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The Forum of International Respiratory Societies (FIRS)-an organization composed of six leading international respiratory societies working together to improve lung health globally through advocacy and joint initiatives-has issued a position statement on the potential adverse effects of electronic cigarettes on human health.

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The statement, now available online ahead of print in the American Journal of Respiratory and Critical Care Medicine (DOI: 10.1164/rccm.201407-1198PP), calls on governments to ban or restrict their use until health impacts are better known.


"The gravity of tobacco use on global health and the historical behavior of the tobacco industry that has included deceit about the health effects of tobacco, intentional marketing to children, and manipulating nicotine levels in cigarettes to maintain addiction should prompt us to proceed cautiously," the statement's lead author, Dean Schraufnagel, MD, Past President of the American Thoracic Society (ATS) and Professor of Medicine and Pathology Program Director of the Pulmonary and Critical Care Fellowship at the University of Illinois at Chicago, said in a news release. "Nicotine is central to lifelong addiction, and these are nicotine-delivery devices."


The position statement notes:


* The safety of electronic cigarettes has not been adequately demonstrated;


* The addictive power of nicotine and its untoward effects should not be underestimated;


* The potential benefits of electronic nicotine delivery devices, including harm reduction and as an aid to smoking cessation, have not been well studied;


* Any potential benefits to an individual smoker should be weighed against the harm to the population overall of leading to an increased social acceptability of smoking and use of nicotine;


* Health and safety claims regarding electronic nicotine-delivery devices should be subject to evidentiary review;


* The adverse health effects for third parties exposed to the emissions of electronic cigarettes cannot be excluded;


* Electronic nicotine-delivery devices should be restricted or banned, at least until more information about their safety is available;


* If electronic nicotine-delivery devices are permitted, they should be regulated as medicines and subject to the same evidentiary review of other medicines;


* If electronic nicotine-delivery devices are not regulated as medicines, they should be regulated as tobacco products;


* Research supported by sources other than the tobacco or electronic cigarette industry should be carried out to determine the impact of electronic nicotine-delivery devices on health in a wide variety of settings;


* The use and population effects of electronic nicotine delivery devices should be monitored; and


* All information derived from this research should be conveyed to the public in a clear manner.



FIRS includes Asociacion Latinoamericana del Thorax, the American College of Chest Physicians, the American Thoracic Society, the Asia Pacific Society of Respirology, the European Respiratory Society, the International Union Against Tuberculosis and Lung Disease, and the Pan African Thoracic Society.