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Will vaping affect my FeNO level?

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Research has shown that cigarette smoking can reduce FeNO levels by around 60%1 but what about vaping? Electronic or ‘e-cigarettes’ have become popular as a substitute for traditional tobacco smoking. However, concerns have been raised about their potential impact on public health. One question of particular interest is whether vaping affects fractional exhaled nitric oxide (FeNO) levels, which can be used to diagnose and manage asthma.2 In this article, we will explore the evidence.

FeNO stands for fractional exhaled nitric oxide. A FeNO test is a simple procedure that measures the level of inflammation in your lungs, which is a common part of asthma.3,4 Having a high FeNO score means you are more likely to be diagnosed with asthma.5 Smokers usually have lower FeNO but what about vaping?1 Does that have the same effect? Like smoking, using e-cigarettes should be taken into account during your asthma assessment but it’s unclear how much it affects FeNO.

With vaping on the rise, several studies have investigated the topic. Research published in 2022 uncovered changes in FeNO after vaping over a 30-minute period.6 The results showed a significant change in FeNO levels, revealing a decrease in FeNO from the patient’s normal level. A substantial increase took place from minute 30 to 45, suggesting the effect of vaping could be temporary. When asthmatics are compared to non-sufferers, some reports indicate a decrease in FeNO in healthy people and an increase in those with asthma. Other studies have reported a decrease in smokers with lung diseases so it seems as though each patient’s circumstances should be viewed individually.6

More research, carried out in 2020, showed that how much our body’s level of nitric oxide is changed by exposure to e-cigarettes has caused some debate.7 This team reported that, although people had reduced FeNO immediately after vaping – indicating a reduction in their airway inflammation – a separate study found there was no significant difference in FeNO after they were exposed to a laboratory-made mixture of propylene glycol and glycerin, the most common substances used in e-cigarette liquids.7,8

Until scientists know more, it is important to remember that the long-term effect of vaping on FeNO levels is still not well understood. Vaping involves inhaling liquids that often contain various chemicals, including nicotine, flavourings, and other additives, that may result in negative lung or respiratory conditions.9

“Any product with ‘cigarette’ in its name should be a red flag for anyone who has asthma or allergies,” stresses the Allergy and Asthma Network of America.9 The charity Asthma + Lung UK agrees, saying that although research suggests vaping causes less exposure to the toxins that cause lung disease than smoking tobacco, e-cigarettes are not risk-free. “We know that vaping can cause inflammation in the airways, which might cause harm over time,” they say.10

In short, current research suggests that vaping can have an impact on FeNO levels, albeit to a lesser extent than traditional smoking. Exposure to vaping seems to cause a temporary decrease in FeNO levels according to some studies, but these changes appear not to last long.6,7,11 However, the long-term effects of vaping on FeNO levels and airway inflammation need further investigation.

Knowing your FeNO score means your healthcare team can take steps to help you control your asthma.3 High FeNO indicates that you could have an asthma attack at any time so it is important to manage your condition and this includes understanding any factors that may affect your FeNO level.3

You can find out more about how FeNO helps doctors to assess airway inflammation for better asthma care at fenoandasthma.com. You can also ask your healthcare team for information and find out where you can take a FeNO test.

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Supporting evidence:

1. Prof. Kjell Alving. Factors affecting FeNO: confounders vs determinants. Available at; https://www.niox.com/prof-alving-webinar/ 2. Menzies-Gow A et al. Clinical utility of fractional exhaled nitric oxide in severe asthma management. Eur Respir J. 2020;55(3):1901633. 3. Busse WW et al. Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. Lancet Respir Med. 2021;9(10):1165-1173. 4. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2022. Available at; https://ginasthma.org/ 5. Wang Z et al. Agency for Healthcare Research and Quality (AHRQ). The clinical utility of fractional exhaled nitric oxide (FeNO) in asthma management. Comparative Effectiveness Reviews, 197. 2017. 6. Kandhola A et al. Measurement and Changes of FeNO Levels While Vaping with a Brief Education Intervention Session. ERJ Open Research. 2022. 7. Traboulsi H et al. Inhalation toxicology of vaping products and implications for pulmonary health. International journal of molecular sciences. 2020;21(10):3495. 8. Harvanko A et al. Stimulus effects of propylene glycol and vegetable glycerin in electronic cigarette liquids. Drug and alcohol dependence. 2019;194:326-9. 9. Allergy & Asthma Network. Can you smoke if you have asthma? Available at; https://allergyasthmanetwork.org/what-is-asthma/vaping-smoking-with-asthma/. Accessed; June 2023 10. Asthma + Lung UK. Vaping and e-cigarettes. Available at; https://www.asthmaandlung.org.uk/living-with/stop-smoking/vaping. Accessed; June 2023 11. Schober W et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. International journal of hygiene and environmental health. 2014;217(6):628-37.

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