specific airway conductance.

“This is not good,” he said. “Nonsmokers started with resistance that is normal, but smokers had above normal resistance.” He illustrated that smoking e-cigarettes increased that resistance “even after 10 minutes of smoking e-cigarettes.

He recruited nine individuals who never smoked and 51 smokers, including 24 with no symptoms 11 with asthma and 16 with COPD. He assessed lung function before and after smoking e-cigarettes. A significant increase in airway resistance was shown in smokers (P=0.033) and in never smokers (P=0.006), he told MedPage Today. Those groups also showed declines in specific airway conductance.

Christina Georgia Gratziou, MD, professor of pulmonary medicine at the University of Athens, who directed the research team, cautioned that the findings were preliminary.

“Our studies indicate that e-cigarettes may cause impairment in lung function,” she toldMedPage Today. “We need to do more studies and we need to extend the study in our population.

“But certainly there are some signs that you have to be careful. We need regulations for these e-cigarettes,” she said.

In commenting on the e-cigarette use, Christopher Bullen, MBchB, PhD, MPH, director of the National Institute for Health Innovation, Auckland, New Zealand, told MedPage Today “There have been concerns about lung function with e-cigarettes. People are concerned that if you are going to inhale something deep into your lungs which these things purport to do they could they be causing some sort of adverse effects on lung function or with long-term use could that cause problems such as cancer.

“The jury is still out on that,” Bullen said. “Some studies have shown that there are small changes in lung function which is similar to what you see with cigarettes.

“Still, I think it is highly likely that e-cigarettes are better than actually smoking tobacco. At this point the e-cigarettes are a lot less harmful,” he said