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Sahu R, Shah K, Malviya R, Paliwal D, Sagar S, Singh S, Prajapati BG, Bhattacharya S. E-Cigarettes and Associated Health Risks: An Update on Cancer Potential. Adv Respir Med 2023; 91:516-531. [PMID: 37987300 PMCID: PMC10660480 DOI: 10.3390/arm91060038] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
The potential cancer risk associated with electronic-cigarette (e-cigarette) use is ongoing and remains a subject of debate. E-Cigarettes work by heating a liquid that usually contains nicotine, flavorings, and other chemicals. When the liquid is heated, users inhale an aerosol into their lungs. While e-cigarettes are generally considered less harmful than traditional tobacco products, they still contain potentially harmful chemicals, which can damage DNA and lead to cancer. Several studies have investigated the potential cancer risk associated with e-cigarette use, while other studies have suggested that e-cigarette aerosol may contain carcinogenic chemicals that could increase the risk of lung and bladder cancer in humans. However, these studies are limited in their scope and do not provide conclusive evidence. Overall, the long-term cancer risk associated with e-cigarette use remains uncertain, more research is needed to fully understand the potential risks and benefits of e-cigarettes. However, this review will allow the investigator to get more recent updates about e-cigarettes.
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Affiliation(s)
- Rakesh Sahu
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Research, GLA University, Mathura 281406, India;
| | - Kamal Shah
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Research, GLA University, Mathura 281406, India;
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
| | - Deepika Paliwal
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
| | - Sakshi Sagar
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
| | - Sudarshan Singh
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Bhupendra G. Prajapati
- Shree S. K. Patel College of Pharmaceutical Education and Research, Ganpat University, Kherva 384012, India
| | - Sankha Bhattacharya
- Department of Pharmaceutics, School of Pharmacy & Technology Management, SVKM’S NMIMS Deemed-to-Be University, Shirpur 425405, India;
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Montjean D, Godin Pagé MH, Bélanger MC, Benkhalifa M, Miron P. An Overview of E-Cigarette Impact on Reproductive Health. Life (Basel) 2023; 13:life13030827. [PMID: 36983982 PMCID: PMC10053939 DOI: 10.3390/life13030827] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Electronic cigarettes (e-cigarettes) are often considered a "safe substitute" for conventional cigarette cessation. The composition of the fluid is not always clearly defined and shows a large variation within brands and manufacturers. More than 80 compounds were detected in liquids and aerosols. E-cigarettes contain nicotine, and the addition of flavorings increases the toxicity of e-cigarette vapour in a significant manner. The heat generated by the e-cigarette leads to the oxidation and decomposition of its components, eventually forming harmful constituents in the inhaled vapour. The effects of these toxicants on male and female reproduction are well established in conventional cigarette smokers. Although toxins were measured at much lower levels in e-cigarette aerosols compared to smoke from a conventional cigarette, there are concerns about their potential impact on male and female reproduction. The information available was mainly obtained from studies conducted in animal models, and investigations in humans are scarce. However, the effects observed in animal models suggest that caution should be taken when vaping and that more research needs to be conducted to identify its potential adverse effects on fertility. The prevalence of e-cigarette usage is alarming, and warnings should be made about the impact of vaping on reproductive health. This document reviews the data regarding the impact of e-cigarette use on male and female reproduction.
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Affiliation(s)
- Debbie Montjean
- Fertilys Fertility Center, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada
| | | | - Marie-Claire Bélanger
- Fertilys Fertility Center, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), CHUM Research Center, 900 Saint-Denis Street, Montreal, QC H2X 0A9, Canada
| | - Moncef Benkhalifa
- Fertilys Fertility Center, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada
- Médecine et Biologie de la Reproduction et Laboratoire PERITOX, Université Picardie Jules Verne, CBH-CHU Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80054 Amiens, France
| | - Pierre Miron
- Fertilys Fertility Center, 1950 Maurice-Gauvin Street, Laval, QC H7S 1Z5, Canada
- Institut National de Recherche Scientifique-Centre Armand-Frappier Santé Biotechnologie, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada
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Alcantara C, Chaparro L, Zagury GJ. Occurrence of metals in e-cigarette liquids: Influence of coils on metal leaching and exposure assessment. Heliyon 2023; 9:e14495. [PMID: 36950607 PMCID: PMC10025154 DOI: 10.1016/j.heliyon.2023.e14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Electronic cigarettes are generally recognized as a safer alternative than conventional cigarettes. Nevertheless, previous research suggests metal (loid) leaching due to coil contact, potentially transferring to the e-liquid and its aerosolized form. In this study, Cr, Cd, Ni, and Pb levels were measured by inductively coupled plasma mass spectrometry (ICP-MS) on 17 samples of e-liquids with different chemical properties (e.g., pH, nicotine content, flavoring, free-base, and nicotine salts). Twelve e-liquids were then put in contact with 36-gauge Kanthal A-1, Nichrome 80, Stainless steel 317 L and disposable coils such as Juul, and Aspire BVC for three days at 200-250 °C for 1 h each day. Metal levels expressed as mean (standard deviation) metal concentration, were below detection (Cd) to very low in bottle samples (Ni ≤ 76 (18); Pb ≤ 16 (1.5); and Cr ≤ 386 (15.6) μg/kg). In the coil extracts, varying concentrations of the same metal (loid) were found, indicating that metal leaching capacity may differ per sample. All samples contained Ni and Cr, followed by Pb to a much lesser extent. Cd levels were mostly below detection limits. Coil + e-liquid combinations with the highest Ni, Cr, and Pb concentrations were: Aspire BVC + Melon 0 mg/mL: Ni = 1.22 E+04 (281); Aspire BVC + Hit Nicotine 40 mg/mL: Cr = 864 (116); and Nichrome 80 + Melon 0 mg/mL: Pb = 56 (5) μg/kg. Overall, results suggest that nicotine salts at 40 mg/mL enhance Cr and Ni transfer. Stainless steel 317 L released very low metal concentrations. A conservative screening level risk characterization showed that 10.5% and 3.5% of the coil extracts may exceed Ni and Cr (III) safe concentrations, respectively. In the aerosol phase, 8.8% of samples might be above Ni equivalent daily dose for chronic exposure and 1.8% for intermediate exposure. Further studies on coil metal leaching could aid in establishing coil manufacturing regulations.
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Affiliation(s)
- Claudia Alcantara
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal (QC), H3C 3A7, Canada
| | - Laura Chaparro
- Les Laboratoires Vaporus Inc., 9704 Trans Canada Route, Saint-Laurent (QC), H4S 1V9, Canada
| | - Gerald J. Zagury
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal (QC), H3C 3A7, Canada
- Corresponding author. Department of Civil, Geological and Mining Engineering Polytechnique Montréal P.O. Box 6079, Station Centre-Ville Montréal, (QC), Canada, H3C 3A7 .
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An integral perspective of canonical cigarette and e-cigarette-related cardiovascular toxicity based on the adverse outcome pathway framework. J Adv Res 2022:S2090-1232(22)00193-X. [PMID: 35998874 DOI: 10.1016/j.jare.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/29/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nowadays, cigarette smoking remains the leading cause of chronic disease and premature death, especially cardiovascular disease. As an emerging tobacco product, e-cigarettes have been advocated as alternatives to canonical cigarettes, and thus may be an aid to promote smoking cessation. However, recent studies indicated that e-cigarettes should not be completely harmless to the cardiovascular system. AIM OF REVIEW This review aimed to build up an integral perspective of cigarettes and e-cigarettes-related cardiovascular toxicity. KEY SCIENTIFIC CONCEPTS OF REVIEW This review adopted the adverse outcome pathway (AOP) framework as a pivotal tool and aimed to elucidate the association between the molecular initiating events (MIEs) induced by cigarette and e-cigarette exposure to the cardiovascular adverse outcome. Since the excessive generation of reactive oxygen species (ROS) has been widely approved to play a critical role in cigarette smoke-related CVD and may also be involved in e-cigarette-induced toxic effects, the ROS overproduction and subsequent oxidative stress are regarded as essential parts of this framework. As far as we know, this should be the first AOP framework focusing on cigarette and e-cigarette-related cardiovascular toxicity, and we hope our work to be a guide in exploring the biomarkers and novel therapies for cardiovascular injury.
