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Bruzzese JM. Asthma and Adolescence: Unique Opportunities for Fostering Asthma Self-Management and Asthma Control. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2024; 37:68-73. [PMID: 39293037 DOI: 10.1089/ped.2024.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
Asthma is a significant worldwide concern among adolescents. Adolescents experience key cognitive and psychosocial developmental changes that they must negotiate as they transition from children to adults. Several of these changes have implications for their ability to effectively manage their asthma. When health care professionals (HCPs) understand these pivotal changes and their role in asthma management, they are better able to work with adolescents and help them become effective asthma self-managers. Therefore, this article reviews the cognitive changes that render adolescents ready to care for their asthma, as well as the following psychosocial changes that may hinder or facilitate self-management: independence from caregivers, reliance on peers, identity development, the role of social media in adolescents' lives, and risk-taking behaviors. Each developmental task is discussed in terms of asthma self-management and offers suggestions for HCPs that may help them work more effectively with adolescents with asthma.
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Liu T, Woodruff PG, Zhou X. Advances in non-type 2 severe asthma: from molecular insights to novel treatment strategies. Eur Respir J 2024; 64:2300826. [PMID: 38697650 PMCID: PMC11325267 DOI: 10.1183/13993003.00826-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
Asthma is a prevalent pulmonary disease that affects more than 300 million people worldwide and imposes a substantial economic burden. While medication can effectively control symptoms in some patients, severe asthma attacks, driven by airway inflammation induced by environmental and infectious exposures, continue to be a major cause of asthma-related mortality. Heterogeneous phenotypes of asthma include type 2 (T2) and non-T2 asthma. Non-T2 asthma is often observed in patients with severe and/or steroid-resistant asthma. This review covers the molecular mechanisms, clinical phenotypes, causes and promising treatments of non-T2 severe asthma. Specifically, we discuss the signalling pathways for non-T2 asthma including the activation of inflammasomes, interferon responses and interleukin-17 pathways, and their contributions to the subtypes, progression and severity of non-T2 asthma. Understanding the molecular mechanisms and genetic determinants underlying non-T2 asthma could form the basis for precision medicine in severe asthma treatment.
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Affiliation(s)
- Tao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine and Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Biochemistry and Molecular Biology, School of Medicine, Southeast University, Nanjing, China
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Xiaobo Zhou
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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3
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Lee YH, Na HG, Choi YS, Bae CH, Song SY, Kim YD. E-cigarettes exacerbate allergic inflammation via cytokine induction and MUC5AC/5B expression in a murine asthma model. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2024; 107:104395. [PMID: 38382584 DOI: 10.1016/j.etap.2024.104395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/07/2023] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
The effects of electronic cigarettes (e-cigarettes) vapor on inflammation and mucin secretion on asthmatics remain insufficiently explored. This study investigated the effects of e-cigarette vapor on allergic inflammation, cytokine production, and MUC5AC/5B expression in murine asthma model. Airway hyperresponsiveness was significantly higher in the e-cigarette-exposed ovalbumin (OVA) sensitization group than in the control, e-cigarette exposure, and OVA sensitization groups. The e-cigarette-exposed OVA sensitization group showed significantly greater infiltration of inflammatory cells and Th2-mediated inflammatory cytokines (interleukin-4 and -5) compared to the control, e-cigarette exposure, and OVA sensitization groups. MUC5AC mucin levels were significantly elevated in the e-cigarette exposure, OVA sensitization, and e-cigarette-exposed OVA sensitization groups, whereas MUC5B mucin levels were significantly elevated in the OVA sensitization and e-cigarette-exposed OVA sensitization groups. The results may suggest that the exposure to e-cigarette vapor in an asthmatics promoted allergic inflammation and increased mucin secretion, ultimately leading to the exacerbation of asthma.
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Affiliation(s)
- Young-Ha Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyung Gyun Na
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Chang Hoon Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Si-Youn Song
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Yong-Dae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea; Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Republic of Korea.
