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Vaping can have long-term risks, according to a new study

As e-cigarette-related lung injury cases continue to lead to hospitalizations, and even deaths, across the US, researchers have found that vaping can have long-term health effects, too. A new study has associated vaping with an elevated risk of chronic lung disease, CNN reports.

Although vapes have been marketed as safer alternatives to regular, combustible cigarettes, the findings, published in the American Journal of Preventive Medicine on Monday, December 16, add to mounting evidence that these products are still dangerous. Initially, we thought we really only had to worry about bootleg vapes, but recent reports that Juul sold more than a million contaminated vape pods that they knew to be contaminated suggests that there are risks to virtually all types.

The CDC, FDA, and state authorities are still investigating exactly which ingredients are to blame for vape-related lung injury, which has led to a reported 2,409 hospitalizations and 52 deaths as of December 10, per the CDC. Unraveling the effects of e-cig ingredients is tricky, partly because they can behave differently when heated and turned into vapor. In fact, substances we typically view as benign — such as vitamin E, found in some food and skincare products yet apparently associated with the lung injury outbreak — may be harmful when vaped.

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In the new study, researchers at the University of California, San Francisco examined data on 32,320 adults in the US, gathered from 2013 to 2016, according to CNN. They homed in on whether these adults had ever vaped, or smoked regular cigarettes or other combustible tobacco products, as well as whether a health professional had told them they had a respiratory condition.

Vapers were 1.3 times more likely to develop chronic lung disease, including bronchitis, asthma, and chronic obstructive pulmonary disease (COPD), than those who had never vaped or smoked, while combustible tobacco smokers were about 1.6 times more likely to do so, Stanton Glantz, director of UCSF’s Center for Tobacco Control Research and Education, and the study’s senior author, told CNN. In other words, even if smokers were slightly more likely than vapers to develop chronic lung disease, vaping was still significantly associated with a higher risk.

Meanwhile, those who vaped and smoked were 3.3 times more likely to develop chronic lung disease, and in fact, many smokers who tried vaping did end up doing both, according to NBC News. “Most adults who use e-cigarettes continue to smoke,” Glantz told the outlet. Indeed, it's still unclear whether vaping can help smokers wean themselves off of regular cigarettes, according to the CDC.

CNN points out that the study relied on self-reported data, which is susceptible to bias. Ideally, the study would have directly measured the health effects of vaping and smoking in the adult participants. Glantz also noted that although three years is a long time, most studies on the development of lung disease last for one or two decades. That his study saw evidence of chronic lung disease associated with vaping after only three years is troubling.

Glantz's study is among the first to investigate the long-term health effects of vaping. Amid the lung injury outbreak — and now, evidence that vaping increases the risk of chronic lung disease — debating whether vaping is "safer" than smoking loses sight of the bigger issue: that vaping appears to carry both short- and long-term risks.