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Influence of Electronic Cigarettes on Selected Physicochemical Properties of Saliva. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063314. [PMID: 35329001 PMCID: PMC8953991 DOI: 10.3390/ijerph19063314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Electronic cigarettes are gaining more popularity not only among cigarettes smokers. Firstly, e-cigarettes were perceived as less harmful than traditional cigarettes, however, nowadays, they are arousing more controversy. The aim of this study was to assess the impact of e-cigarette usage on selected physicochemical properties of saliva. (2) Methods: The study population included 128 patients: 40 patients using e-cigarettes, 39 patients smoking traditional cigarettes, and 49 non-smoking patients (non-smokers). Laboratory tests involved verification of saliva values of pH and concentration of total protein, calcium, and phosphates. (3) Results: Among e-cigarette users, the value of pH was lower and the concentration of total protein, calcium, and phosphates was higher than in the group of non-smokers. Statistically significant differences were observed in relation to calcium. Among traditional cigarette smokers, the value of pH was lower, concentrations of total protein and phosphates were higher than in the group of non-smokers. Statistically significant differences were observed in relation to total protein. (4) Conclusions: Saliva of e-cigarette users presents changes in physicochemical composition in comparison to traditional cigarette smokers and non-smokers, however, statistically significant differences were observed only in calcium concentration. Further longitudinal studies on a larger study group should be conducted to assess the effect of observed changes in oral health.
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Zutrauen S, Do MT, Ghandour L, Moore-Hepburn C, Beno S, Richmond SA, Chadi N. Acute injury or illness related to the inhalation of vaping aerosols among children and adolescents across Canada: A cross-sectional survey of Canadian paediatricians. Paediatr Child Health 2022; 27:43-49. [DOI: 10.1093/pch/pxab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vaping prevalence rates have increased among Canadian youth. Evidence suggests that vaping poses significant health risks to children and adolescents.
Objectives
The objectives of the study were to investigate epidemiological characteristics of acute injury/illness cases due to the inhalation of vaping aerosols among children and adolescents across Canada and to explore factors contributing to severe cases.
Methods
Data from the 2019 Canadian Paediatric Surveillance Program cross-sectional survey on vaping-related injury/illness were used. Analyses focused on injury/illness cases (n=71) among children and adolescents aged 0 to 17 years who presented to participating paediatricians for a harm related to the inhalation of vaping aerosols. We conducted descriptive analyses and performed logistic regression to explore associations between severe presentations requiring hospitalization or intensive care unit (ICU) admission and selected case characteristics.
Results
Of the 71 reported injury/illness cases related to inhalation of vaping aerosols, 56% of patients were male, and 68% were aged 15 to 17 years. Nicotine vaping was reported in 42% of cases, and cannabis vaping in 24%. Fifty-four per cent presented with respiratory distress, 18% with symptoms of nicotine toxicity, and 41% required hospitalization and/or admission to the ICU. Cases presenting with respiratory distress were more likely to be hospitalized/admitted to the ICU (odds ratio [OR]=5.37, 95% confidence interval [CI]:1.76 to 16.39).
Conclusions
The inhalation of vaping aerosols among children and adolescents may contribute to acute injury/illness. Clear associations between study variables and severe cases could not be established due to a small sample size. Additional research is needed to determine predictors and preventable risk factors of severe vaping-related injuries.
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Affiliation(s)
- Sarah Zutrauen
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Minh T Do
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Consumer and Hazardous Products Safety Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Lina Ghandour
- Consumer and Hazardous Products Safety Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Charlotte Moore-Hepburn
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suzanne Beno
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah A Richmond
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Paediatrics, Sainte-Justine University Hospital Centre, Montréal, Québec, Canada
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Lu L, Xiang M, Lu H, Tian Z, Gao Y. Progress in quantification of nicotine content and form distribution in electronic cigarette liquids and aerosols. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:359-377. [PMID: 35037007 DOI: 10.1039/d1ay01679b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Each electronic cigarette (e-cigarette) is a battery-powered system which converts electronic cigarette liquids (e-liquids) into the inhalable phase by heating the solution when it is in use. After four generations of development, e-cigarettes tend to be more customized and user-operable. The main components in the e-liquid and the aerosol are vegetable glycerin, propylene glycol, nicotine, organic acid and some flavor ingredients. Among them, nicotine is closely associated with the irritation and physiological satisfaction caused by tobacco products, and it is the core functional substance of e-cigarettes. For this reason, the quantification of nicotine content and nicotine form distribution mainly focuses on the components of the e-liquid and the released aerosol. Up to now, various technologies and methods have been applied in the analysis and research of nicotine content and nicotine form distribution in the e-liquid and its aerosol. GC-MS is often used as the most viable tool for the analysis of volatile organic compounds and can be widely applied in the measurement of nicotine related chemicals; there are a number of quantitation strategies using LC-MS, LC-MS/MS or 1H NMR for the analysis of e-cigarette samples. We also reviewed the four main methods for determining the distribution of nicotine forms, which are pH value derivation, solvent extraction, SPME and NMR methods. These research methods are of great significance to the upgrading and development of e-cigarette products.
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Affiliation(s)
- Lehua Lu
- Shanghai New Tobacco Product Research Institute, Xiupu Road 3733, Shanghai 201315, China.
| | - Menghui Xiang
- School of Chemical Science & Engineering, Shanghai Key Laboratory of Chemical Assessment and Sustainability, Tongji University, Shanghai 200092, China.
| | - Haoran Lu
- School of Chemical Science & Engineering, Shanghai Key Laboratory of Chemical Assessment and Sustainability, Tongji University, Shanghai 200092, China.
| | - Zhixin Tian
- School of Chemical Science & Engineering, Shanghai Key Laboratory of Chemical Assessment and Sustainability, Tongji University, Shanghai 200092, China.
| | - Yihan Gao
- Shanghai New Tobacco Product Research Institute, Xiupu Road 3733, Shanghai 201315, China.
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Influence of Electronic Cigarettes on Antioxidant Capacity and Nucleotide Metabolites in Saliva. TOXICS 2021; 9:toxics9100263. [PMID: 34678959 PMCID: PMC8538442 DOI: 10.3390/toxics9100263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
The balance between reactive oxygen species production and the activity of antioxidant systems present in saliva is an important element in maintaining oral environment homeostasis. E-cigarettes adversely affect the oral cavity and their cytotoxic effect is related to oxidative stress. The aim of this study was to assess the influence of using electronic cigarettes on antioxidant capacity of saliva. The study involved 110 subjects (35 e-cigarettes users, 33 traditional cigarettes smokers and 42 non-smokers). Laboratory analysis involved quantitation of uric acid, hypoxanthine, xanthine, TAOS (total antioxidant status) and TEAC (Trolox equivalent antioxidant capacity) in saliva. Lower values for TAOS and TEAC were observed among e-cigarettes users and traditional cigarettes smokers in comparison to non-smokers. Uric acid concentration tended to be higher among e-cigarettes users while no differences in hypoxanthine and xanthine saliva concentrations were observed. Electronic cigarettes usage affects antioxidant capacity of saliva to the same extent as traditional cigarettes, when comparing smokers to non-smokers. Further longitudinal studies on a larger study group are needed to assess the effect of changes in antioxidant status on oral health.