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4
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Glantz S, Lempert LK. Vuse Solo e-cigarettes do not provide net benefits to public health: a scientific analysis of FDA's marketing authorisation. Tob Control 2024; 33:e108-e115. [PMID: 36764683 PMCID: PMC10409877 DOI: 10.1136/tc-2022-057296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 11/04/2022] [Indexed: 02/12/2023]
Abstract
In October 2021, the US Food and Drug Administration (FDA) authorised marketing of RJ Reynolds Vapor Company's (RJR) Vuse Solo e-cigarette through FDA's Premarket Tobacco Product Application (PMTA) pathway. FDA concluded that RJR demonstrated Vuse products met the statutory standard of providing a net benefit to public health. A review of FDA's scientific justification reveals deficiencies: (1) not adequately considering Vuse's popularity with youth and evidence that e-cigarettes expanded the nicotine market and stimulate cigarette smoking; (2) trading youth addiction for unproven adult benefit without quantifying these risks and benefits; (3) not considering design factors that appeal to youth; (4) not addressing evidence that e-cigarettes used as consumer products do not help smokers quit and promote relapse in former smokers; (5) not discussing evidence that dual use is more dangerous than smoking; (6) narrowly focusing on the fact that e-cigarettes deliver lower levels of some toxicants without addressing direct evidence on adverse health effects; (7) downplaying significant evidence of other substantial harms; (8) not acting on FDA's own study showing no all-cause mortality benefit of reducing (but not stopping) cigarette use; and (9) improperly considering e-cigarettes' high abuse liability and potential for high youth addiction and undermining tobacco cessation. Because marketing these products is not appropriate for the protection of the public health, FDA should reconsider its Vuse marketing order as statutorily required and not use it as a template for other e-cigarette PMTAs. Policymakers outside the USA should anticipate that tobacco companies will use FDA's decision to try to weaken tobacco control regulation of e-cigarettes and promote their products.
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Affiliation(s)
| | - Lauren Kass Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
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5
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Mattingly DT, Cook S, Hirschtick JL, Patel A, Arenberg DA, Barnes GD, Levy DT, Meza R, Fleischer NL. Longitudinal associations between exclusive, dual, and polytobacco use and asthma among US youth. Prev Med 2023; 171:107512. [PMID: 37054989 PMCID: PMC11181903 DOI: 10.1016/j.ypmed.2023.107512] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
Little is known about the respiratory health effects of dual (two products) and polytobacco (three or more products) use among youth in the United States. Thus, we followed a longitudinal cohort of youth into adulthood using data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study, examining incident asthma at each follow-up (Waves 2-5). We classified past 30-day tobacco use as 1) no products (never/former use), 2) exclusive cigarettes, 3) exclusive electronic nicotine delivery systems (ENDS), 4) exclusive other combustible (OC) tobacco products (cigars, hookah, pipe), 5) dual cigarettes/OC and ENDS, 6) dual cigarettes and OCs, and 7) polytobacco use (cigarettes, OCs, and ENDS). Using discrete time survival models, we analyzed the incidence of asthma across Waves 2-5, predicted by time-varying tobacco use lagged by one wave, and adjusted for potential baseline confounders. Asthma was reported by 574 of the 9141 respondents, with an average annual incidence of 1.44% (range 0.35% to 2.02%, Waves 2-5). In adjusted models, exclusive cigarette use (HR: 1.71, 95% CI: 1.11-2.64) and dual cigarette and OC use (HR: 2.78, 95% CI: 1.65-4.70) were associated with incident asthma compared to never/former use, while exclusive ENDS use (HR: 1.50, 95% CI: 0.92-2.44) and polytobacco use (HR: 1.95, 95% CI: 0.86-4.44) were not. To conclude, youth who use cigarettes with or without OCs had higher risk of incident asthma. Further longitudinal studies on the respiratory health effects of ENDS and dual/polytobacco use are needed as products continue to evolve.
