New studies suggesting a relationship between various ailments and vaping have been published. Sadly, most lack context and objectivity.

According to a study published last May, in the journal JAMA Network Open, asthmatic adults who reported vaping in the past month were over three times more likely to develop asthma before the age of 27 than those who had never vaped. Given the circulating concerns about the presence of potentially harmful chemicals in vaping products which could trigger asthma, the current study explored the impact of electronic nicotine delivery systems (ENDS) on pulmonary function and respiratory health.

The research team drew data from a large study on tobacco and health outcomes, which included almost 25,000 adults and high school-age teens, surveyed across eight different periods between 2013 and 2021. They found that by 2021, over 11 million U.S. adults reported regular vaping, with over 2.5 million high school students vaping by 2022.

Subsequently the researchers used data from the study to evaluate the link between vaping and early-onset asthma. They concluded that adults who had vaped recently had a 252% higher likelihood of developing asthma early in life compared to non-vapers. Interestingly, no similar correlation was found among youth.
While the research team emphasized the need for public education on the risks of vaping, they may have failed to mention a factor that could explain these findings. Given that it has been previously established that most adult vapers are former smokers, isn’t it possible that the reason why the vaping adults (and not the vaping youth) were more likely to develop asthma, was due to their previous smoking? In fact, previous studies have found that switching from smoking to vaping greatly improves asthma symptoms and those of other respiratory conditions such as COPD.

Collecting superficial data without obtaining background information on participants
Interestingly, a link between suffering from asthma and eczema has been previously established, and a recent study involving over 35,000 U.S. households reported that children with a vaping parent had a 24% higher risk of eczema (atopic dermatitis) than those with non-vaping parents. Led by Dr. Golara Honari from Stanford University, the research suggested that toxins in vape aerosols might trigger skin changes in children. However, once again, we have no information as to whether these parents were previous smokers, and therefore cannot exclude the fact that it could be the previous smoking which triggered the problem.

Additionally, a study published in Toxicology in Vitro investigated the effects of e-cigarette vapour on cultured skin cells. It suggested that exposure to vapour can induce cellular damage, inflammatory responses, and a decrease in cell viability, suggesting a detrimental impact on skin health. While another study in the Journal of Investigative Dermatology explored the effects of nicotine on skin wound healing and found that nicotine could delay the healing process and increase the risk of infections.

Meanwhile, research presented at the ATS 2024 International Conference indicated that former cigarette smokers who vape may have a higher risk of lung cancer than those who do not vape. Led by Dr. Yeon Wook Kim from Seoul National University, this large population-based study, reported that vapes contain carcinogenic compounds similar to traditional cigarettes. The study evaluated over 4 million former smokers and found increased lung cancer and mortality risks among those who vaped.

Similarly, a recent study published in the American Journal of Respiratory Cell and Molecular Biology reported that vaping may cause similar harmful genetic changes as smoking, particularly changes linked to a higher risk of lung cancer. The study involved 30 young adults, including exclusive vapers, smokers, and non-users. Researchers reported that both vapers and smokers exhibited alterations in DNA methylation—a process that can switch genes on or off—affecting critical genes like HIC1, a tumor-suppressing gene associated with lung cancer.

Jumping to conclusions?
Discussing these findings with physician, researcher and smoking cessation expert, Dr. Colin Mendelsohn, he told Vaping Post that the study did indicate that vapers displayed more changes than non-users. However he added, while there were DNA mutations in both vapers and smokers, the changes in smokers were three times more common than in vapers. “In this study, there were mutagenic changes (mutations in the DNA which can lead to cancer) in both vapers and smokers. The changes in smokers were three times more common in vapers.”
“This level of mutagenic change is more than expected given the huge difference in the toxicology of smoking and vaping. Most of the toxicants in smoke are absent from vapour and those present are at levels, mostly below 1% of those in smoke, so changes are possible but are expected to be much less,” explained Mendelsohn.

“It is possible that the vaping caused the changes, but this is not proven. One possible explanation is that some vapers had been past smokers and had not revealed this to the research team.”Dr. Colin Mendelsohn, Physician and Smoking Cessation Expert

In line with comments about previous studies indicating elevated disease risk in vapers, Dr. Mendelsohn highlighted that this could be due to the previous smoking. “It is possible that the vaping caused the changes, but this is not proven. One possible explanation is that some vapers had been past smokers and had not revealed this to the research team.”

Carelessly inferring causations from correlations
Sadly it has become a common occurrence for researchers to correlate any manifested elevated disease risk in current vapers with their vaping, without taking into account their current and and previous smoking status, as well as the amount previously smoked. “The findings conflict with other studies that have found no mutagenic effect from vaping. (Thorne 2016; Emma 2023; Rudd 2020),” added Mendelsohn.

The award winning smoking cessation expert, reiterated the importance of viewing vaping in the right context: as a smoking cessation tool, or at least an alternative to smoking used to reduce the harm from the latter. “Another important question is the clinical significance of these findings. To what extent do they predict cancer in particular? Other studies have estimated that the lifetime risk of cancer from vaping is <0.5% of that from smoking. So a small increase in risk is still likely to be very small overall.”