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Zakiyah N, Purwadi FV, Insani WN, Abdulah R, Puspitasari IM, Barliana MI, Lesmana R, Amaliya A, Suwantika AA. Effectiveness and Safety Profile of Alternative Tobacco and Nicotine Products for Smoking Reduction and Cessation: A Systematic Review. J Multidiscip Healthc 2021; 14:1955-1975. [PMID: 34326646 PMCID: PMC8315778 DOI: 10.2147/jmdh.s319727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Alternative tobacco and nicotine products such as electronic cigarettes (EC), smokeless tobacco, and nicotine replacement therapy (NRT) are currently being assessed as options in tobacco harm reduction due to their potential role in smoking reduction and smoking cessation. OBJECTIVE To provide the current evidence on the effectiveness and safety of various alternative tobacco and nicotine products for smoking reduction and cessation. METHODS A systematic review using databases from MEDLINE (PubMed), EMBASE, and The Cochrane Library was conducted up to December 2020 to identify eligible experimental and observational studies assessing the use of alternative tobacco and nicotine products on smoking reduction and smoking cessation and the safety of these products. The Cochrane Risk of Bias 2 (RoB 2) and ROBINS-I tools were used to assess the risk of bias of the included studies. Results were described through a narrative synthesis of the evidence. RESULTS From 1955 retrieved references, 44 studies (31 randomized controlled trials/RCTs and 13 prospective cohort studies) met the inclusion criteria and were included in the review. Twenty-nine studies were assessing EC, one study evaluated heat-not-burn (HNB) product, five studies were focused on snus, and nine studies assessed NRT in the form of nicotine patch, gum, etc. The overall results suggested that alternative tobacco and nicotine products in the form of EC, snus, and NRT can moderately reduce daily cigarette consumption and has potential to assist smoking cessation attempts, with fewer adverse events. CONCLUSION The findings suggested that alternative tobacco and nicotine products have a potential role in assisting smoking reduction and cessation, highlighting their role in the tobacco harm reduction approach. Further studies should focus on investigating long-term outcomes, safety, and effectiveness of alternative tobacco and nicotine products to better inform smoking reduction/cessation policy. PROSPERO REGISTRATION NUMBER CRD42020205830.
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Affiliation(s)
- Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Febby V Purwadi
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Widya N Insani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Melisa I Barliana
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Biological Pharmacy, Biotechnology Pharmacy Laboratory, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ronny Lesmana
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Division of Physiology, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Division of Biological Activity, Central Laboratory, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Amaliya Amaliya
- Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Miglio F, Naroo S, Zeri F, Tavazzi S, Ponzini E. The effect of active smoking, passive smoking, and e-cigarettes on the tear film: An updated comprehensive review. Exp Eye Res 2021; 210:108691. [PMID: 34224681 DOI: 10.1016/j.exer.2021.108691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/23/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022]
Abstract
Active tobacco smoking, passive smoking, and e-cigarette smoking have been associated with different systemic and ocular diseases. The precorneal tear film plays an important role in eye health and its analysis can provide useful information on ocular status. This review investigates the effects of different types of smoking on the precorneal tear film, by analyzing the peer-reviewed literature on this topic. Specifically, tear evaporation rate, stability, volume, ferning, osmolarity, and physical composition (lipids and proteins) of tear film are detailed. Most of the reported works show that cigarette smoking reduces tear film stability and quality by affecting its components. This review highlights that smoking severely affects the tear film, but a single test is not sufficient to determine these effects because smoking can impact different parts of the eye.
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Affiliation(s)
- Federica Miglio
- University of Milano-Bicocca, Materials Science Department, Via R. Cozzi 55, I-20125, Milan, Italy; University of Milano-Bicocca, COMiB Research Center, Via R. Cozzi 55, I-20125, Milan, Italy
| | - Shehzad Naroo
- College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Fabrizio Zeri
- University of Milano-Bicocca, Materials Science Department, Via R. Cozzi 55, I-20125, Milan, Italy; University of Milano-Bicocca, COMiB Research Center, Via R. Cozzi 55, I-20125, Milan, Italy; College of Health & Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Silvia Tavazzi
- University of Milano-Bicocca, Materials Science Department, Via R. Cozzi 55, I-20125, Milan, Italy; University of Milano-Bicocca, COMiB Research Center, Via R. Cozzi 55, I-20125, Milan, Italy
| | - Erika Ponzini
- University of Milano-Bicocca, Materials Science Department, Via R. Cozzi 55, I-20125, Milan, Italy; University of Milano-Bicocca, COMiB Research Center, Via R. Cozzi 55, I-20125, Milan, Italy.
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Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res 2021; 22:151. [PMID: 34006276 PMCID: PMC8129966 DOI: 10.1186/s12931-021-01737-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
The electronic cigarette (e-cigarette), for many considered as a safe alternative to conventional cigarettes, has revolutionised the tobacco industry in the last decades. In e-cigarettes, tobacco combustion is replaced by e-liquid heating, leading some manufacturers to propose that e-cigarettes have less harmful respiratory effects than tobacco consumption. Other innovative features such as the adjustment of nicotine content and the choice of pleasant flavours have won over many users. Nevertheless, the safety of e-cigarette consumption and its potential as a smoking cessation method remain controversial due to limited evidence. Moreover, it has been reported that the heating process itself can lead to the formation of new decomposition compounds of questionable toxicity. Numerous in vivo and in vitro studies have been performed to better understand the impact of these new inhalable compounds on human health. Results of toxicological analyses suggest that e-cigarettes can be safer than conventional cigarettes, although harmful effects from short-term e-cigarette use have been described. Worryingly, the potential long-term effects of e-cigarette consumption have been scarcely investigated. In this review, we take stock of the main findings in this field and their consequences for human health including coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Patrice Marques
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibañez 15, 46010, Valencia, Spain.,Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain
| | - Laura Piqueras
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibañez 15, 46010, Valencia, Spain.,Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain.,CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, ISCIII, Av. Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Maria-Jesus Sanz
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibañez 15, 46010, Valencia, Spain. .,Institute of Health Research INCLIVA, University Clinic Hospital of Valencia, Valencia, Spain. .,CIBERDEM-Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, ISCIII, Av. Monforte de Lemos 3-5, 28029, Madrid, Spain.
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Abstract
PURPOSE OF REVIEW Tobacco smoking is the most significant modifiable risk factor in the development of cardiovascular disease (CVD). Exposure to mainstream cigarette smoke (MCS) is associated with CVD through the development of endothelial dysfunction, a condition characterized by an imbalance of vasoactive factors in the vasculature. This dysfunction is thought to be induced in part by aldehydes generated at high levels in MCS. RECENT FINDINGS Electronic cigarettes (e-cigs) may also pose CVD risk. Although the health effects of e-cigs are still largely unknown, the presence of aldehydes in e-cig aerosol suggests that e-cigs may induce adverse cardiovascular outcomes similar to those seen with MCS exposure. Herein, we review studies of traditional and emerging tobacco product use, shared harmful and potentially harmful constituents, and measures of biomarkers of harm (endothelial dysfunction) to examine a potential and distinct role of aldehydes in cardiovascular harm associated with cigarette and e-cig use.
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Affiliation(s)
- Jordan Lynch
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA.
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA.