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Affiliation(s)
- Delvon T Mattingly
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA.
| | - Steven Cook
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA
| | - Jana L Hirschtick
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA
| | - Akash Patel
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA
| | - Douglas A Arenberg
- University of Michigan Medical School, Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Ann Arbor, MI 48109, USA
| | - Geoffrey D Barnes
- University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI 48109, USA; University of Michigan, Frankel Cardiovascular Center, Ann Arbor, MI 48109, USA
| | - David T Levy
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Rafael Meza
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA; BC Cancer Research Center, Department of Integrative Oncology, Vancouver, British Columbia, Canada
| | - Nancy L Fleischer
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA
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Afolabi F, Rao DR. E-cigarettes and asthma in adolescents. Curr Opin Allergy Clin Immunol 2023; 23:137-143. [PMID: 36821483 DOI: 10.1097/aci.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW E-cigarettes have been long purported to be a mechanism of harm reduction in current smokers. However, market expansion to adolescents has been aggressive, despite government interventions. Research examining the adverse effects of e-cigarettes in teens with asthma has been limited. We discuss the most recent data on the pulmonary manifestations of e-cigarettes use and exposure in adolescents with asthma. RECENT FINDINGS Adolescents with asthma are more likely to be e-cigarette users than those without asthma and more likely to have asthma exacerbations. Increased pulmonary inflammatory cytokines have been seen in e-cigarette users and mouse models. Yet, providers are not confident in e-cigarette screening and counselling despite acknowledging adolescents are using e-cigarettes regularly. SUMMARY Since the introduction of e-cigarettes into the United States market in 2007, adolescents use of these products has risen, even after a brief decline during the height of the COVID-19 pandemic. This review will describe the most recent studies on e-cigarette use trends, cytotoxicity of e-cigarette aerosol and associations with the diagnosis and symptoms of asthma. Knowledge gaps, advocacy efforts, evidence on e-cigarette cessation will be highlighted.
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Affiliation(s)
- Folashade Afolabi
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center
- Children's Health Medical Center
- University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Devika R Rao
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center
- Children's Health Medical Center
- University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
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Klain A, Dinardo G, Salvatori A, Indolfi C, Contieri M, Brindisi G, Decimo F, Zicari AM, Miraglia del Giudice M. An Overview on the Primary Factors That Contribute to Non-Allergic Asthma in Children. J Clin Med 2022; 11:6567. [PMID: 36362795 PMCID: PMC9654665 DOI: 10.3390/jcm11216567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 04/13/2024] Open
Abstract
The prevalence of non-allergic asthma in childhood is low, peaking in late adulthood. It is triggered by factors other than allergens, like cold and dry air, respiratory infections, hormonal changes, smoke and air pollution. In the literature, there are few studies that describe non-allergic asthma in pediatric age. Even though it is a less common disorder in kids, it is crucial to identify the causes in order to keep asthma under control, particularly in patients not responding to conventional treatments. In this review, we discuss non-IgE-mediated forms of asthma, collecting the latest research on etiopathogenesis and treatment.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessandra Salvatori
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Marcella Contieri
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulia Brindisi
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Anna Maria Zicari
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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8
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Song Y, Li X, Li C, Xu S, Liu Y, Wu X. What Are the Effects of Electronic Cigarettes on Lung Function Compared to Non-Electronic Cigarettes? A Systematic Analysis. Int J Public Health 2022; 67:1604989. [PMID: 36250151 PMCID: PMC9561085 DOI: 10.3389/ijph.2022.1604989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
Objective: The effects of e-cigarettes on lung function were compared between the e-cigarette and the non-e-cigarette group, as well as self-changes after inhaling e-cigarettes. Method: From March 1st, 2022, relevant literature was selected from four databases through a predefined retrieval strategy. Strict literature screening and quality evaluation were conducted. The study followed PRISMA guidelines. Results: Our results showed that CO (SMD: −1.48, 95%: −2.82–0.15) and FeNO (SMD: −0.66, 95%: −1.32, −0.01) were significantly decreased after e-cigarette usage. Only asthmatic smokers showed a statistically significant increase in flow resistance after inhaling e-cigarettes. Conversely, the decrease of FEV1/FVC% in the non-e-cigarette groups exceeded that in the e-cigarette group (SMD:1.18, 95%: 0.11–2.26). The degree of O2 saturation decrease was also less than that for the cigarette groups (SMD:0.32, 95%: 0.04–0.59), especially when compared to the conventional cigarette group (SMD:0.56, 95%: 0.04–1.08). Conclusion: The current findings indicate that short-term e-cigarette inhalation has a similar (but not significant) effect on lung function, as compared with non-e-cigarettes. More clinical studies are needed to explore the safety of inhaling e-cigarettes, especially in vulnerable populations.
