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Summary of presentations:

Health effects of e-cigarettes and heated tobacco products

Presented by Magnus Lundbäck, Sweden

Efficacy of different methods of smoking cessation

Presented by Linnea Hedman, Sweden

Are e-cigarettes a less harmful replacement for smoking cigarettes?

That is what all major tobacco industries, all with e-cigarette brands of their own, argue. However, the major target group for these products are not smokers, but nicotine-naïve youths and children. Marketed aggressively in social media channels such as TikTok and Snapchat, they reach a young audience, under the radar for most grown-ups. The fruity and candy-like flavors also happen to be just what kids like.

Rocketing market

The market is growing rapidly and the global market for these products has been estimated to 28 billion dollars. According to a national survey among teenagers in Sweden, the share of teenagers in the 11th school year that had vaped at least once in the past 30 days increased from roughly 5% in 2021 to a jaw-dropping 25% the following year. (Report from CAN, the Swedish Council for Information on Alcohol and Other Drugs).

Lung injury from use

The first wakeup call was in 2019, and the identification of EVALI (e-cigarette or vaping use-associated lung injury). More than 2500 cases were found, whereof 60 fatal cases, often (but not always) associated with use of THL (cannabis oil) with additive Vitamine E acetate.

A harmful cocktail

The aerosol from e-liquids has been found to contain fine and ultrafine particles, reaching all parts of the lungs. These particles contain carcinogenic substances (nitrose amines, polycyclic aromatic hydrocarbons (PAH)), and formaldehyde, triggering inflammation, reactive oxygen species which impose oxidative stress and metals, causing allergies. In the frustrating wait to learn long term consequences of e-cigarettes, vaping and heated tobacco product use, short-term human studies might indicate future risks. What is known is that vaping increases airway obstruction, increases the concentration of particles in lungs, elevates blood pressure, pulse and levels of endothelial progenitor cells.

Short term effects

Cardiologist Magnus Lundbäck and team have been looking specifically at cardiovascular effects of short-term exposure and have found that vaping nicotine is associated with increased arterial stiffness1 and increased levels of blood markers for vascular stress and vascular injury and increased thrombosis2.

Can vaping cause COPD or lung cancer?

In animal studies, e-cigarette use causes emphysema and COPD but as these diseases develop over time, it might still be a while before vaping can be linked to COPD in humans. Answering a question from the audience on whether vaping can cause lung cancer, Magnus responded that it is highly likely given the proof of inflammatory response, presence of markers of cell injury and e-liquid content of carcinogenic substances.

Are e-cigarettes helpful in smoking cessation?

The decision to quit smoking is a personal decision, and the majority of quit attempts are unassisted, and the most successful ones are the spontaneous quit attempts, without cutting down3. In some countries, e.g. the UK, e-cigarettes are recommended as nicotine replacement products, even in pregnancy. However, according to behavioral scientist Linnea Hedman, most of the studies on use of vaping as smoking cessation tool include people that were already motivated to stop smoking. Hedman presented the outcome of a systematic review4 on e-cigarette smoking and subsequent smoking cessation, finding no quality evidence for use of e-cigarettes as way to stop smoking.

So – how to stop?

She ends with a recommendation to use WHO’s “A guide for tobacco users to quit” and to make use of local phone smoking cessation help numbers. Focus, says Hedman, should be to aim for freedom from dependency.

Erika Petersson
Medical Digital Content Manager, Chiesi


  1. Antoniewicz L, Brynedal A, Hedman L, Lundbäck M, Bosson JA. Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways. Cardiovasc Toxicol. 2019 Oct;19(5):441-450. doi: 10.1007/s12012-019-09516-x. PMID: 30963443; PMCID: PMC6746878.
  2. Lyytinen, G., Brynedal, A., Anesäter, E. et al. Electronic Cigarette Vaping with Nicotine Causes Increased Thrombogenicity and Impaired Microvascular Function in Healthy Volunteers: A Randomised Clinical Trial. Cardiovasc Toxicol 23, 255–264 (2023).
  3. Claire Garnett, Lion Shahab, Tobias Raupach, Robert West, Jamie Brown, Understanding the Association Between Spontaneous Quit Attempts and Improved Smoking Cessation Success Rates: A Population Survey in England With 6-Month Follow-up, Nicotine & Tobacco Research, Volume 22, Issue 9, September 2020, Pages 1460–1467,
  4. Hedman L, Galanti MR, Ryk L, Gilljam H, Adermark L. Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis. Tobacco Prevention & Cessation. 2021;7(October):62.

A missing measurement: vaping exposure

The exposure from the use of e-cigarettes cannot be easily quantified in analogy with the standard “pack years” for quantifying exposure of cigarette. For studies on correlation between exposure and risks, a standardized measure will be needed.

ID 8659-18.06.2024