- University of Louisville American Heart Association - Tobacco Regulation and Addiction Center, Louisville, KY, 40202, USA.
| | - Lexiao Jin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Andre Richardson
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA
- University of Louisville American Heart Association - Tobacco Regulation and Addiction Center, Louisville, KY, 40202, USA
| | - Daniel J Conklin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, 40292, USA
- Diabetes & Obesity Center, University of Louisville, Louisville, KY, 40292, USA
- University of Louisville American Heart Association - Tobacco Regulation and Addiction Center, Louisville, KY, 40202, USA
- Superfund Research Center, University of Louisville, Louisville, KY, 40202, USA
- Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY, 40292, USA
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13
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Martuzevicius D, Prasauskas T, Setyan A, O'Connell G, Cahours X, Julien R, Colard S. Characterization of the Spatial and Temporal Dispersion Differences Between Exhaled E-Cigarette Mist and Cigarette Smoke. Nicotine Tob Res 2020; 21:1371-1377. [PMID: 29924352 PMCID: PMC6751519 DOI: 10.1093/ntr/nty121] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/17/2018] [Indexed: 11/14/2022]
Abstract
Introduction There are fundamental differences between electronic cigarettes (e-cigarettes) and conventional cigarette product categories with regards to potential environmental exposures, notably that e-cigarettes do not contain tobacco or generate side-stream emissions. Here we assess the spatial and temporal patterns of exhaled e-cigarette aerosol at a bystander’s position, and compare it with conventional cigarette smoke emissions. Methods Smokers were asked to use e-cigarettes or smoke conventional cigarettes in a room-simulating chamber. Volunteers used the products at different distances from a heated mannequin, representing a bystander, and under different room ventilation rates. Aerosol particle concentrations and size distributions at the bystander’s position were measured. Results For both product categories, the particle concentrations registered following each puff were in the same order of magnitude. However, for e-cigarettes the particle concentration returned rapidly to background values within seconds; for conventional cigarettes it increased with successive puffs, returning to background levels after 30–45 minutes. Unlike for the e-cigarette devices tested, such temporal variation was dependent on the room ventilation rate. Particle size measurements showed that exhaled e-cigarette particles were smaller than those emitted during smoking conventional cigarettes and evaporated almost immediately after exhalation, thus affecting the removal of particles through evaporation rather than displacement by ventilation. Conclusions Significant differences between emissions from the tested e- and conventional cigarettes are reported. Exhaled e-cigarette particles are liquid droplets evaporating rapidly; conventional cigarette smoke particles are far more stable and linger. Implications • Several factors potentially influencing particle behavior after exhalation of e-cigarette aerosols or emitted during smoking conventional cigarettes were studied. • Differences in particle size between those exhaled following use of e-cigarettes and those emitted during smoking of conventional cigarettes were observed. • E-cigarette particle concentrations decreased rapidly following exhalation due to evaporation. • The removal of particles following smoking conventional cigarettes was much slower and was dependent on the room ventilation rate.
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Affiliation(s)
- Dainius Martuzevicius
- Department of Environmental Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Tadas Prasauskas
- Department of Environmental Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Ari Setyan
- Empa (Swiss Federal Laboratories for Materials Science and Technology), Laboratory for Advanced Analytical Technologies, Dübendorf, Switzerland.,ETH Zürich, Institute of Environmental Engineering, Zürich, Switzerland
| | | | | | - Rémi Julien
- SEITA-Imperial Brands, Fleury-les-Aubrais, France
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14
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Krüsemann EJZ, Boesveldt S, de Graaf K, Talhout R. An E-Liquid Flavor Wheel: A Shared Vocabulary Based on Systematically Reviewing E-Liquid Flavor Classifications in Literature. Nicotine Tob Res 2020; 21:1310-1319. [PMID: 29788484 PMCID: PMC6751518 DOI: 10.1093/ntr/nty101] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/16/2018] [Indexed: 01/03/2023]
Abstract
Introduction E-liquids are available in a high variety of flavors. A systematic classification of e-liquid flavors is necessary to increase comparability of research results. In the food, alcohol, and fragrance industry, flavors are classified using flavor wheels. We systematically reviewed literature on flavors related to electronic cigarette use, to investigate how e-liquid flavors have been classified in research, and propose an e-liquid flavor wheel to classify e-liquids based on marketing descriptions. Methods The search was conducted in May 2017 using PubMed and Embase databases. Keywords included terms associated with electronic cigarette, flavors, liking, learning, and wanting in articles. Results were independently screened and reviewed. Flavor categories used in the articles reviewed were extracted. Results Searches yielded 386 unique articles of which 28 were included. Forty-three main flavor categories were reported in these articles (eg, tobacco, menthol, mint, fruit, bakery/dessert, alcohol, nuts, spice, candy, coffee/tea, beverages, chocolate, sweet flavors, vanilla, and unflavored). Flavor classifications of e-liquids in literature showed similarities and differences across studies. Our proposed e-liquid flavor wheel contains 13 main categories and 90 subcategories, which summarize flavor categories from literature to find a shared vocabulary. For classification of e-liquids using our flavor wheel, marketing descriptions should be used. Conclusions We have proposed a flavor wheel for classification of e-liquids. Further research is needed to test the flavor wheels’ empirical value. Consistently classifying e-liquid flavors using our flavor wheel in research (eg, experimental, marketing, or qualitative studies) minimizes interpretation differences and increases comparability of results. Implications We reviewed e-liquid flavors and flavor categories used in research. A large variation in the naming of flavor categories was found and e-liquid flavors were not consistently classified. We developed an e-liquid flavor wheel and provided a guideline for systematic classification of e-liquids based on marketing descriptions. Our flavor wheel summarizes e-liquid flavors and categories used in literature in order to create a shared vocabulary. Applying our flavor wheel in research on e-liquids will improve data interpretation, increase comparability across studies, and support policy makers in developing rules for regulation of e-liquid flavors.
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Affiliation(s)
- Erna J Z Krüsemann
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Antonie van Leeuwenhoeklaan, MA Bilthoven, The Netherlands.,Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, The Netherlands
| | - Kees de Graaf
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, The Netherlands
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Antonie van Leeuwenhoeklaan, MA Bilthoven, The Netherlands
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15
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Abstract
SIGNIFICANCE Prominent ocular surface dryness and poor tear film quality among electronic cigarette (e-cigarette) smokers (or vapers) indicate potential harm to the eyes from vaping. These findings may serve as precautionary signs for e-cigarette users and exposed bystanders. PURPOSE Little is known about the effect of e-cigarettes on the eyes except for reported eye irritation among individuals who were exposed to e-cigarette vapors and e-liquids. This study aims to investigate the effect of vaping on ocular surface health of long-term vapers. METHODS Twenty-one vapers and 21 healthy nonsmokers who are all male underwent measurements of the Ocular Surface Disease Index, noninvasive tear breakup time, fluorescein breakup time, ocular surface staining, tear meniscus height, and the Schirmer test. The effect of voltage used during vaping was also evaluated against the measurements. RESULTS Vapers experienced moderate-to-severe eye dryness (25.0 [interquartile range, 14.6 to 43.7]) as indicated by the Ocular Surface Disease Index. Significant reductions of noninvasive tear breakup time (3.13 ± 0.97 vs. 6.57 ± 2.31 seconds; P < .0001), fluorescein breakup time (2.68 [interquartile range, 2.33 to 3.18] vs. 4.12 [3.56 to 5.07] seconds; P < .0001), and tear meniscus height (203.0 [193.0 to 225.5] vs. 235.0 [210.0 to 253.50] μm; P = .002) were noted in vapers, but the Schirmer test showed higher results (14.5 [12.0 to 17.0] vs. 8.0 [7.0 to 11.0] mm; P = .001) compared with nonsmokers. Increase in vaping voltage aggravated the dry eye symptoms and tear instability (P < .05). Higher Schirmer test result was also noted as voltage increases. CONCLUSIONS Vapers showed moderate-to-severe symptomatic dry eye and poorer tear film quality compared with nonsmokers. High vaping voltage may have aggravated the dry eye syndrome because of hazardous by-products from pyrolysis of the e-liquid constituents. Investigation of the ocular surface health at cellular and molecular levels is warranted to gain a deeper understanding on the effect of e-cigarette to the eyes.
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Cichońska D, Kusiak A, Kochańska B, Ochocińska J, Świetlik D. Influence of Electronic Cigarettes on Selected Antibacterial Properties of Saliva. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4433. [PMID: 31726698 PMCID: PMC6888580 DOI: 10.3390/ijerph16224433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/22/2022]
Abstract
The aim of this study was to estimate changes in selected physicochemical properties of saliva collected from users of electronic cigarettes. Methods: The study population consisted of 120 patients (40 users of electronic cigarettes, 40 smokers of traditional cigarettes and 40 non-smokers). Laboratory tests included verification of saliva amount of lysozyme, lactoferrin and IgA. Results: Among e-cigarette users, statistically significant differences were observed in values of lysozyme and lactoferrin; however, no statistically significant differences for the IgA value were found. In the group of traditional cigarette smokers, statistically significant differences were observed among all tested parameters in relation to the control group. In relation to IgA, statistically significant differences were found between e-cigarette users and traditional cigarette smokers, to the disadvantage of the latter. Conclusion: Saliva of e-cigarette users showed changes of antibacterial properties in comparison to the control group and traditional cigarette smokers. Further longitudinal studies on larger study groups should be conducted in order to assess the effect of observed changes in the antibacterial properties of saliva on oral health.
