Respiratory Experts Release Statement on E-Cigarettes

A new position statement released last week by the Forum of International Respiratory Societies (FIRS) calls attention to the potential adverse health effects of electronic cigarettes and the need for more research about these products.

The group, composed of experts from the world’s leading respiratory health organizations, is calling upon governments to ban or restrict the use of electronic nicotine delivery devices until their health impact is better understood.
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Lead author Dean E. Schraufnagel, MD, presented the statement July 9 at a panel discussion organized by FIRS and the Noncommunicable Disease Alliance to dovetail with the United Nations High-Level Review on the Prevention and Control of Noncommunicable Diseases on July 10-11.

“The gravity of tobacco use on global health and the historical behavior of the tobacco industry that has included deceit about the health effects of tobacco, intentional marketing to children, and manipulating nicotine levels in cigarettes to maintain addiction is background to this statement,” said Schraufnagel, who is past president of the American Thoracic Society.

The statement repeatedly stresses the lack of conclusive research about electronic cigarettes and the need for more evidence-based literature to clear up the many unknowns about them—most importantly, the safety and health impact of these products. The authors say this research needs to come from sources other than the tobacco or e-cigarette industry, should be carried out in a wide variety of settings, and should be subjected to evidentiary review and conveyed clearly and completely to the public.

The paper warns that the addictive power of nicotine and its deleterious health effects should not be underestimated, and advises monitoring of the use of e-cigarettes and their effects on third parties.

“The tobacco industry has previously presented ‘safe’ tobacco options, such as cigarette filters and low tar cigarettes, that have caused untold suffering and the premature death of millions of people,” Schraufnagel said. “Nicotine is central to lifelong addiction, and these are nicotine delivery devices. We must proceed cautiously.”

As for the potential benefits of electronic nicotine delivery devices, the statement notes that their role as an aid to smoking cessation and as a method of harm reduction has not been well studied.

The statement emphasizes that while e-cigarettes generate less tar and carcinogens than combustible cigarettes, there hasn’t been adequate research into the health risks of these devices.

The authors also contend that the increasing availability of e-cigarettes may have a considerable adverse health impact overall, by increasing initiation of combustible nicotine delivery products, impeding the cessation of these products, and increasing social acceptability of smoking and use of nicotine.

“Simply stated, (the Forum’s) position is that the actions of nicotine on the body are as potent as any medicine. Since these are nicotine delivery systems, they should be subject to the same evidentiary scrutiny and regulation as other medicines,” Schraufnagel said. “Nicotine is a tobacco product; if these devices are not regulated as medicine, they should be subject to same regulation as other tobacco products.”

You can read the position statement in its entirety here.

—Colleen Mullarkey

References

1. Schraufnagel DE. “Electronic Cigarettes: A Position Statement of the Forum of International Respiratory Societies.” Presented at: Shared Drivers, Shared Solutions: NCDs, Lung Health and Sustainable Development, New York, N.Y. July 9, 2014.

2. Schraufnagel DE, Blasi F, Drummond MB, Lam DC, Latif E, Rosen MJ, et al. Electronic cigarettes: A position statement of the Forum of International Respiratory Societies. Am J Respir Crit Care Med. 9 Jul 2014. [Epub ahead of print]. DOI: 10.1164/rccm.201407-1198PP