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Affiliation(s)
- Yumeng Song
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xin Li
- Department of Infectious Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Chaoxiu Li
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Shuang Xu
- Department of library of China Medical University, Library of China Medical University, Shenyang, China
| | - Yong Liu
- Department of Stomatology, Dalian University, Dalian, China
- Periodontology and Preventive Dentistry, Saarland University, Saarbrücken, Germany
- *Correspondence: Xiaomei Wu, ; Yong Liu,
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Xiaomei Wu, ; Yong Liu,
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9
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Asfar T, Jebai R, Li W, Oluwole OJ, Ferdous T, Gautam P, Schmidt M, Noar SM, Lindblom EN, Eissenberg T, Bursac Z, Vallone D, Maziak W. Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies. Tob Control 2022:tobaccocontrol-2022-057495. [PMID: 36252567 PMCID: PMC10043882 DOI: 10.1136/tc-2022-057495] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This umbrella review aims to summarise the evidence about electronic nicotine delivery systems' (ENDS) risk and safety health profile to inform ENDS health communication strategies. DATA SOURCES AND STUDY SELECTION Six databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4. DATA EXTRACTION Findings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine's Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive. DATA SYNTHESIS We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes. CONCLUSIONS As evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided. PROSPERO REGISTRATION NUMBER CRD42021241630.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rime Jebai
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Olusanya Joshua Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tarana Ferdous
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Prem Gautam
- Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, TN, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina System, Chapel Hill, NC, USA
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Thomas Eissenberg
- Psychology and Institute for Drug/Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Zoran Bursac
- Biostatistics, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA
| | - Donna Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Truth Initiative Schroeder Institute, New York University College of Global Public Health, New York, NY, USA
| | - Wasim Maziak
- Epidemiology, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA
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10
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Travis N, Knoll M, Cadham CJ, Cook S, Warner KE, Fleischer NL, Douglas CE, Sánchez-Romero LM, Mistry R, Meza R, Hirschtick JL, Levy DT. Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9054. [PMID: 35897421 PMCID: PMC9330875 DOI: 10.3390/ijerph19159054] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included in our umbrella review. There was a clear underreporting of e-cigarette devices and e-liquid types, e-cigarette and cigarette exposure, and the health and smoking status of study participants. Overall, the findings suggest that short-term use of e-cigarettes may be associated with acute cardiopulmonary risks, although to a lesser extent than cigarette use. Long-term e-cigarette use may have pulmonary/respiratory benefits in those who switch from chronic cigarette smoking, particularly in individuals with asthma and chronic obstructive pulmonary disease (COPD). Evidence on intermediate and long-term carcinogenic effects is lacking. This umbrella review underscores the urgent need for systematic reviews with better adherence to established reporting guidelines, consistent definitions of duration of e-cigarette use, a focus on newer devices, and accounting for the impacts of former or current smoking.
