The effects of vaping in vapers who have never smoked

Despite certain limitations, the study reveals an absence of significant difference in respiratory symptoms between the group of vapers and the control group.

Nouvelle recherche du Center of Excellence for the Acceleration of Harm Reduction

Last April, we reported to you the latest advances in the VERITAS study (Vaping Effects: Real-world InTernAtional Surveillance). Started in 2023, it aimed to study the respiratory effects of vaping in vapers without a history of smoking. A difficult research to carry out since it was necessary to find participants who use an electronic cigarette without having smoked regularly in the past. A few days ago, the results of VERITAS were published in the medical journal, Scientific Reports¹.

Nearly 750 participants

For this research, the team of Professor Riccardo Polosa, well known for his numerous studies concerning personal vaporizers, recruited a total of 748 participants.

471 made up the cohort of vapers. They had to have used an electronic cigarette at least once in the last 7 days, to have smoked fewer than 100 combustible cigarettes in their lifetime, and to have never used, or less than once a week, other products tobacco or containing nicotine.

The remaining 257 participants represented the control cohort. They had to meet the same criteria, but without having vaped.

Methodology

All participants were asked to complete a questionnaire assessing the frequency of occurrence of the following respiratory symptoms:

• Morning cough accompanied by phlegm or mucus.
• Cough frequently during the day.
• Experiencing shortness of breath that makes it difficult to carry out normal daily tasks.
• Being easily out of breath during normal daily activities.
• Having wheezing or a ringing sound in the chest at times when no physical activity is being performed.

Each symptom was accompanied by different responses which were worth a distinct number of points:

• Never: 0 days in the last 30 days = 1 point
• Rarely: 1 to 5 days in the last 30 days = 2 points
• Occasionally: 6 to 15 days = 3 points
• Most days: 16 to 29 days = 4 points
• Every day = 5 points

Results

As the authors of this study indicate, the majority of vapers and control cohorts (85% or more) reported never experiencing each of the five symptoms, “what is below the optimal threshold for differentiating participants with (or without) a diagnosis of respiratory disease”.

After adjusting for certain covariates (effects of age, sex, professional status and education level), the group of vapers had a higher frequency of respiratory symptoms. However, the mean difference was only 0.18 whereas a difference of at least 0.57 would have been required to obtain a clinically significant difference.

This lack of significant difference was also repeated when the researchers studied each of the symptoms individually. The largest difference observed was for the symptom of wheezing, where the difference between the two groups was 0.24, still less than half the figure needed to establish a clinically meaningful difference.

It also seems important to note that smoking history (less than 100 cigarettes smoked in total in life) was higher in the vaping group (30.8% of participants compared to 12.1% in the control cohort), while such as the use of other tobacco products or products containing nicotine, with 18.1% among vapers and 5.8% for the control group.

In conclusion

This study is particularly interesting, since few studies succeed in recruiting vapers who have never smoked, or only rarely, during their life. Its results demonstrate that respiratory symptoms between vapers and non-vapers are generally similar, although e-cigarette users report symptoms more often than the control group, particularly at higher frequencies. « rares » or “occasional”. For scientists, this difference could be explained in particular by the irritating effects of vaping.

“The present study (…) focuses on e-cigarette users without an established or recent smoking history, and thus provides new evidence that vaping, in the absence of a smoking history, is not associated with clinically significant increase in frequency of respiratory symptoms »conclude the researchers.

Limits to keep in mind

It should be noted, however, that this study has several limitations.

First, due to its cross-sectional and observational nature, this research does not make it possible to establish a causal link between vaping and respiratory symptoms. Then, if, in certain cases, the group of vapers actually reported more respiratory symptoms, the participants in this group were more numerous to have declared a smoking history, even though it was limited to a maximum of 100 cigarettes smoked during the life.

Certain factors that could potentially distort the results have also not been studied, such as exposure to environmental pollutants in professional life, or even vaping other substances. For example, when some respondents reported vaping non-nicotine products, perhaps it was cannabis or another substance that could have effects on respiratory symptoms.

Finally, it should be noted that this study was carried out on the internet, based on the participants’ statements. In other words, the respiratory symptoms declared by the participants were not subject to any medical control, just like the absence of a smoking history or any of the information identified in this research.

This study therefore provides new reassuring data concerning the effects of vaping on respiratory health, but its results must still be subject to a certain caution.

¹ Goicoechea, J.Z., Boughner, A., Lee, J.J.C. et al. Respiratory symptoms among e-cigarette users without an established smoking history in the VERITAS cohort. Sci Rep 14, 28549 (2024). https://doi.org/10.1038/s41598-024-80221-8

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