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Affiliation(s)
- Dominika Cichońska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdańsk, 80-204 Gdańsk, Poland;
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdańsk, 80-204 Gdańsk, Poland;
| | - Barbara Kochańska
- Department of Conservative Dentistry, Medical University of Gdańsk, 80-204 Gdańsk, Poland; (B.K.)
| | - Jolanta Ochocińska
- Department of Conservative Dentistry, Medical University of Gdańsk, 80-204 Gdańsk, Poland; (B.K.)
| | - Dariusz Świetlik
- Department of Biostatistics and Neural Networks, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
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17
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Modeling drug exposure in rodents using e-cigarettes and other electronic nicotine delivery systems. J Neurosci Methods 2019; 330:108458. [PMID: 31614162 DOI: 10.1016/j.jneumeth.2019.108458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 12/25/2022]
Abstract
Smoking tobacco products is the leading cause of preventable death worldwide. Coordinated efforts have successfully reduced tobacco cigarette smoking in the United States; however, electronic cigarettes (e-cigarette) and other electronic nicotine delivery systems (ENDS) recently have replaced traditional cigarettes for many users. While the clinical risks associated with long-term ENDS use remain unclear, advancements in preclinical rodent models will enhance our understanding of their overall health effects. This review examines the peripheral and central effects of ENDS-mediated exposure to nicotine and other drugs of abuse in rodents and evaluates current techniques for implementing ENDS in preclinical research.
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18
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Maessen GC, Wijnhoven AM, Neijzen RL, Paulus MC, van Heel DAM, Bomers BHA, Boersma LE, Konya B, van der Heyden MAG. Nicotine intoxication by e-cigarette liquids: a study of case reports and pathophysiology. Clin Toxicol (Phila) 2019; 58:1-8. [PMID: 31286797 DOI: 10.1080/15563650.2019.1636994] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Electronic cigarettes (e-cigarettes), the smokeless alternative to conventional tobacco cigarettes, have become increasingly popular. E-cigarettes vaporise e-liquid, a solution of highly concentrated nicotine, propylene glycol (PG) and vegetable glycerine (VG). With the popularity of e-cigarettes, e-liquid refills have become easily accessible and several cases of intoxication due to the ingestion of e-liquid have been reported. We provide an overview of these cases, their pathophysiology and patients' characteristics.Methods: We carried out a retrospective evaluation of the scientific literature reporting on cases of liquid nicotine intoxication, using the following inclusion criteria: (1) the article is or contains a case report, (2) describes an intoxication with e-liquid, (3) the substance contains nicotine, and (4) intake is oral, intravenous or subcutaneous.Results: We found 26 case reports describing a total of 31 patients who suffered from e-liquid intoxication. All intoxications up to the age of six were reported as unintentional, whereas nearly all cases from ages 13 to 53 were due to suicide attempts. The three most prevalent symptoms of e-liquid intoxication were tachycardia, altered mental status and vomiting. Eleven cases resulted in the death of the patient. In the survivors, the highest plasma concentration of nicotine was 800 µg L-1, while the lowest concentration in the non-survivors was 1600 µg L-1.Conclusions: There is a mismatch between the generally accepted lethal oral nicotine dose of 60 mg, resulting in approximately 180 µg L-1 plasma concentration, and the 4.4- to 8.9-fold higher lethal plasma concentrations we found in cases of e-liquid intoxication. In these severe intoxications, plasma cotinine concentration does not act as a more reliable indicator of nicotine intoxication than nicotine itself. The ages of the patients display a bimodal distribution. In patients above the age of 10, intoxication results mainly from suicide attempts rather than accidental ingestion. The role of PG and VG in e-liquid intoxications is remarkably unclear. However, the similarity across nicotine and PG toxicity symptoms leads us to believe a cumulative effect cannot be excluded.
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Affiliation(s)
- Gerdinique C Maessen
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anjali M Wijnhoven
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosalie L Neijzen
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michelle C Paulus
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dayna A M van Heel
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart H A Bomers
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucie E Boersma
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Burak Konya
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Choi A, Le M, Rahim T, Rose C, Kosatsky T. Electronic cigarette exposures reported to the British Columbia Drug and Poison Information Centre: an observational case series. CMAJ Open 2019; 7:E462-E471. [PMID: 31320329 PMCID: PMC6639097 DOI: 10.9778/cmajo.20180203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDSs), including electronic cigarettes (e-cigarettes), are rapidly gaining popularity. The aim of this study was to use poison centre data to describe epidemiological trends in ENDS-related exposures. METHODS We conducted an observational case series study using records containing both coded fields and free-text narratives from the British Columbia Drug and Poison Information Centre for all calls involving exposure to ENDS received from 2012 to 2017. We described trends in exposures and exposed people, as well as clinical effects. RESULTS A total of 243 calls were recorded for 186 unique exposures to ENDS devices, e-juice, e-cigarette cartridges and other associated paraphernalia over the study period. Calls related to ENDS exposures increased nearly sixfold between 2013 and 2014 and did not decline subsequently. Exposures were most frequently documented in children aged 4 years or less (81 [43.5%]), with 58 (31.0%) in 1- and 2-year-olds. Seventy-two exposures (89%) in children aged 4 years or less were due to accidental ingestion, whereas adults aged 25 years or more called the poison centre following ENDS malfunctions (7 [23%], spills (4 [13%]) and exposure to e-juice mistaken for other substances (4 [13%]). Of the 186 exposed people, 87 (46.8%) reported symptoms. INTERPRETATION British Columbia experienced a sixfold increase in ENDS-related calls to the provincial poison centre between 2012 and 2017, driven by ingestions in young children. Regulatory approaches aimed at minimizing children's access to ENDS, clear labelling of nicotine concentration, and packaging that reduces the likelihood of spills, product confusion and malfunction should be considered.
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Affiliation(s)
- Alex Choi
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Megan Le
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Tissa Rahim
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Caren Rose
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
| | - Tom Kosatsky
- School of Population and Public Health (Choi, Le, Rose), Faculty of Medicine, University of British Columbia; BC Centre for Disease Control (Rahim, Rose, Kosatsky), Vancouver, BC
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21
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Czoli CD, Goniewicz ML, Palumbo M, Leigh N, White CM, Hammond D. Identification of flavouring chemicals and potential toxicants in e-cigarette products in Ontario, Canada. Canadian Journal of Public Health 2019; 110:542-550. [PMID: 31025300 DOI: 10.17269/s41997-019-00208-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The current study examined constituents of e-cigarette products on the Canadian market, with a focus on the province of Ontario. METHODS E-cigarettes were systematically purchased at 80 retail outlets across 4 cities in Ontario, Canada, in January-February 2015. Product constituents were identified using gas chromatography and mass spectrometry. Additionally, tobacco-specific nitrosamines (TSNAs) were quantified in tested products using liquid chromatography with tandem mass spectrometry. RESULTS A total of 166 e-cigarette products were purchased, including disposable products (33%), refillable products (14%), and e-liquids (53%). Overall, e-cigarette products had an average of 6.2 (SD = 3.6) flavouring chemicals. E-cigarettes with sweet flavours (e.g., desserts, alcoholic drinks) had a significantly greater number of flavouring chemicals when compared with tobacco- and menthol-flavoured products (p < 0.05). Approximately one fifth (21%) of products contained flavouring chemicals with potential risk of inhalation toxicity (benzyl alcohol, benzaldehyde, vanillin). An additional 8 toxicants (e.g., acrolein, diacetyl) were detected in a total of 14 e-cigarette products. Measurable levels of TSNAs were detected in 70% of tested products. CONCLUSION E-cigarettes purchased in Ontario, Canada, contained several constituents that may present excess risk, including some flavouring chemicals and carcinogenic nitrosamines. Further research is needed to determine whether the levels of these constituents have implications for the magnitude of risk to users. The findings reveal several policy gaps that may be addressed by developing regulatory product standards and labelling practices for e-cigarettes.