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Affiliation(s)
- Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA; (M.K.); (L.M.S.-R.); (D.T.L.)
| | - Marie Knoll
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA; (M.K.); (L.M.S.-R.); (D.T.L.)
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (C.J.C.); (K.E.W.); (C.E.D.)
| | - Steven Cook
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.C.); (N.L.F.); (R.M.); (J.L.H.)
| | - Kenneth E. Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (C.J.C.); (K.E.W.); (C.E.D.)
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.C.); (N.L.F.); (R.M.); (J.L.H.)
| | - Clifford E. Douglas
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (C.J.C.); (K.E.W.); (C.E.D.)
| | - Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA; (M.K.); (L.M.S.-R.); (D.T.L.)
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.C.); (N.L.F.); (R.M.); (J.L.H.)
| | - Jana L. Hirschtick
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.C.); (N.L.F.); (R.M.); (J.L.H.)
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown Medical University, Washington, DC 20057, USA; (M.K.); (L.M.S.-R.); (D.T.L.)
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11
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Esteban-Lopez M, Perry MD, Garbinski LD, Manevski M, Andre M, Ceyhan Y, Caobi A, Paul P, Lau LS, Ramelow J, Owens F, Souchak J, Ales E, El-Hage N. Health effects and known pathology associated with the use of E-cigarettes. Toxicol Rep 2022; 9:1357-1368. [PMID: 36561957 PMCID: PMC9764206 DOI: 10.1016/j.toxrep.2022.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/25/2022] Open
Abstract
In recent years, new nicotine delivery methods have emerged, and many users are choosing electronic cigarettes (e-cigarettes) over traditional tobacco cigarettes. E-cigarette use is very popular among adolescents, with more than 3.5 million currently using these products in the US. Despite the increased prevalence of e-cigarette use, there is limited knowledge regarding the health impact of e-cigarettes on the general population. Based on published findings by others, E-cigarette is associated with lung injury outbreak, which increased health and safety concerns related to consuming this product. Different components of e-cigarettes, including food-safe liquid solvents and flavorings, can cause health issues related to pneumonia, pulmonary injury, and bronchiolitis. In addition, e-cigarettes contain alarmingly high levels of carcinogens and toxicants that may have long-lasting effects on other organ systems, including the development of neurological manifestations, lung cancer, cardiovascular disorders, and tooth decay. Despite the well- documented potential for harm, e-cigarettes do not appear to increase susceptibility to SARS-CoV- 2 infection. Furthermore, some studies have found that e-cigarette users experience improvements in lung health and minimal adverse effects. Therefore, more studies are needed to provide a definitive conclusion on the long-term safety of e-cigarettes. The purpose of this review is to inform the readers about the possible health-risks associated with the use of e-cigarettes, especially among the group of young and young-adults, from a molecular biology point of view.
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Key Words
- AEC, airway epithelial cells
- AM, alveolar macrophages
- BAL, bronchial alveolar lavage
- CC16, Clara cell protein 16
- CM, cardiomyocyte
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CS, cigarette smoke
- CSC, Cancer Stem Cell
- CYP, cytochrome P450
- E-cigarettes
- E2F1, E2F transcription factor 1
- EMT, epithelial-to-mesenchymal transition
- ENDS, electronic nicotine delivery system
- EVALI
- EVALI, e-cigarette or vaping product use-associated lung injury
- FDA, Food and Drug Administration
- FOXO3, forkhead box O3
- HNSCC, head and neck squamous cancer cells
- HUVEC, human umbilical vein endothelial cells
- Health risks
- IL, interleukin
- LDL, low-density lipoprotein
- MCP-1, monocyte chemoattractant protein-1
- MMP9, matrix metallopeptidase 9
- MPP, Mycoplasma pneumoniae pneumonia
- NET, neutrophil extracellular traps
- NK, natural killer
- NOX, NADPH oxidase
- NQO-1, NAD(P)H quinone dehydrogenase 1
- Nicotine
- Nrf2, nuclear factor erythroid 2-related factor 2
- OGG1/2, 8-oxoguanine glycosylase
- OS, oxidative stress
- Oct4,, Octamer-binding transcription factor 4
- PAFR, platelet-activating factor receptor
