Updated: June 2016
If you trawl the net, you'll find little data on how e-cigarettes effect your lungs.
So, with some help from researcher Paul Bergen and vaping bloggers (and from lots of you lovely readers!) I asked vapers how switching to an electronic cigarette had affected their smoker's cough, ability to exercise and do strenuous jobs and lung capacity.
I'm leaving the detailed analysis to scientist and researcher Dr Konstantinos Farsalinos, who has kindly agreed to analyse the results. You can read his analysis here.
(Since this post was originally written, we've updated it to include results from the latest research. You can also see the results of the first long term study into lungs here.)
Update: Read Dr Farsalinos' analysis here.
Chart 1: How Long Have People Been Using Electronic Cigarettes?
We asked:
How long have you been using electronic cigarettes:
Obviously, the less time you have been vaping the less likely it is to have any effect on your health.
It's interesting, though, that nearly 40% of those surveyed have been vaping for more than a year. That's very different from the survey we carried out with the University of Alberta in 2009, when most vapers had only been using electronic cigarettes for a short period of time.
Chart 2: Change In Smoking Habits After Switching To Ecigs.
We asked:
Which of the following is true:
- After switching to e-cigs, you smoked fewer tobacco cigarettes (or stopped smoking tobacco altogether).
- After switching to e-cigs, you smoked more tobacco cigarettes.
- You didn't smoke before using e-cigs.
Although the survey is focussed on health improvements, it's heartening to see only 4 people claimed they smoked more after switching to e-cigs. I was surprised, though, to see 17 people who hadn't smoked before starting to use e-cigarettes.
Chart 3: Vaping v. Smoking
We asked:
Do you:
- vape daily and only vape
- vape mostly with the occasional or rare cigarette
- still smoke, but vape more than you smoke
- still smoke, and smoke more than you vape
This question is important, because we need to see if any health improvements are greater among people who only use electronic cigarettes. (I am going to leave the cross analysis to Dr Farsalinos, though!)
Again, it's not the focus of the survey, but it's good to see that 77% have stopped using tobacco cigarettes entirely, and 15% only have the occasional cigarette.
Chart 4 Smoker's Cough After Switching
We asked:
If you had a recurring cough before switching to electronic cigarettes:
- is the cough worse?
- is the cough unchanged?
- has the cough got better or disappeared?
- question not applicable
The results were clear: almost two thirds (63.9%) felt that their smoker's cough was better after switching to ecigarettes. Less than 3.4% felt that the cough was worse or unchanged.
Related: Why you cough when you vape - and how to stop it
Chart 5: Ability to Exercise After Switching To Vaping
We asked:
Has your ability to exercise:
- got worse
- improved
- stayed the same
- question not applicable
Great news if you like sport - 72.9% of vapers reported an improved ability to exercise after switching.
Chart 6: Ability to Do Strenuous Jobs After Switching to Vaping
We asked:
Has your ability to do strenuous jobs (e.g. gardening, lifting, housework e.t.c.):
- got worse
- got better
- stayed the same
- question not applicable
Of course, some people don't exercise - but nearly all of us have to do housework. So we wanted to know how vapers' ability to do tiring jobs had changed.
Over 66% of vapers had experienced an improvement in ability to do strenuous jobs, although this did not match the number of people who reported an improvement in the ability to exercise.
Chart 7: Lung Capacity After Switching to Electronic Cigarettes
We asked:If you are aware of your lung capacity, has it:
- got worse
- improved
- stayed the same
- question not applicable
The aim of the survey was to work out what the effect of electronic cigarettes on the lungs were, so this was the most important question! The results were amazing - over 70% reported an improvement in lung capacity.
Chart 8: Were Changes in Lung Capacity Confirmed by a Doctor?
We asked:
Have changes in lung capacity been confirmed by a doctor:
- yes
- no
- question not applicable
Assessing your change in lung capacity is a more subjective question than most of the questions here.
But from conversations with vapers I know some have had their lung capacity measured, usually because of existing health problems.
22.2% of the vapers told us that changes in lung capacity had been confirmed by a doctor, which I hope will be useful when assessing the validity of the results.