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Affiliation(s)
- Christine D Czoli
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Mary Palumbo
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Noel Leigh
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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Sudden sensorineural hearing loss associated with electronic cigarette liquid: The first case in the literature. Int J Pediatr Otorhinolaryngol 2018; 114:26-28. [PMID: 30262362 DOI: 10.1016/j.ijporl.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 01/10/2023]
Abstract
Pediatric sudden sensorineural hearing loss (SSNHL) is a quite rare otologic emergency. Etiology of SSNHL isn't enough clear. Electronic cigarette (EC) is a device that uses increasingly and it contain liquid which keep nicotin and various chemicals. This liquid can be ingested mistakenly by children and various side effects may develop. But hearing loss wasn't reported before as a side effect. We presented an interesting case, she was 6-year-old who developed bilaterally SSNHL associated with drinking electronic cigarette liquid.
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23
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Comprehensive determination of flavouring additives and nicotine in e-cigarette refill solutions. Part I: Liquid chromatography-tandem mass spectrometry analysis. J Chromatogr A 2017; 1519:45-54. [DOI: 10.1016/j.chroma.2017.08.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 11/22/2022]
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Ogunwale M, Li M, Ramakrishnam Raju MV, Chen Y, Nantz MH, Conklin DJ, Fu XA. Aldehyde Detection in Electronic Cigarette Aerosols. ACS OMEGA 2017; 2:1207-1214. [PMID: 28393137 PMCID: PMC5377270 DOI: 10.1021/acsomega.6b00489] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/14/2017] [Indexed: 05/23/2023]
Abstract
Acetaldehyde, acrolein, and formaldehyde are the principal toxic aldehydes present in cigarette smoke and contribute to the risk of cardiovascular disease and noncancerous pulmonary disease. The rapid growth of the use of electronic cigarettes (e-cigarettes) has raised concerns over emissions of these harmful aldehydes. This work determines emissions of these aldehydes in both free and bound (aldehyde-hemiacetal) forms and other carbonyls from the use of e-cigarettes. A novel silicon microreactor with a coating phase of 4-(2-aminooxyethyl)-morpholin-4-ium chloride (AMAH) was used to trap carbonyl compounds in the aerosols of e-cigarettes via oximation reactions. AMAH-aldehyde adducts were measured using gas chromatography-mass spectrometry. 1H nuclear magnetic resonance spectroscopy was used to analyze hemiacetals in the aerosols. These aldehydes were detected in the aerosols of all e-cigarettes. Newer-generation e-cigarette devices generated more aldehydes than the first-generation e-cigarettes because of higher battery power output. Formaldehyde-hemiacetal was detected in the aerosols generated from some e-liquids using the newer e-cigarette devices at a battery power output of 11.7 W and above. The emission of these aldehydes from all e-cigarettes, especially higher levels of aldehydes from the newer-generation e-cigarette devices, indicates the risk of using e-cigarettes.
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Affiliation(s)
- Mumiye
A. Ogunwale
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
| | - Mingxiao Li
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
| | - Mandapati V. Ramakrishnam Raju
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
| | - Yizheng Chen
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
| | - Michael H. Nantz
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
| | - Daniel J. Conklin
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
| | - Xiao-An Fu
- Department
of Chemistry, Department of Chemical Engineering,
and American Heart Association—Tobacco
Regulation and Addiction Center, University
of Louisville, Louisville, Kentucky 40292, United States
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25
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Liberman J, Wann S. E-Cigarettes-What a Practicing Cardiologist Needs to Know. Am J Cardiol 2017; 119:681-686. [PMID: 28017304 DOI: 10.1016/j.amjcard.2016.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
Cardiologists and other physicians caring for patients who either smoke tobacco or are potential or active users of E-cigarettes have many questions about this increasingly popular method for delivering nicotine to the brain: (1) What are E-cigarettes? (2) What harm do E-cigarettes pose to users and bystanders? (3) Can E-cigarettes help tobacco smokers quit? (4) Are E-cigarettes a gateway to tobacco smoking, addicting new users, particularly the young, to nicotine? and (5) Should E-cigarettes be tolerated, or even favored over tobacco, as a less harmful substitute for those unable to stop smoking tobacco? This editorial summarizes evidence and expert opinion, preparing the physician for informed discussion of this controversial subject with their patients and colleagues. Although E-cigarettes may be less harmful than tobacco cigarettes, they are definitely not harmless. Particularly concerning are the well-financed commercial interests marketing E-cigarettes to our youth. As new regulatory policies are developed, we must not allow E-cigarettes to reverse our progress in reducing tobacco smoking, the leading cause of preventable death in the United States.
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Affiliation(s)
- Joshua Liberman
- Columbia St. Mary's Cardiovascular Physicians, Ascension Healthcare, Milwaukee, Wisconsin
| | - Samuel Wann
- Columbia St. Mary's Cardiovascular Physicians, Ascension Healthcare, Milwaukee, Wisconsin.
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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27
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Rouabhia M, Park HJ, Semlali A, Zakrzewski A, Chmielewski W, Chakir J. E-Cigarette Vapor Induces an Apoptotic Response in Human Gingival Epithelial Cells Through the Caspase-3 Pathway. J Cell Physiol 2016; 232:1539-1547. [PMID: 27808425 DOI: 10.1002/jcp.25677] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022]
Abstract
Electronic cigarettes represent an increasingly significant proportion of today's consumable tobacco products. E-cigarettes contain several chemicals which may promote oral diseases. The aim of this study was to investigate the effect of e-cigarette vapor on human gingival epithelial cells. Results show that e-cigarette vapor altered the morphology of cells from small cuboidal form to large undefined shapes. Both single and multiple exposures to e-cigarette vapor led to a bulky morphology with large faint nuclei and an enlarged cytoplasm. E-cigarette vapor also increased L-lactate dehydrogenase (LDH) activity in the targeted cells. This activity was greater with repeated exposures. Furthermore, e-cigarette vapor increased apoptotic/necrotic epithelial cell percentages compared to that observed in the control. Epithelial cell apoptosis was confirmed by TUNEL assay showing that exposure to e-cigarette vapor increased apoptotic cell numbers, particularly after two and three exposures. This negative effect involved the caspase-3 pathway, the activity of which was greater with repeated exposure and which decreased following the use of caspase-3 inhibitor. The adverse effects of e-cigarette vapor on gingival epithelial cells may lead to dysregulated gingival cell function and result in oral disease. J. Cell. Physiol. 232: 1539-1547, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mahmoud Rouabhia
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Hyun Jin Park
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Abdelhabib Semlali
- Department of Biochemistry, Genome Research Chair, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew Zakrzewski
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Witold Chmielewski
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Jamila Chakir
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
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Richter L, Pugh BS, Smith PH, Ball SA. The co-occurrence of nicotine and other substance use and addiction among youth and adults in the United States: implications for research, practice, and policy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:132-145. [DOI: 10.1080/00952990.2016.1193511] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Linda Richter
- The National Center on Addiction and Substance Abuse, New York, NY, USA
| | - Brandie S. Pugh
- The National Center on Addiction and Substance Abuse, New York, NY, USA
| | - Philip H. Smith
- Department of Community Health and Social Medicine, Sophie Davis Biomedical Education/CUNY School of Medicine, The City College of New York, New York, NY, USA
| | - Samuel A. Ball
- The National Center on Addiction and Substance Abuse, New York, NY, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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29
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Putzhammer R, Doppler C, Jakschitz T, Heinz K, Förste J, Danzl K, Messner B, Bernhard D. Vapours of US and EU Market Leader Electronic Cigarette Brands and Liquids Are Cytotoxic for Human Vascular Endothelial Cells. PLoS One 2016; 11:e0157337. [PMID: 27351725 PMCID: PMC4924852 DOI: 10.1371/journal.pone.0157337] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/28/2016] [Indexed: 12/03/2022] Open
Abstract
The present study was conducted to provide toxicological data on e-cigarette vapours of different e-cigarette brands and liquids from systems viewed as leaders in the e-cigarette market and to compare e-cigarette vapour toxicity to the toxicity of conventional strong high-nicotine cigarette smoke. Using an adapted version of a previously constructed cigarette smoke constituent sampling device, we collected the hydrophilic fraction of e-cigarette vapour and exposed human umbilical vein endothelial cells (HUVECs) to the mixture of compounds present in the vapour of 4 different single-use e-cigarettes, 6 different liquid vapours produced by the same refillable e-cigarette, and one e-cigarette with an exchangeable liquid cartridge. After incubation of cells with various concentrations and for various periods of time we analysed cell death induction, proliferation rates, the occurrence of intra-cellular reactive oxygen species, cell morphology, and we also measured e-cigarette heating coil temperatures. Overall, conventional cigarette smoke extract showed the most severe impact on endothelial cells. However, some e-cigarette vapour extracts showed high cytotoxicity, inhibition of cell proliferation, and alterations in cell morphology, which were comparable to conventional high-nicotine cigarettes. The vapours generated from different liquids using the same e-cigarette show substantial differences, pointing to the liquids as an important source for toxicity. E-cigarette vapour-mediated induction of oxidative stress was significant in one out of the 11 analysed vapours. There is a high variability in the acute cytotoxicity of e-cigarette vapours depending on the liquid and on the e-cigarettes used. Some products showed toxic effects close to a conventional high-nicotine cigarette. Liquid nicotine, menthol content, and the formation of acute intracellular reactive oxygen species do not seem to be the central elements in e-cigarette vapour toxicity.
