Real World Evidence Doesn’t Support Pneumonia Concerns

— London, UK

Contrary to the headlines, a recent study published in the European Respiratory Journal offers no proof that vaping causes, or significantly increases, the risk of getting pneumonia. In fact, vaping may even decrease the risk in many users, who otherwise would be smoking.

While the research suggests that vaping might increase the risk of pneumonia-related bacteria “sticking” to human and mouse cells, this is speculation and not real evidence. Even senior author Jonathan Grigg, MD, of Queen Mary University of London, admitted that the bacteria that causes pneumonia can be present in airways without causing illness. Curiously, researchers didn’t report whether or not the mice exposed to both vapor and the bacteria actually became sick with pneumonia more often than the mice that weren’t exposed to vapor. In fact, a recently published paper by the same researchers who had originally thought that the “stickiness” increased risk shows that it plays a negligible role in increasing the risk of pneumonia.

“Researchers need to come up with a model that predicts future risk for pneumonia, given all of the different factors that contribute to it,” said Dr. Brian Carter, CASAA’s Director of Scientific Communications. “Then, and only then, can the effect of vaping be accurately estimated in terms of risk.”

“Even if they have the data to do this enormous undertaking, it’s likely that any possible increased risk of pneumonia related to vapor products would be so small as to be inconsequential,” Dr. Carter said. “At the least, that’s the most reasonable conclusion given the small amount of data they’ve provided. These are highly dubious and unreplicated findings that haven’t been proven in real-world situations. It is grossly unethical to report these ‘speculations’ that the general public will likely take as fact.”

Additionally, the researchers did not comment on past studies of propylene glycol, a primary ingredient in vapor products. Studies as far back as the 1940’s through the present day have shown that propylene glycol in aerosol form is a potent antibacterial agent, with “pronounced effects on both pneumococci and hemolytic streptococci.” It was also found that “control tests showed that failure of the glycol-treated microorganisms to grow on the agar plates was due to actual death of the bacteria.” This antibacterial effect of propylene glycol on bacteria is an important question that researchers didn’t ask. Clearly, dead bacteria isn’t going to lead to an infection, regardless of how much of it “sticks.”

Researchers also cited several study limitations, including lack of data on whether the vapor “stickiness” actually would cause humans to get pneumonia. While there are several bacteria types that cause respiratory illness, the study reported on a single type of bacteria associated with pneumonia, Streptococcus pneumoniae, commonly referred to as pneumococcal bacteria. Moreover, they completely failed to account for the effect of immunization that is widely available for this particular cause of pneumonia, which has been shown to reduce the risk of getting this form of the disease dramatically in both smokers and non-smokers.

It is important to note that real-world statistics don’t support the concern that vaping might increase the incidence of pneumonia. “While many would ask that we compare the risk to smoking, it is important to compare this alleged risk to other more important risks that affect the population as a whole. When compared to these other risk factors, it becomes clear that any potential risk from vaping is negligible,” said Bruce Nye, RN, CASAA Board Vice-president. “E-cigarette use has been around for more than 10 years, yet the incidence of pneumonia from all causes has decreased, due in large part to the increased use of pneumonia vaccine and improved hygiene.”

As pointed out in the 2016 study, “Respiratory infections and pneumonia: potential benefits of switching from smoking to vaping” (David Campagna, et al.) “Despite millions of regular vapor users, there has been no evidence of new emerging pneumonia outbreaks in recent years, or reports of infectious pneumonia in the medical literature.” A quick review of FDA Medwatch reports (here and here) of adverse events possibly related to vapor products reveals only three mentions of pneumonia. Considering the fact that pneumonia is a common illness affecting approximately 3 million people a year in the United States, those three unconfirmed reports are more likely due to other well known factors.

“The researchers failed to note that there are no cases of pneumonia in someone using vapor products that did not have other, well known, causal factors present that on their own would be cause for the disease. Indeed, it appears that these researches have deliberately used data and speculation in order to discredit one of the most important low-risk alternatives to smoking.” said Nye.

Both Dr. Carter and Nye agree: “The effect of this type of unfounded pseudo-scientific scare tactic by press release discourages smokers from trying products with a vastly lower risk, leaving them to continue to smoke and placing them at higher risk for diseases, including pneumonia. This is ethically questionable, directly harmful to smokers, and goes against the goal of good public health practice.”