Molecular Imaging of Pulmonary Inflammation: Claiming That Vaping Is More Harmful Than Smoking Is Unsupported
Abstract
TO THE EDITOR:We read with interest the recent pilot study by Wetherill et al. (1). The authors used F-6-(1/2)(2-fluoropropyl)-4methylpyridin-2-amine (F-NOS) PET imaging to quantify inducible nitric oxide synthase expression to characterize oxidative stress and inflammation in the lungs of 5 electronic cigarette (EC) users, 5 tobacco cigarette (TC) smokers, and 5 controls who had never smoked or vaped. PET imaging showedmuch greater F-NOS nondisplaceable binding potential in the lungs of EC users than in TC smokers, but contrary to expectations, no difference between TC smokers and controls was found. The reported absence of difference in F-NOS nondisplaceable binding potential between TC smokers and controls is inconsistent with the suggestion given by enhanced nondisplaceable binding potential on F-NOS imaging that there is oxidative stress and inflammation in the lungs, given that smoking causes both inflammatory responses and oxidative stress. This issue renders interpretation of the study’s findings invalid. In consideration of the very small sample size and low reproducibility of F-NOS PET imaging, the likelihood of chance findings is very high. There would have been more confidence in the interpretation if former smokers had been included in the study design; however, this was not done. Important confounders, such as allergies of the upper respiratory tract with inducible nitric oxide synthase upregulation and high levels of exhaled nitric oxide (2) and prior and…
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Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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