The first e-cigarettes hit stands about 14 years ago, bolstered by marketers’ claims that they were a safer alternative to regular, combustible cigarettes. Since then, such assertions have fallen out of the spotlight, as thousands of people have become sick following e-cigarette use, and efforts to curb the five million teens who vape have made national news.

Finally, a long-term study is revisiting the industry’s raison d’être. Published in the American Journal of Preventive Medicine, the research found e-cigarette use significantly increases a person’s risk of developing chronic lung diseases like asthma, bronchitis, emphysema, or chronic obstructive pulmonary disease.

What Did the Study Find?

The study authors looked at data that tracked the tobacco habits of 32,000 Americans from 2013 and 2016, none of whom had any reported lung disease initially. Because the research is longitudinal, it offers the most substantial evidence of a causal link between adult e-cigarette use and lung disease.

Researchers concluded “that for e-cigarette users, the odds of developing lung disease increased by about a third, even after controlling for their tobacco use and their clinical and demographic information,” senior author Stanton Glantz, Ph.D., a UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education, said in a statement; “E-cigarettes are harmful on their own, and the effects are independent of smoking conventional tobacco.”

In addition, the study found that people who vaped and smoked tobacco were at an even higher risk of developing chronic lung disease than those who used either product alone. “Dual users, the most common use pattern among people who use e-cigarettes, get the combined risk of e-cigarettes and conventional cigarettes, so they’re actually worse off than tobacco smokers,” Dr. Glantz explained.

What Does EVALI Have To Do With It?

The injuries described in this research differ from those attributed to the mysterious vaping-related lung disease, also known as EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury). As of Dec. 3, EVALI has caused 2,409 hospitalizations and 52 deaths, according to the Centers for Disease Control and Prevention.

What Does the Study Mean for Clinicians?

The results aren’t cut and dry for providers seeking more information to assist patients who smoke. The research did find that switching from smoked tobacco to e-cigarettes lowered the risk of developing lung disease — but fewer than 1% of the smokers completely switched.

“Switching from conventional cigarettes to e-cigarettes exclusively could reduce the risk of lung disease, but very few people do it,” according to Dr. Glantz. “For most smokers, they simply add e-cigarettes and become dual users, significantly increasing their risk of developing lung disease above just smoking.”

The CDC says that “advising patients to discontinue use of e-cigarettes, or vaping, products should be integral to the care approach.” Providers should have resources available or refer patients to services that can help them stop smoking or vaping. For patients who’ve successfully quit smoking using e-cigarettes, discourage them from returning to smoking. Instead, educate them about FDA-approved cessation tools.