E-cigarettes and respiratory health

In-depth interview conducted by Simona Petrozzi, with Prof. Luca Richeldi, pulmonologist – Director of the Complex Operative Unit of Pneumology at the Agostino Gemelli University Hospital IRCCS in Rome and Full Professor of Respiratory Diseases at the Catholic University of the Sacred Heart.

Alterations of respiratory function
Professor, in recent years we have seen an increasing spread of electronic cigarettes. From a pulmonology perspective, how do you assess this phenomenon and what are the main concerns today regarding respiratory health?

"The main concerns are related to the long-term effects of inhaling aerosols containing nicotine, solvents, flavorings, and other chemical substances, which are not yet fully known. Available studies have highlighted possible inflammatory effects on the airways with alterations in respiratory function.

The experience with EVALI (E-cigarette or Vaping-Associated Lung Injury) has shown that some types of e-cigarettes can also cause serious and persistent lung damage. Many smokers consider e-cigs a less harmful choice compared to traditional cigarettes. From a medical point of view, what effects can they have on the lungs and airways, especially with long-term use? E-cigarettes expose the lungs to fewer toxic substances than traditional cigarettes, but that doesn’t mean they are risk-free. Most studies agree that they are likely less harmful than combustible smoking, but the effects of long-term use are not yet fully understood, precisely because widespread use of this type of cigarette only began about ten years ago.

To make a comparison, the effects of cigarette smoking on mortality and lung cancer were understood thanks to studies with at least 30 years of follow-up. For this reason, one of the main concerns is that the most significant effects of chronic exposure to e-cigarette aerosols may only emerge in the coming decades.

The discomfort of young smokers
More and more teenagers are turning to e-cigarettes, often without ever having smoked before. How concerned are you about this fact, and what risks do you see in the development of early nicotine addiction?

"Particular attention should be given precisely to young people and non-smokers. In these individuals, e-cigarettes do not represent a harm reduction tool, but a potential gateway to nicotine addiction. The problem is not only about exposure to a potentially harmful and addictive substance

But above all, the fact that the adolescent brain is still developing. Available evidence suggests possible effects on attention, concentration, learning ability, and impulse control. Finally, the earlier the exposure to nicotine, the greater the likelihood that addiction will persist into adulthood. Some specialists believe that e-cigarettes can help certain patients reduce or quit traditional smoking. In your clinical experience, can they really be a useful tool, or do they still present too many uncertainties? The most important message remains that the lungs are organs designed to breathe clean air. For smokers, the goal should always be complete cessation of nicotine use, using scientifically validated therapeutic methods and tools. 'Lungs are made to breathe clean air.

If you were to leave a message for young people and for those who today use e-cigarettes casually, what advice would you give as a doctor and as someone who deals with respiratory diseases every day? «I would tell young people not to be fooled by the idea that something that looks modern or technologically advanced is necessarily harmless. Every day we see how precious respiratory function is and how difficult it can be to recover once it’s compromised. Lungs are made to breathe clean air, not aerosols, smoke, or inhaled chemicals. The advice I would give is to protect this asset from a young age, because many respiratory diseases develop slowly and their effects only become evident after years. True freedom isn’t choosing between different ways to take nicotine, but not being dependent on any of them.»