- PAHs, polycyclic aromatic hydrocarbons
- PG, propylene glycol
- ROS, reactive oxygen species
- Sox2,, SRY (sex determining region Y)-box 2
- THC, Tetrahydrocannabinol
- TNF‐α, tumor necrosis factor alpha
- VAPI, vaping-associated pulmonary injury
- VG, vegetable glycerin
- Vaping
- XPC, xeroderma pigmentosum complementation group C
- Yap1, Yes associated protein 1
- ZEB, zinc finger E-box binding homeobox
- ZO-1, zonula occludens-1
- e-cigarettes, electronic cigarettes
- e-liquid, e-cigarette liquid
- e-vapor, e-cigarette vapor
- iPSC-EC, induced pluripotent stem cell-derived endothelial cells
- pAMPK, phospho-AMP-activated protein kinase
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Affiliation(s)
- Maria Esteban-Lopez
- Departments of Human and Molecular Genetics, Florida International University, Miami, FL 33199, USA
| | - Marissa D. Perry
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Luis D. Garbinski
- Cell Biology and Pharmacology and Florida International University, Miami, FL 33199, USA
| | - Marko Manevski
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Mickensone Andre
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Yasemin Ceyhan
- Departments of Human and Molecular Genetics, Florida International University, Miami, FL 33199, USA
| | - Allen Caobi
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Patience Paul
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Lee Seng Lau
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Julian Ramelow
- Herbert Wertheim College of Medicine, Biological Sciences in the College of Arts, Science and Education and the Biomolecular Sciences Institute, Florida International University, Miami, FL 33199, USA
| | - Florida Owens
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA
| | - Joseph Souchak
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Evan Ales
- Translational Glycobiology, Florida International University, Miami, FL 33199, USA
| | - Nazira El-Hage
- Immunology and Nano-medicine, Florida International University, Miami, FL 33199, USA,Correspondence to: Department of Immunology and Nanomedicine, Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
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12
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Silver NA, Kierstead EC, Briggs J, Schillo B. Charming e-cigarette users with distorted science: a survey examining social media platform use, nicotine-related misinformation and attitudes towards the tobacco industry. BMJ Open 2022; 12:e057027. [PMID: 35649587 PMCID: PMC9160585 DOI: 10.1136/bmjopen-2021-057027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the role of social media in promoting recall and belief of distorted science about nicotine and COVID-19 and whether recall and belief predict tobacco industry beliefs. DESIGN Young adults aged 18-34 years (N=1225) were surveyed cross-sectionally via online Qualtrics panel. The survey assessed recall and belief in three claims about nicotine and COVID-19 and three about nicotine in general followed by assessments of industry beliefs and use of social media. Ordinal logistic regression with robust standard errors controlling for gender, race/ethnicity, education, current e-cigarette use and age was used to examine relationships between variables. RESULTS Twitter use was associated with higher odds of recall (OR=1.21, 95% CI=1.01 to 1.44) and belief (OR=1.26, 95% CI=1.04 to 1.52) in COVID-19-specific distorted science. YouTube use was associated with higher odds of believing COVID-19-specific distorted science (OR=1.32, 95% CI=1.09 to 1.60). Reddit use was associated with lower odds of believing COVID-19-specific distorted science (OR=0.72, 95% CI=0.59 to 0.88). Recall (OR=1.26, 95% CI=1.07 to 1.47) and belief (OR=1.28, 95% CI=1.09 to 1.50) in distorted science about nicotine in general as well as belief in distorted science specific to COVID-19 (OR=1.61, 95% CI=1.34 to 1.95) were associated with more positive beliefs about the tobacco industry. Belief in distorted science about nicotine in general was also associated with more negative beliefs about the tobacco industry (OR=1.18, 95% CI=1.02 to 1.35). CONCLUSIONS Use of social media platforms may help to both spread and dispel distorted science about nicotine. Addressing distorted science about nicotine is important, as it appears to be associated with more favourable views of the tobacco industry which may erode public support for effective regulation.