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Affiliation(s)
- Raphaela Putzhammer
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- MCI Management Center Innsbruck, Biotechnology, Innsbruck, Austria
| | - Christian Doppler
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Katharina Heinz
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Juliane Förste
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- MCI Management Center Innsbruck, Biotechnology, Innsbruck, Austria
| | - Katarina Danzl
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Messner
- Cardiac Surgery Research Laboratory, Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David Bernhard
- Cardiac Surgery Research Laboratory, University Clinic for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
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30
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Review on quantitation methods for hazardous pollutants released by e-cigarette (EC) smoking. Trends Analyt Chem 2016. [DOI: 10.1016/j.trac.2016.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí AA, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EFM, ZuWallack RL. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir Rev 2016; 24:159-72. [PMID: 26028628 PMCID: PMC9487818 DOI: 10.1183/16000617.00000315] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers and patient advocates believe will have the greatest impact on patient-centred outcomes. ATS/ERS statement highlighting research areas that will have the greatest impact on patient-centred outcomes in COPDhttp://ow.ly/LXW2J
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32
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Castaldelli-Maia JM, Ventriglio A, Bhugra D. Tobacco smoking: From 'glamour' to 'stigma'. A comprehensive review. Psychiatry Clin Neurosci 2016; 70:24-33. [PMID: 26449875 DOI: 10.1111/pcn.12365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 01/08/2023]
Abstract
In this narrative review, we explore the history of tobacco smoking, its associations and portrayal of its use with luxury and glamour in the past, and intriguingly, its subsequent transformation into a mass consumption industrialized product encouraged by advertising and film. Then, we describe the next phase where tobacco in parts of the world has become an unwanted product. However, the number of smokers is still increasing, especially in new markets, and increasingly younger individuals are being attracted to it, despite the well-known health consequences of tobacco use. We also explore current smoking behaviors, looking at trends in the prevalence of consumption throughout the world, discrimination against smokers, light and/or intermittent smokers, and the electronic cigarette (e-cigarette). We place these changes in the context of neuroscience, which may help explain why the cognitive effects of smoking can be important reinforcers for its consumption despite strong anti-smoking pressure in Western countries.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Neuroscience, Medical School, ABC Foundation, Santo André, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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33
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Riley HEM, Berry-Bibee E, England LJ, Jamieson DJ, Marchbanks PA, Curtis KM. Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review. Contraception 2015; 93:190-208. [PMID: 26546021 DOI: 10.1016/j.contraception.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 10/26/2015] [Accepted: 11/01/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Women who use combined hormonal contraceptives and cigarettes have an increased risk for cardiovascular (CV) events. We reviewed the literature to determine whether women who use hormonal contraceptives (HC) and electronic cigarettes (e-cigarettes) also have an increased risk. STUDY DESIGN Systematic review. METHODS We searched for articles reporting myocardial infarction (MI), stroke, venous thromboembolism, peripheral arterial disease or changes to CV markers in women using e-cigarettes and HC. We also searched for indirect evidence, such as CV outcomes among e-cigarette users in the general population and among HC users exposed to nicotine, propylene glycol or glycerol. RESULTS No articles reported on outcomes among e-cigarette users using HC. Among the general population, 13 articles reported on heart rate or blood pressure after e-cigarette use. These markers generally remained normal, even when significant changes were observed. In three studies, changes were less pronounced after e-cigarette use than cigarette use. One MI was reported among 1012 people exposed to e-cigarettes in these studies. One article on nicotine and HC exposure found both exposures to be significantly associated with acute changes to heart rate, though mean heart rate remained normal. No articles on propylene glycol or glycerol and HC exposure were identified. CONCLUSION We identified no evidence on CV outcomes among e-cigarette users using HC. Limited data reporting mostly acute outcomes suggested that CV events are rare among e-cigarette users in the general population and that e-cigarettes may affect heart rate and blood pressure less than conventional cigarettes. There is a need for research assessing joint HC and e-cigarette exposure on clinical CV outcomes.
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Affiliation(s)
- Halley E M Riley
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Erin Berry-Bibee
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucinda J England
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Denise J Jamieson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Polly A Marchbanks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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34
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Alawsi F, Nour R, Prabhu S. Are e-cigarettes a gateway to smoking or a pathway to quitting? Br Dent J 2015; 219:111-5. [DOI: 10.1038/sj.bdj.2015.591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 01/04/2023]
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35
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Cytotoxicity and apoptosis induction by e-cigarette fluids in human gingival fibroblasts. Clin Oral Investig 2015; 20:477-83. [DOI: 10.1007/s00784-015-1537-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
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36
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí A, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EFM, ZuWallack RL. An Official American Thoracic Society/European Respiratory Society Statement: Research questions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015; 191:e4-e27. [PMID: 25830527 DOI: 10.1164/rccm.201501-0044st] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. METHODS Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarized, and then salient knowledge gaps were identified. RESULTS Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. CONCLUSIONS Great strides have been made in the diagnosis, assessment, and management of COPD as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS Research Statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centered outcomes.
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37
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Knorst MM, Benedetto IG, Hoffmeister MC, Gazzana MB. The electronic cigarette: the new cigarette of the 21st century? J Bras Pneumol 2015; 40:564-72. [PMID: 25410845 PMCID: PMC4263338 DOI: 10.1590/s1806-37132014000500013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/27/2014] [Indexed: 11/22/2022] Open
Abstract
The electronic nicotine delivery system, also known as the electronic cigarette, is
generating considerable controversy, not only in the general population but also
among health professionals. Smokers the world over have been increasingly using
electronic cigarettes as an aid to smoking cessation and as a substitute for
conventional cigarettes. There are few available data regarding the safety of
electronic cigarettes. There is as yet no evidence that electronic cigarettes are
effective in treating nicotine addiction. Some smokers have reported using electronic
cigarettes for over a year, often combined with conventional cigarettes, thus
prolonging nicotine addiction. In addition, the increasing use of electronic
cigarettes by adolescents is a cause for concern. The objective of this study was to
describe electronic cigarettes and their components, as well as to review the
literature regarding their safety; their impact on smoking initiation and smoking
cessation; and regulatory issues related to their use.
