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The paradox of the safer cigarette: understanding the pulmonary effects of electronic cigarettes
PP-PDPI, 30 Jun 2024 04:00:55

Kassandra Allbright, John Villandre, Laura E. Crotty Alexander, Michael Zhang, Kambez H. Benam, John Evankovich, Melanie Königshoff, Divay Chandra
European Respiratory Journal 2024 63: 2301494; DOI: 10.1183/13993003.01494-2023 


Electronic cigarette (e-cigarette) use continues to rise globally. E-cigarettes have been presented as safer alternatives to combustion cigarettes that can mitigate the harm associated with tobacco products; however, the degree to which e-cigarette use itself can lead to morbidity and mortality is not fully defined. Herein we describe how e-cigarettes function; discuss the current knowledge of the effects of e-cigarette aerosol on lung cell cytotoxicity, inflammation, antipathogen immune response, mucociliary clearance, oxidative stress, DNA damage, carcinogenesis, matrix remodelling and airway hyperresponsiveness; and summarise the impact on lung diseases, including COPD, respiratory infection, lung cancer and asthma. We highlight how the inclusion of nicotine or flavouring compounds in e-liquids can impact lung toxicity. Finally, we consider the paradox of the safer cigarette: the toxicities of e-cigarettes that can mitigate their potential to serve as a harm reduction tool in the fight against traditional cigarettes, and we summarise the research needed in this underinvestigated area.

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