Impact of Chewing Bags, E-Cigarettes, and Combustible Cigarettes on Arterial Stiffness and Small Airway Function in Healthy Students

Several substitute products are discussed as a healthier alternative to smoking, thereunder e-cigarettes and smokeless tobacco products, e.g., chewing bags, which are increasingly used in this context. We investigated the acute effects of chewing bags compared to combustible cigarettes and e-cigarettes with and without nicotine on small airways and arterial stiffness in a head-to-head design. This single-center, four-arm cross-overstudy included 20 healthy occasional smokers (25 +/- 0.6 years). On four test days, participants consumed one product per day. Before, during, and after consumption, peripheral and central hemodynamic as well as arterial stiffness parameters were measured by Mobil-O-Graph (TM) (I.E.M., Germany). Resistance and small airway function were assessed by tremoFlo (R) c-100 (THORASYS Thoracic Medical Systems Inc.). The combustible cigarette and the e-cigarettes with and without nicotine significantly increased the resistance of the small airways (p < 0.05), while chewing bags had no effect. All nicotine containing products (e-cigarette with nicotine, combustible cigarette, chewing bag) as well as the e-cigarette without nicotine significantly increased parameters of hemodynamic and arterial stiffness. Changes in blood pressure and arterial stiffness were similar after smoking, vaping, and using chewing bags. We conclude that e-cigarettes and combustible cigarettes have similar acute harmful effects on small airway dysfunction. All nicotine containing products are associated with an increased cardiovascular risk compared with no product use.

Automated summary

This study compared the acute effects of chewing bags, combustible cigarettes, and e-cigarettes with and without nicotine on small airway function and arterial stiffness. The results showed that combustible cigarettes and e-cigarettes with nicotine significantly increased the resistance of small airways, while chewing bags had no effect. All nicotine-containing products, including e-cigarettes, combustible cigarettes, and chewing bags, as well as e-cigarettes without nicotine, significantly increased hemodynamic and arterial stiffness parameters. The study concluded that e-cigarettes and combustible cigarettes have similar acute harmful effects on small airway dysfunction, and all nicotine-containing products are associated with an increased cardiovascular risk compared to no product use.