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Affiliation(s)
- Nathan A Silver
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Elexis C Kierstead
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Jodie Briggs
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Barbara Schillo
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
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13
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Chatziparasidis G, Kantar A. Vaping in Asthmatic Adolescents: Time to Deal with the Elephant in the Room. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030311. [PMID: 35327682 PMCID: PMC8947668 DOI: 10.3390/children9030311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
Adolescence is a period characterized by developmental, psychological, and psychosocial alterations, with a major impact on youths’ attitudes and perceptions. Adolescents with asthma may not comply with treatment and may develop risky behaviors, including smoking, vaping, and other substance use, leading to unanticipated exacerbations and consequences. Vaping has become extremely popular in this age group, and studies have suggested that it has potential adverse effects on asthmatic airways. More well-designed studies are needed to confirm the initial worrying data, and action must be taken by both medical officers and health authorities to deal with the elephant in the room and curb the vaping pandemic. The aim of this paper is to provide a review of the current knowledge regarding the effect of vaping on adolescents with asthma and to propose actions to restrain this fast-growing trend.
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Affiliation(s)
- Grigorios Chatziparasidis
- Primary Cilia Dyskinesia Unit, School of Medicine, University of Thessaly, 41110 Thessaly, Greece
- Correspondence:
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Gruppo Ospedaliero San Donato, Bergamo and University Vita Salute San Raffaele, 24046 Milano, Italy;
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14
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Abstract
Since the spread of tobacco from the Americas hundreds of years ago, tobacco cigarettes and, more recently, alternative tobacco products have become global products of nicotine addiction. Within the evolving alternative tobacco product space, electronic cigarette (e-cigarette) vaping has surpassed conventional cigarette smoking among adolescents and young adults in the United States and beyond. This review describes the experimental and clinical evidence of e-cigarette toxicity and deleterious health effects. Adverse health effects related to e-cigarette aerosols are influenced by several factors, including e-liquid components, physical device factors, chemical changes related to heating, and health of the e-cigarette user (e.g., asthmatic). Federal, state, and local regulations have attempted to govern e-cigarette flavors, manufacturing, distribution, and availability, particularly to underaged youths. However, the evolving e-cigarette landscape continues to impede timely toxicological studies and hinder progress made toward our understanding of the long-term health consequence of e-cigarettes.
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Affiliation(s)
- Terry Gordon
- Department of Environmental Medicine, NYU School of Medicine, New York, NY 10010, USA;
| | - Emma Karey
- Department of Environmental Medicine, NYU School of Medicine, New York, NY 10010, USA;
| | - Meghan E Rebuli
- Department of Pediatrics and Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA
| | - Yael-Natalie H Escobar
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA
| | - Ilona Jaspers
- Department of Pediatrics and Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, USA
| | - Lung Chi Chen
- Department of Environmental Medicine, NYU School of Medicine, New York, NY 10010, USA;
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15
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Lee WK, Smith CL, Gao CX, Borg BM, Nilsen K, Brown D, Makar A, McCrabb T, Thompson BR, Abramson MJ. Reply to: 'Respiratory harms from vaping: Questions for debate and discussion'. Respirology 2021; 27:96-98. [PMID: 34878194 DOI: 10.1111/resp.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Wai Kit Lee
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Youth Mental Health (Orygen), University of Melbourne, Melbourne, Victoria, Australia
| | - Brigitte M Borg
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Kristopher Nilsen
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - David Brown
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Annie Makar