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Affiliation(s)
- Marli Maria Knorst
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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38
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí A, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EF, ZuWallack RL. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir J 2015; 45:879-905. [DOI: 10.1183/09031936.00009015] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulatedviadiscussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes.
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39
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Sussan TE, Gajghate S, Thimmulappa RK, Ma J, Kim JH, Sudini K, Consolini N, Cormier SA, Lomnicki S, Hasan F, Pekosz A, Biswal S. Exposure to electronic cigarettes impairs pulmonary anti-bacterial and anti-viral defenses in a mouse model. PLoS One 2015; 10:e0116861. [PMID: 25651083 PMCID: PMC4317176 DOI: 10.1371/journal.pone.0116861] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/24/2014] [Indexed: 12/17/2022] Open
Abstract
Electronic cigarettes (E-cigs) have experienced sharp increases in popularity over the past five years due to many factors, including aggressive marketing, increased restrictions on conventional cigarettes, and a perception that E-cigs are healthy alternatives to cigarettes. Despite this perception, studies on health effects in humans are extremely limited and in vivo animal models have not been generated. Presently, we determined that E-cig vapor contains 7x1011 free radicals per puff. To determine whether E-cig exposure impacts pulmonary responses in mice, we developed an inhalation chamber for E-cig exposure. Mice that were exposed to E-cig vapor contained serum cotinine concentrations that are comparable to human E-cig users. E-cig exposure for 2 weeks produced a significant increase in oxidative stress and moderate macrophage-mediated inflammation. Since, COPD patients are susceptible to bacterial and viral infections, we tested effects of E-cigs on immune response. Mice that were exposed to E-cig vapor showed significantly impaired pulmonary bacterial clearance, compared to air-exposed mice, following an intranasal infection with Streptococcus pneumonia. This defective bacterial clearance was partially due to reduced phagocytosis by alveolar macrophages from E-cig exposed mice. In response to Influenza A virus infection, E-cig exposed mice displayed increased lung viral titers and enhanced virus-induced illness and mortality. In summary, this study reports a murine model of E-cig exposure and demonstrates that E-cig exposure elicits impaired pulmonary anti-microbial defenses. Hence, E-cig exposure as an alternative to cigarette smoking must be rigorously tested in users for their effects on immune response and susceptibility to bacterial and viral infections.
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Affiliation(s)
- Thomas E. Sussan
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (TES); (SB)
| | - Sachin Gajghate
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rajesh K. Thimmulappa
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jinfang Ma
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jung-Hyun Kim
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kuladeep Sudini
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nicola Consolini
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stephania A. Cormier
- Children′s Research Foundation Institute, University of Tennessee Health Science Center, 50 N. Dunlap, Memphis, Tennessee, United States of America
| | - Slawo Lomnicki
- Department of Environmental Sciences, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Farhana Hasan
- Department of Chemistry, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shyam Biswal
- Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (TES); (SB)
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40
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McNeill A, Etter JF, Farsalinos K, Hajek P, le Houezec J, McRobbie H. A critique of a World Health Organization-commissioned report and associated paper on electronic cigarettes. Addiction 2014; 109:2128-34. [PMID: 25196419 DOI: 10.1111/add.12730] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The World Health Organization (WHO) recently commissioned a report reviewing evidence on electronic cigarettes and making policy recommendations. A version of it was subsequently published as an academic paper. We identify important errors in the description and interpretation of the studies reviewed, and find many of its key conclusions misleading.
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Affiliation(s)
- Ann McNeill
- King's College London, Institute of Psychiatry, UK Centre for Tobacco and Alcohol Studies, London, UK
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Ordonez JE, Kleinschmidt KC, Forrester MB. Electronic cigarette exposures reported to Texas poison centers. Nicotine Tob Res 2014; 17:209-11. [PMID: 25344956 DOI: 10.1093/ntr/ntu223] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Exposure to the liquid nicotine solutions in electronic cigarettes (e-cigs) may be dangerous because they are highly concentrated. Little is known about the impact of exposure on public health. This study describes e-cig exposures reported to poison centers. METHODS All e-cig exposures reported to Texas poison centers during 2009 to February 2014 were identified. Exposures involving other substances in addition to e-cigs and exposures not followed to a final medical outcome were included. The distributions of exposures by demographic and clinical factors were determined. RESULTS Of 225 total exposures, 2 were reported in January 2009, 6 in 2010, 11 in 2011, 43 in 2012, 123 in 2013, and 40 through February 2014. Fifty-three percent (n = 119) occurred among individuals aged <5 years old, 41% (n = 93) occurred among individuals aged >20 years old, and 6% (n = 13) occurred among individuals aged 6-19 years. Fifty percent were female. The route of exposure was 78% ingestion. Eighty-seven percent of the exposures were unintentional, and 5% were intentional. The exposures occurred at patients' own residences in 95% of the cases. The clinical effects reported most often were vomiting (20%), nausea (10%), headache (4%), ocular irritation (5%), dizziness (5%), and lethargy (2%). CONCLUSION E-cig exposures reported to poison centers are increasing. Most of the patients are young children, and the exposures most frequently occur through ingestion. Reported exposures often do not have serious outcomes.
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Affiliation(s)
| | - Kurt C Kleinschmidt
- Parkland Health and Hospital System, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX
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De Long NE, Barra NG, Hardy DB, Holloway AC. Is it safe to use smoking cessation therapeutics during pregnancy? Expert Opin Drug Saf 2014; 13:1721-31. [PMID: 25330815 DOI: 10.1517/14740338.2014.973846] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Worldwide, 10 to 35% of pregnant women smoke. It is clear that smoking cessation has positive impacts for both the mother and child, yet many women are still unable to quit due to the addictive properties of nicotine. There are limited data surrounding their safety and efficacy in pregnancy. AREAS COVERED This review highlights evidence from clinical studies and animal experiments regarding the effects of smoking cessation therapeutics on pregnancy, neonatal and long-term postnatal outcomes. EXPERT OPINION There are insufficient data at this time to recommend the use of varenicline and/or bupropion for smoking cessation during pregnancy. In addition, the efficacy and safety of nicotine replacement therapy use for smoking cessation in pregnant women has not been clearly demonstrated. Until further studies are completed, there will continue to be considerable uncertainty regarding the use of these drugs in pregnancy despite the well-documented benefits of smoking cessation.
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Affiliation(s)
- Nicole E De Long
- McMaster University, Department of Obstetrics and Gynecology , RM HSC-3N52, 1280 Main Street West, Hamilton, Ontario, L8S 4K1 , Canada +1 905 525 9140 ext. 22130 ; +1 905 524 2911 ;
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Bhatnagar A, Whitsel LP, Ribisl KM, Bullen C, Chaloupka F, Piano MR, Robertson RM, McAuley T, Goff D, Benowitz N. Electronic cigarettes: a policy statement from the American Heart Association. Circulation 2014; 130:1418-36. [PMID: 25156991 DOI: 10.1161/cir.0000000000000107] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stillman FA, Soong A, Zheng LY, Navas-Acien A. E-cigarette use in air transit: self-reported data from US flight attendants. Tob Control 2014; 24:417-8. [PMID: 24950696 PMCID: PMC4484500 DOI: 10.1136/tobaccocontrol-2013-051514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Frances A Stillman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco, Baltimore, Maryland, USA
| | - Andrea Soong
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco, Baltimore, Maryland, USA
| | - Laura Y Zheng
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Vakkalanka JP, Hardison LS, Holstege CP. Epidemiological trends in electronic cigarette exposures reported to U.S. Poison Centers. Clin Toxicol (Phila) 2014; 52:542-8. [DOI: 10.3109/15563650.2014.913176] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Jerome S Brody
- 1 Department of Medicine and Pulmonary Center Boston University School of Medicine Boston, Massachusetts
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