TY - JOUR T1 - There can be smoke without fire: warranted caution in promoting electronic cigarettes and heat not burn devices as a safer alternative to cigarette smoking JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00114-2019 VL - 5 IS - 3 SP - 00114-2019 AU - Kielan Darcy McAlinden AU - Sukhwinder Singh Sohal AU - Pawan Sharma Y1 - 2019/07/01 UR - http://openres.ersjournals.com/content/5/3/00114-2019.abstract N2 - The damaging health effects of active and second-hand cigarette smoking are well documented. Tobacco smoke exposure is the primary cause of COPD, which is estimated to become the third leading cause of global mortality by 2030 [1]. In 2012 it was estimated that 1.8 million new cases of lung cancer occurred globally, making it the most common form of cancer [1]. Maternal smoking and intrauterine exposure to tobacco smoke and nicotine have been linked not only to negative pregnancy outcomes such as miscarriage and preterm birth, but also to numerous adverse pathophysiological outcomes in the child, including an increased risk of developing asthma and COPD due to impaired lung development [2]. The global rates of smoking during pregnancy, particularly in the lower socioeconomic status countries, remain too high [3]. The World Health Organization estimates that in 2015, ∼20% of the world's adult population were current smokers; fortunately, the prevalence of tobacco smoking is on a gradual decline [4]. The tobacco industry is currently changing strategies, shifting the focus from tobacco cigarettes, and promoting the “safer” alternative in electronic cigarettes (e-cigarettes) and now heat not burn (HNB) devices [5]. These devices still deliver nicotine and the rise in the number of dual users (of both traditional cigarettes and e-cigarettes) is alarming [6, 7].The tobacco industry is now shifting its focus from combustible cigarettes to promoting the “safer” electronic nicotine delivery alternatives. This editorial presents emerging challenges these devices pose to human health. http://bit.ly/2xdAjD0 ER -