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Tom McCrabb
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia.,School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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BCG for the prevention and treatment of allergic asthma. Vaccine 2021; 39:7341-7352. [PMID: 34417052 DOI: 10.1016/j.vaccine.2021.07.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022]
Abstract
Allergic diseases, in particular atopic asthma, have been on the rise in most industrialized countries for several decades now. Allergic asthma is characterized by airway narrowing, bronchial hyperresponsiveness, excessive airway mucus production, eosinophil influx in the lungs and an imbalance of the Th1/Th2 responses, including elevated IgE levels. Most available interventions provide only short-term relief from disease symptoms and do not alter the underlying immune imbalance. A number of studies, mostly in mouse models, have shown that Mycobacterium bovis bacillus Calmette-Guérin (BCG) treatment is capable of preventing or reducing an established allergen-driven inflammatory response, by redirecting pathogenic Th2 towards protective Th1 and/or regulatory T cell responses. Dendritic cells stimulated by BCG appear to be a crucial first step in the immunomodulatory effects of BCG. While the protective and therapeutic effects of BCG against allergy and asthma are well documented in animal models, they are less clear in humans, both in observational studies and in randomized controlled trials. The purpose of this article is to provide an up-to-date overview of the available evidence on the anti-allergy, in particular anti-asthma effects of BCG in mice, rats and humans.
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17
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Kotoulas SC, Katsaounou P, Riha R, Grigoriou I, Papakosta D, Spyratos D, Porpodis K, Domvri K, Pataka A. Electronic Cigarettes and Asthma: What Do We Know So Far? J Pers Med 2021; 11:jpm11080723. [PMID: 34442368 PMCID: PMC8399607 DOI: 10.3390/jpm11080723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 12/20/2022] Open
Abstract
Electronic cigarettes (EC) are a novel product, marketed as an alternative to tobacco cigarette. Its effects on human health have not been investigated widely yet, especially in specific populations such as patients with asthma. With this review, we use the existing literature in order to answer four crucial questions concerning: (1) ECs' role in the pathogenesis of asthma; (2) ECs' effects on lung function and airway inflammation in patients with asthma; (3) ECs' effects on asthma clinical characteristics in asthmatics who use it regularly; and (4) ECs' effectiveness as a smoking cessation tool in these patients. Evidence suggests that many EC compounds might contribute to the pathogenesis of asthma. Lung function seems to deteriorate by the use of EC in this population, while airway inflammation alters, with the aggravation of T-helper-type-2 (Th2) inflammation being the most prominent but not the exclusive effect. EC also seems to worsen asthma symptoms and the rate and severity of exacerbations in asthmatics who are current vapers, whilst evidence suggests that its effectiveness as a smoking cessation tool might be limited. Asthmatic patients should avoid using EC.
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Affiliation(s)
- Serafeim-Chrysovalantis Kotoulas
- Clinic of Respiratory Failure, General Hospital of Thessaloniki Georgios Papanikolaou, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (I.G.); (A.P.)
- Correspondence: ; Tel.: +30-6977-705450
| | - Paraskevi Katsaounou
- 1st ICU “Evangelismos Hospital”, School of Medicine, National and Kapodistrian University of Athens, Ypsilantou 45-47, 10676 Athens, Greece;
| | - Renata Riha
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK;
| | - Ioanna Grigoriou
- Clinic of Respiratory Failure, General Hospital of Thessaloniki Georgios Papanikolaou, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (I.G.); (A.P.)
| | - Despoina Papakosta
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Dionysios Spyratos
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Konstantinos Porpodis
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Kalliopi Domvri
- Department of Pulmonary Medicine, General Hospital of Thessaloniki “Georgios Papanikolaou”, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (D.P.); (D.S.); (K.P.); (K.D.)
| | - Athanasia Pataka
- Clinic of Respiratory Failure, General Hospital of Thessaloniki Georgios Papanikolaou, Aristotle University of Thessaloniki, Leoforos Papanikolaou, 57010 Thessaloniki, Greece; (I.G.); (A.P.)
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