Vaping does not produce clinically important respiratory symptoms, indicates a new international study. Significantly, it’s among the first large-scale studies to look at people who vape but do not have histories of smoking—histories which have led to smoking-related harms being attributed to vaping in past research.
The study, published in the journal Scientific Reports, has been heralded by tobacco harm reduction advocates, though its interpretation has also been the target of some pushback. It’s part of the VERITAS project, led by researchers from of the Center of Excellence for Acceleration of Harm Reduction (CoEHAR), at the University of Catania, Italy.
“This is the first study to focus on how vaping affects the lungs of people who have never smoked, removing the confusion caused by previous smoking,” Dr. Riccardo Polosa, CoEHAR’s founder and one of the study authors, told Filter.
A “common flaw” in the “vast majority” of vaping research, he explained, is that studies fail to identify and study the health of people who have only vaped, hampering researchers’ ability to understand the effects of vaping in isolation.
The new research was conducted with a cross-sectional group of adults who had never smoked, across six global regions in five continents.
One cohort consisted of 491 people who vaped, and had done so in the past seven days. A control group comprised 247 people who had never regularly vaped. Most people in each group were in the 25-44 age range.
Participants in the vaping group were asked for details about their past and current use of nicotine products; disposable and fruit-flavored vapes were most commonly used.
All participants then completed a validated questionnaire known as the Respiratory Symptom Experience Scale (RSES), which Polosa, who is a professor of internal medicine at the University of Catania, with a specialization in respiratory diseases, described as an “important strength” of the study.
The difference between vapers and non-vapers who’d never smoked was very slight. It “wasn’t large enough to matter clinically,” Polosa said.
The RSES required people to report whether—and if so, how frequently—they had experienced various symptoms in the past 30 days, other than when exercising strenuously.
Their answers—concerning symptoms such as coughing in the morning or throughout the day, shortness of breath and wheezing—were given in the form of scores from 0 (never) to 5 (every day) in each category, which could then be averaged out.
Altogether, the combined average score for the vaping group was 0.18 higher than for the control group. This, the researchers wrote, represented “significantly higher frequency of respiratory symptoms”—but at a rate only about one-third of “the minimal clinically important difference of 0.57 for this scoring.”
In other words, the difference between vapers and non-vapers who’d never smoked was very slight. It “wasn’t large enough to matter clinically,” Polosa said.
The authors also cautioned against interpreting their results as proving that vapes caused the difference, when “reverse causation”—people with pre-existing symptoms being more likely to choose vapes instead of cigarettes—might be another possibility.
“Furthermore,” the researchers added, “the absolute frequency of these respiratory symptoms among vapers was relatively low.”
“These findings align with prior research showing minimal respiratory symptoms in vapers, and challenge claims that vaping is as harmful as smoking.”
“Most participants in both groups reported little or no symptoms,” Polosa said, and 83 percent of the vaping group “rarely” or “never” experienced respiratory problems. “These findings align with prior research showing minimal respiratory symptoms in vapers, and challenge claims that vaping is as harmful as smoking.”
One researcher whose controversial work has been associated with such claims is Dr. Stanton Glantz, a retired professor of medicine at the University of California San Francisco.
Glantz respond to the Veritas study with a scathing blog post, provocatively titled, “E-cig advocates publish results showing e-cig users have more respiratory symptoms than nonsmokers.” Focusing on the difference between the vaping and control cohorts, he accused Polosa and his colleagues of “minimizing the importance of the results.”
Asked about that accusation, Polosa replied: “The clinical relevance of the statistically significant difference in RSES between the two study groups [per the] findings is close to zero.”
Polosa continued that while he welcomed constructive feedback, “Stan’s assessment reflects a superficial understanding of the RSES, which has led to errors in his conclusions.”
Glantz has for years been an outspoken opponent of vapes as a tobacco harm reduction strategy. In 2020, a study he co-authored—purportedly indicating that people who vaped had more than twice the heart-attack risk of people who’d never vaped or smoked—was retracted by the Journal of the American Heart Association. It turned out, most of the subjects who’d suffered heart attacks had done so before they started vaping.
Polosa emphasized that his own research adds to the evidence that vapes are relatively harmless, and far safer than the cigarettes they typically replace.
The study “highlights the need for balanced discussions about vaping,” he said. “Future studies, especially those tracking participants over time, are necessary to guide policies on vaping risks and benefits.”
Image (cropped) by David_SMC via Pixabay
Both CoEHAR and The Influence Foundation, which operates Filter, have received grants from Global Action to End Smoking. Filter‘s Editorial Independence Policy applies.
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