(Fewer people answered this question, as we used skip logic so that people who had answered not applicable to question eight jumped to the end of the survey.)
Potential Problems With This Survey
Of course, as Professor Carl Philips recently pointed out, all open surveys have problems. To my mind some of the biggest problems with this survey are:
1. As participants were recruited by social media, vaping forums and blogs, many participants are likely to be enthusiastic vapers which may lead to bias in subjective questions.
2. At the same time, there is also a danger that:
- those who don't like vaping will deliberately answer questions to throw vaping in a negative light
- people may misread the questions, especially if they are completing the survey in a hurry
3. Ideally, this study would be carried out by a University or a Doctor - the only reason we did it was because the data was simply not out there.
Nevertheless, the results are fascinating, back up anecdotal evidence - and hopefully will inspire further research.
E-Cigarettes and Your Lungs: What the Research Says
While the survey showed that vapers report improvements in smoker’s coughs, their ability to exercise or do strenuous work and in their lung capacity, we are also starting to see plenty of peer-reviewed research looking into the effect of vaping on our lungs.
The results, as you may expect (or at least hope), are in agreement with the results of the survey, although research does reveal a few extra details that are important to vapers.
Before we take a look at what the research says, it’s important to remember that all we have so far is short-term evidence.
This can give us a general idea of how vaping is likely to affect our lungs over time.
But it’s not easy to say that something which looks bad over the short-term will really be bad over the long term, or that something that looks good over the short term will really be good over the long term. It’s not ideal, but that’s just how it is.
The evidence so far comes in the form of cell studies, studies on real-world vapers and older evidence on the effects of PG and VG themselves.
Cell Studies
Drawing conclusions based on cells removed from a body (in vitro – i.e. in a cell culture) is quite hard. They don’t necessarily react like they would in a real person, and it’s hard to expose them to a realistic amount of vapour or e-liquid. However, they’re a useful starting-point for finding potential ways something could cause harm or have beneficial effects.For e-cigarettes, the studies looking at the effects on human lung cells have found some evidence of inflammation, but they suggest that the toxicity of vapour depends more on the flavourings used than the key ingredients of PG, VG and nicotine. The effects from exposure to smoke are much worse.
Real-World Vapers
Studies looking at real-world vapers address exactly what we’re interested in, but the ones we have so far only look over the very short term, even just 5 minutes of vaping.
These studies often show small effects from vaping on a measure of inflammation (exhaled nitric oxide) and minor increases in airway resistance. Both of these effects are small and probably won’t translate into real-world risks for vapers. A study looking at the main type of lung function test in use (spirometry testing) showed no impact of either first-hand or second-hand vaping on the lungs.
Another study looked at this type of test in asthmatic smokers, and found improvements in spirometry results after switching to vaping, and improvements in the condition overall. This was a very small study, but it’s still promising.
Other Evidence on Inhaling PG and VG
Although flavourings in particular can change things, what we’re mainly doing when we vape is inhaling PG and VG, so evidence on that can be useful too.
There are quite a few animal studies on inhaling PG and VG, with one example looking at PG inhalation in monkeys and rats for up to 18 months. This found no apparent impacts on the lungs from breathing air completely saturated with PG.
A study looking at VG inhalation in rats found only minor changes in the cells lining the airways after 13 weeks.
PG is also used in theatrical fog machines, and there is some evidence on this too. One study followed 439 performers in Broadway musicals for two years, and found that those exposed to the most PG fog reported more breathing-related symptoms, and showed signs of inflammation. However, there were no serious health effects found.
For vapers, the big limitation here is that we’re inhaling a lot more PG, as well as VG, but it’s still an encouraging sign.
Also see: Propylene Glycol in E-Cigs: Is PG dangerous to inhale?
What Does it All Mean?
The studies so far strongly support the conclusion that vaping is much better for your lungs than smoking, but if you’re worried about absolute risk (in comparison to neither smoking nor vaping), the answer is a quite tedious “we’re not sure yet.”
There probably will be some effects on our lungs, but we don’t have any evidence to definitively show that. The bottom line is: for your health, it’s best not to smoke or vape, but if it’s a choice between the two, vaping is the best option by far.
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