Thursday, 31 May 2018 09:49

By Dr Farsalinos

The biological and clinical evidence that e-cigarettes are really bad for health are rapidly growing. Now, the first evidence linking e-cigarettes with chronic obstructive lung disease (COPD) and laryngeal cancer is raising serious concerns about users of these products and has the public health community sending warning messages to everyone that not only there is no proof that e-cigarettes are less harmful than smoking but that they may very well be even more risky.

Here is a case report proving the link between e-cigarettes and COPD as well as laryngeal cancer. It is the medical history of a 64 year-old retired mechanic in commercial ships. He was a smoker since the age of 16, smoking 3-4 packs (60-80 cigarettes) per day. In 2001, at the age of 47, he was diagnosed with COPD. Despite that, he continued to smoke at the same rate. In 2011, at the age of 57, he was diagnosed with laryngeal cancer. He underwent surgery followed by radiotherapy. During radiotherapy he was still smoking 3 cigarettes per day. Once the radiotherapy sessions ended, he went back to the previous consumption (3-4 packs per day). In 2013, at the age of 59 and 2 years after the laryngeal cancer diagnosis, he tried a 2nd generation e-cigarette (eGo type battery) as a smoking cessation aid, without success. In early 2016, at the age of 62, he had a serious COPD crisis and deterioration of his condition. He was hospitalized in a respiratory disease clinic and was discharged few days later with oxygen therapy at home and instructions to use oxygen for 18 hours per day. He was basically institutionalized at home, being unable to go out and developing dyspnea even when walking from one room to the next inside the house. But he kept on smoking. One week later (after 46 years of smoking) he decided to try a 3rd generation e-cigarette (variable wattage battery and tank atomizer). He managed to quit smoking on day 1. He stopped using oxygen therapy after about 1 week, and he eventually returned all the oxygen equipment and nebulizers that he obtained after the hospitalization. Today, he is fully mobilized, he is riding a scooter, he is building his own atomizer coils and he managed to convince his son and other relatives to quit smoking with the use of e-cigarettes.

This person is an e-cigarette user and suffers from COPD and laryngeal cancer. But the link between e-cigarettes and these diseases is not only coming from this case report. This person, along with 1000 other daily e-cigarette users and non-users participated in a cross sectional survey which examined the association between these conditions and e-cigarette use. The study found 11 e-cigarette users like the case presented above, but only 6 non-users with these conditions. That meant that e-cigarette users were about twice as likely to have COPD and laryngeal cancer compared to non-users (I think the odds ratio is about 1.86 with the number I present above). The findings are extremely alarming and cannot be ignored. This is clinical evidence added to the biological data from cell and animal studies showing that e-cigarettes cause inflammation, genetic changes and immunological modulation (ignoring that usually there was no comparison with smoking while exposure levels to e-cigarettes were extreme).

Note #1: the above is a real case of smoker who developed serious medical conditions BEFORE he initiated e-cigarette use. The participation to the cross sectional survey is science fiction, not different from comments that such an association (i.e. people who smoke and develop smoking-related disease at some point become desperate and try e-cigarettes as an aid to quit smoking) is proof of a “link” between e-cigarettes and disease (clearly implying that e-cigarettes cause the disease). To their credit, the authors of the study (conference abstract) clearly mentioned that: “Due to the fact that the data is cross-sectional, it is unknown whether E-cigs could contribute to COPD development, or if people who have COPD are more likely to use E-cigs (possibly as a harm reduction method).”

Note #2: let’s assume that the case report above was a bit different, that the smoker switched from smoking to e-cigarette use in 2011 (after 41 years of smoking) and developed laryngeal cancer in 2016 (5 years after vaping). If anyone believes that the cause for the laryngeal cancer would be vaping and not smoking, I would appreciate if he would email me with his/her “convincing” arguments…