-- Lack of Clear Communications About E-Cigarettes Could Lead to More Deaths 
Due to Combustible Cigarette Smoking

Smokers should be confident that vaping with e-cigarettes is much less harmful 
to the lungs than smoking cigarettes, according to a new review of the relevant 
science. A new article published in the Expert Review of Respiratory Medicine 
journal contends that there is growing evidence showing that electronic 
cigarette (EC) emission aerosols are relatively safe compared to tobacco smoke. 
Led by Dr. Riccardo Polosa, director of CoEHAR, the Center of Excellence for 
the Acceleration of HArm Reduction at the University of Catania, The effect of 
e-cigarette aerosol emissions on respiratory health: a narrative review 
(https://bit.ly/2KvFzJN ) provides a critical assessment of the research 
published on the effects of ECs on respiratory system. 

Link: https://www.tandfonline.com/doi/full/10.1080/17476348.2019.1649146

"For smokers who want to do something about their health, our review shows that 
switching to vaping is a very good option if they don't want to or can't quit 
completely.  No-one can prove that e-cigarettes are one hundred percent safe, 
but all the science points to vaping being very much safer than smoking," said 
Dr. Polosa. 

Polosa added: "We agree with Public Health England and the Royal College of 
Physicians of London that it is reasonable to proceed on the basis that vaping 
is at least 95% less risky than smoking, and probably even less risky than 
that."

The findings indicate that the lack of clear and accurate reporting of 
experimental studies has resulted in confusion about the respiratory health 
risks of ECs. 

"The millions of deaths resulting from cigarette smoking illustrate an ongoing, 
immediate and preventable tragedy that should be fully factored into a rational 
risk-benefit analysis," said Dr. Polosa. "In our view, there is a growing body 
of evidence that suggests substituting ECs for cigarettes is an effective 
method of curbing the use of tobacco cigarettes. Unfortunately, consumer 
understanding of the relative risks is distorted and in the past few years 
fewer adult smokers have perceived e-cigarettes as less harmful than tobacco 
cigarettes. These misperceptions have real consequences and require 
corrections."  

The article by Polosa et al. is the first attempt to correct most of these 
misperceptions and to provide authoritative reference when communicating to the 
public how to improve personal and public health of smokers. Former smokers 
currently using ECs and smokers intending to use ECs as a substitute for 
smoking have the right to know the factual information about the potential 
risks and benefits of these products. Improvement in risk communication can 
promote more switching among smokers who do not want or cannot quit and 
eventually reduce or prevent some of the respiratory deaths and disease caused 
by tobacco smoking.

The authors of the review also found that smokers who substituted cigarettes 
with ECs experienced improvements in smoking symptoms (cough, phlegm) and 
exhibited lower levels of exhaled carbon monoxide. These results were even more 
beneficial for smokers who completely replaced cigarettes with ECs. 

For smokers with diseases such as asthma and chronic obstructive pulmonary 
disease (COPD), EC use may have a beneficial effect on symptoms, though 
additional data is needed to determine the complete effect ECs may have on lung 
function. 

Dr. Donald Tashkin, pulmonologist and professor at the David Geffen School of 
Medicine at the University of California, explains: "Yielding accurate findings 
for determining the respiratory health risks and benefits of e-cigarette use 
requires substantial improvement of current research designs. Obviously, only 
large, long-range prospective studies of vapers who have never smoked can 
provide definitive data to demonstrate any potential impacts regular use of 
vaping products may have on long term health." 

Dr. Polosa concludes: "Challenging uninformative or even misleading research 
due to problem with methodology and interpretation of these studies is not 
enough. It is urgent to address common mistakes and to develop robust and 
realistic methodological recommendations in order to adequately assess the 
impact of EC use on human health under normal condition of use. The adoption of 
standardised methods can enable better tobacco harm reduction science."

Notes to Editors - Authors' Biographies:

Riccardo Polosa, MD, PhD, is full Professor of Internal Medicine at the 
University of Catania (Italy), and Director of the Center of Excellence for the 
Acceleration of HArm Reduction (CoEHAR) within the same University. He is 
convenor for the European Working Group on "Requirements and test methods for 
emissions of electronic cigarettes," within the European Committee for 
Standardization (CEN/TC 437). Dr. Polosa is also Coordinator of the "Scientific 
Committee on electronic cigarettes research" promoted by the Italian 
Antismoking League (LIAF).

Renee O'Leary, PhD, is a literature review consultant (21st Century Literature 
Reviews) and tobacco control researcher, and a research affiliate with the 
Canadian Institute for Substance Use Research (Victoria, Canada).  She is the 
author of the evidence report, Clearing the Air: A systematic review on the 
harms and benefits of e-cigarettes and vapour devices (2017), and an EC policy 
article, Claims in vapour device(e-cigarette) regulation: A Narrative Policy 
Framework analysis.  

Dr. Donald Tashkin, MD, is a pulmonologist in Los Angeles, California and 
Professor of Medicine at the David Geffen School of Medicine at the University 
of California, Los Angeles. In the past 2 decades, he has been a leading voice 
in the clinical assessment of marijuana's effect on users' lung health and has 
led efforts into understanding marijuana's effects and associations with other 
pulmonary conditions including chronic obstructive pulmonary disease. 

Dr. Rosalia Emma, M.Sc., PhD, is a researcher at the University of Catania. She 
is currently conducting a study involving the toxicological assessment of 
liquids of electronic cigarettes at the Department of Biomedical Sciences and 
Biotechnologies of the same University.

Dr. Massimo Caruso, M.Sc., PhD, is a researcher and contract Professor of 
Immunopathology at the University of Catania, with expertise in biological 
aspects of asthma and other respiratory diseases. He is conducting a study to 
verify the quality of the methodology used in many toxicological assessments 
conducted on ECs by the tobacco industry. 

MEDIA CONTACT 
CoEHAR Press office 
E-mail: valeria.nicolosi@coehar.it and valeria.nicolosi@hotmail.it 

University of Catania Press office 
E-mail: stampa@unict.it 

SOURCE Riccardo Polosa, University of Catania