The University of Birmingham is launching a groundbreaking research project to shed light on the long-term pros and cons of vaping as a smoking cessation method. With £1.55 million in funding from the Medical Research Council (MRC), the EVALUATE study will, for the first time, examine over a year how e-cigarettes affect the airways. This could provide crucial data to clarify the safety of vaping as a transitional solution and assess risks with prolonged use.
Unlike previous studies that only captured snapshots of lung function, EVALUATE dynamically tracks changes over 12 months. The project focuses on the biological effects of vaping on lung epithelial cells, immune cells, inflammatory markers, and the airway microbiome. The goal is to understand if and how e-cigarettes promote or damage lung recovery after smoking.
The study involves 200 healthy smokers from the smoking cessation clinic and community services of the University Hospitals Birmingham (UHB) NHS Foundation Trust. Half of the participants will switch to nicotine replacement therapies such as patches or gums, and the other half to e-cigarettes. The group will be supplemented by 40 individuals who have neither smoked nor vaped, to provide comparison data. Samples, including blood, immune cells, and epithelial cells from the airways – the latter through bronchoscopies – will be regularly collected throughout the year.
Lead researcher Aaron Scott, Associate Professor of Respiratory Sciences at UHB, emphasizes the importance of cell studies. Airway immune cells and the epithelium lining the lungs are central to the development of smoking-related diseases. Previous laboratory experiments by Scott's team have already shown that harmful substances in e-cigarette vapor – generated by the breakdown of e-liquid – can damage immune cells, regardless of nicotine. Some of these toxins are similar to components of cigarette smoke and could burden the airways.
The interdisciplinary team is also analyzing changes in the airway microbiome. Billions of microorganisms in the lungs and on the mucous membranes maintain a delicate balance that smoking massively disrupts. The study will clarify whether vaping restores or further destabilizes this balance, and how this develops over time. This will be supplemented by a multi-omics analysis tracking gene and protein expression to decipher molecular mechanisms of cell regeneration after smoking cessation.
Professor David Thickett, head of respiratory medicine at the University of Birmingham and clinical coordinator of the project, highlights that EVALUATE will provide clear data on the safety of vaping as a short-term strategy. At the same time, it aims to identify risks associated with long-term use, enabling affected individuals to make informed decisions – for example, how long e-cigarettes should be used after quitting smoking. The study runs parallel to a clinical trial in patients with chronic obstructive pulmonary disease (COPD), examining the impact of e-cigarettes in vulnerable groups.
Other partners, including the University of Bath and Aberystwyth University, are investigating the accumulation of pollutants in the airways using mass spectrometry. This allows for precise measurements of how toxins change from smoking to vaping and whether they impair immune function. The NIHR Birmingham Biomedical Research Centre supports sample collection and analysis.
Recruitment begins in autumn 2025. Interested smokers can contact the UHB smoking cessation clinic by email. The results could have a lasting impact on public health policy, especially given the rise in vaping among adolescents and ex-smokers. Previous evidence suggests that e-cigarettes are more harmful than not smoking, but less risky than cigarettes – however, long-term data is lacking.
Experts such as Jonathan Blades from Asthma and Lung UK are calling for complementary measures: in addition to more research, the swift passage of the Tobacco and Vapes Bill is essential to curb the marketing of e-cigarettes to young people. The UK Department of Health emphasizes: vaping is an effective aid for smoking cessation, but absolutely taboo for non-smokers and children.
EVALUATE marks a milestone in tobacco research and could help support millions of smokers in quitting safely, while highlighting the limitations of vaping as a health alternative. The University of Birmingham is thus building on its international expertise in e-cigarette studies and promises practical insights for clinics and prevention programs.
