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expert reaction to case study of an individual who developed a lung disease following use of a cannabis e-cigarette

A case study, published in the European Respiratory Journal, reports on an individual who developed a lung disease following use of a cannabis e-cigarette.


Prof John Britton, Director of the UK Centre for Tobacco & Alcohol Studies and Consultant in Respiratory Medicine at the University of Nottingham, said:

“The case describes giant cell interstitial pneumonia, which the authors conclude is due to cobalt exposure from the patient’s e-cigarette. Cobalt exposure can indeed cause this condition, but it is hard to see how they reached this conclusion given that no cobalt particles were detected in the lung samples from the patient. This case is thus yet another example of serious lung disease in someone using an electronic cigarette to vape cannabis, but the extreme rarity of such complications among people who do not vape cannabis demonstrates that the risk of similar acute lung disease among people who vape nicotine as an alternative to smoking tobacco is very low.

“The ERJ editorial is wrong in relation to each and every one of the seven arguments put forward.

“They argue that conventional quitting methods are effective – yet millions of people continue to smoke despite easy access to those methods. Vaping offers another way out, far less dangerous than smoking, and complementing – not replacing – conventional approaches.

“They argue that there is no evidence that vaping is an effective cessation aid.  This is false.  A high quality, peer-reviewed randomised trial earlier this year showed convincingly that ecigs are twice as effective as conventional nicotine replacement therapies.  

“They argue that the tobacco harm reduction strategy is based on undocumented assumptions that alternative nicotine delivery products are generally harmless.  But they are wrong.  No credible scientist argues that vaping is 100% safe – just that it is far less harmful than smoking. 

“They argue that e-cigarette use is likely to increase the likelihood of smoking initiation.  Not only is there no evidence for this claim, but UK smoking rates continue to fall rapidly in both adults and children.  If vaping led to smoking, we would see that pattern being reversed – and it is not.  There is no evidence that vaping is driving smoking prevalence up in other parts of the world either.

“They argue that smokers see vaping as a viable alternative to the use of evidence-based smoking cessation services and smoking cessation pharmacotherapy.  That’s true, but it is a good thing. Vaping enables smokers to quit for good.  It’s helping smokers, not harming them.

“They argue that the EU the tobacco harm reduction strategy is based on incorrect claims that we cannot curb the tobacco epidemic, and that many effective strategies exist to reduce smoking at a population level.  If that is true however, why does the EU still have 100 million smokers?  It’s not that other policies don’t work – it’s just completely illogical to exclude this new one.

“So I’m afraid I think it is these authors who have it wrong.  They are so opposed to nicotine dependency in any form that they are risking the lives of smokers who would benefit by switching completely to e-cigarettes.  There is nothing in this new paper that should change advice to smokers.  If you smoke, switch.  If you don’t smoke, don’t vape.  And just as you wouldn’t buy unlicensed alcoholic drinks, don’t vape cannabis or other bootleg products.”


Dr Nick Hopkinson, Reader in Respiratory Medicine at Imperial College London, said:

“Following on from the outbreak of lung disease in the US that has been linked to vaping cannabis oil, this case provides further reason to avoid it.

“The higher temperature involved in vaping cannabis oil compared to normal products may increase the risk that metal from the heating element is inhaled. 

“People who are vaping in the UK should only use products regulated by the MHRA. Although vaping is much safer than smoking cigarettes, people who do vape should try to quit that too in the long term – but not at the expense of going back to smoking.”


‘Giant cell interstitial pneumonia secondary to cobalt exposure from e-cigarette use’ by Elliott Fels et al. was published in the European Respiratory Journal at 00:01 UK time Thursday 5 December 2019. 


Declared interests

Dr Hopkinson is also the Medical Director of the British Lung Foundation

No others to declare

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