Regional Healthcare Agency of Abruzzo, Pescara, Italy.
Eur Rev Med Pharmacol Sci. 2019 Jan;23(1):402-412. doi: 10.26355/eurrev_201901_16789.
More than a decade after e-cigarette (e-cig) market launch, limited information are available on their safety after 24 months of use. In 2013, we started the first observational study assessing e-cig long-term effectiveness and safety, directly comparing tobacco smokers and e-cig users. Here we report the results after four years of follow-up.
Adults (30-75 years) were included if: smokers of ≥1 tobacco cigarette/day (tobacco smokers); users of any type of e-cig inhaling ≥50 puffs weekly (e-cig users); users of both tobacco and e-cig (dual users). Data were collected by phone and/or internet, and carbon monoxide levels tested in 50% of those declaring tobacco abstinence. Main outcomes were: possibly smoking-related diseases (PSRD; validated through hospital discharge data or visit in 62.6% of the sample); 4-year tobacco abstinence; number of tobacco cigarettes/day.
Data were available for 228 e-cig users (all ex-smokers), 471 tobacco smokers, 216 dual users. A PSRD was observed in 73 subjects (8.0%). No differences emerged across groups in PSRD rates, with negligible variations in self-reported health. Of e-cig users, 63.6% remained tobacco abstinent; dual users and tobacco smokers showed non-significantly different rates of tobacco (33.8% vs. 26.8%) and all-product (20.2% vs. 19.4%) cessation, and a similar decrease in cigarettes/day. Almost 40% of the sample switched at least once (tobacco smokers: 17.2%; dual users: 81.9%).
After four years, a scarce, non-significant harm reduction was observed among e-cig or dual users. Given the long-lasting health effects of tobacco smoking, the benefits of e-cig use may start being detectable at the next follow-up (six years). The complete switch to e-cig may help tobacco quitters remain abstinent, but e-cig use in addition to tobacco did not increase the likelihood of smoking cessation or reduction.
电子烟（e-cigarette）市场推出十多年后，我们对其使用 24 个月后的安全性知之甚少。2013 年，我们开始进行第一项观察性研究，直接比较吸烟者和电子烟使用者，评估电子烟的长期效果和安全性。在这里，我们报告了四年随访后的结果。
纳入标准为：每天至少吸 1 支香烟的成年人（吸烟者）；每周至少吸 50 口任何类型电子烟的成年人（电子烟使用者）；同时使用烟草和电子烟的成年人（双重使用者）。通过电话和/或互联网收集数据，并对 50%声称已戒烟的人进行一氧化碳检测。主要结果为：可能与吸烟相关的疾病（PSRD；通过对样本中 62.6%的人的住院记录或就诊情况进行验证）；4 年的烟草戒烟；每天吸烟的数量。
228 名电子烟使用者（均为前吸烟者）、471 名吸烟者和 216 名双重使用者可提供数据。73 名受试者（8.0%）出现 PSRD。各组 PSRD 发生率无差异，自述健康状况变化不大。在电子烟使用者中，63.6%仍保持烟草戒烟；双重使用者和吸烟者的烟草（33.8%比 26.8%）和所有产品（20.2%比 19.4%）戒烟率差异无统计学意义，每日吸烟量也有相似下降。样本中近 40%的人至少换过一次（吸烟者：17.2%；双重使用者：81.9%）。
四年后，电子烟或双重使用者的危害减少较少，无显著差异。鉴于吸烟对健康的长期影响，电子烟使用的益处可能在下一次随访（六年）中开始显现。完全改用电子烟可能有助于帮助戒烟者保持戒烟状态，但电子烟的使用并不能增加戒烟或减少吸烟的可能性。
