Electronic cigarettes. A position statement of the forum of international respiratory societies

Cytotoxic impact of nicotine products on periodontal ligament cells

OBJECTIVES

The primary objective of this in vitro experiment was an assessment of proliferative capacity, metabolic activity, and potential cellular detriment of human periodontal ligament cells (hPDL) exposed to cigarette smoke (CS), electronic cigarette vapor (eCV), and heated tobacco product aerosol (HTP), or air (control).

MATERIALS AND METHODS

Using a CAD/CAM-designed exposition chamber, hPDL were exposed to CS, eCV, HTP, or air (control) based on the Health Canada Intense Smoking Regime. Cell proliferation, metabolic activity, and cellular detriment were assessed at various time points.

RESULTS

Compared to the control, hPDL exposed to CS exhibited significantly decreased cell numbers at all time points. HTP exposure led to reduced cell numbers 48 h and 72 h post-exposure, while eCV-exposed cells showed no significant decrease. The metabolic activity of eCV-treated hPDL was slightly reduced at 7 h but recovered at 24 h and 48 h. In contrast, CS-treated cells exhibited significantly decreased metabolic activity at 24 h and 48 h, and HTP-exposed cells showed a significant decrease after 48 h. Flow cytometry indicated both apoptotic and necrotic cell death following CS exposure, with necrotic cell death being more pronounced.

CONCLUSIONS

eCV and HTP demonstrated comparatively reduced detrimental effects on hPDL compared to CS.

CLINICAL RELEVANCE

The findings suggest that conventional cigarette smoke poses a substantial risk to periodontal health by significantly impairing cell proliferation and metabolic activity. However, alternatives such as eCV and HTP may offer a comparatively reduced risk.

E-cigarettes exacerbate allergic inflammation via cytokine induction and MUC5AC/5B expression in a murine asthma model

The effects of electronic cigarettes (e-cigarettes) vapor on inflammation and mucin secretion on asthmatics remain insufficiently explored. This study investigated the effects of e-cigarette vapor on allergic inflammation, cytokine production, and MUC5AC/5B expression in murine asthma model. Airway hyperresponsiveness was significantly higher in the e-cigarette-exposed ovalbumin (OVA) sensitization group than in the control, e-cigarette exposure, and OVA sensitization groups. The e-cigarette-exposed OVA sensitization group showed significantly greater infiltration of inflammatory cells and Th2-mediated inflammatory cytokines (interleukin-4 and -5) compared to the control, e-cigarette exposure, and OVA sensitization groups. MUC5AC mucin levels were significantly elevated in the e-cigarette exposure, OVA sensitization, and e-cigarette-exposed OVA sensitization groups, whereas MUC5B mucin levels were significantly elevated in the OVA sensitization and e-cigarette-exposed OVA sensitization groups. The results may suggest that the exposure to e-cigarette vapor in an asthmatics promoted allergic inflammation and increased mucin secretion, ultimately leading to the exacerbation of asthma.

Associations between e-cigarette use and sleep health among adults in the United States, NHANES 2015-2018

OBJECTIVE

To examine the associations between e-cigarette use or dual (e-cigarette and combustible cigarette) use and short sleep duration and trouble sleeping among U.S. adults.

METHODS

We used 2015-2018 data from the National Health and Nutrition Examination Survey (NHANES) (n = 11,659). E-cigarette use and dual use were categorized as current, former, and never use. Short sleep duration was defined as sleep duration ≤6 h. Trouble sleeping was self-reported. Weighted logistic regression analyses were performed.

RESULTS

Among those with current e-cigarette use, 53.9 % were with current dual use and 23.8 % were with former dual use. Compared to never e-cigarette use, current e-cigarette use was associated with significantly higher odds of trouble sleeping (OR = 2.16, 95 % CI: 1.49-3.13), adjusting for potential confounders. Significant associations were also observed for former e-cigarette use versus never use with trouble sleeping (OR = 1.54, 95 % CI: 1.15-2.07) after full adjustment. Current cigarette use was associated with both short sleep duration (OR = 1.65, 95 % CI: 1.28-2.14) and trouble sleeping (OR = 1.36, 95 % CI: 1.03-1.79) after full adjustment. Additionally, the fully adjusted ORs for short sleep duration and trouble sleeping were 1.64 (95 % CI: 1.06-2.54) and 2.14 (95 % CI: 1.34-3.42) among those with current dual use, and 1.46 (95 % CI: 1.17-1.81) and 2.11 (95 % CI: 1.66-2.67) among those with former dual use, compared to those without dual use.

CONCLUSIONS

Current cigarette use or dual use is associated with significantly higher odds of short sleep duration and trouble sleeping. Moreover, former e-cigarette use or dual use is associated with increased odds of trouble sleeping.

Comparative analysis of e-cigarette prevalence and influencing factors among adolescents in Jiangsu Province, China

Objective

The objectives of this study were to investigate electronic cigarette (e-cigarette) and cigarette use in Jiangsu Province, China, by analyzing the two-year trends of e-cigarette using and to explore the factors influencing the experimentation and use of e-cigarettes.

Methods

We conducted a cross-sectional study following the standard methodology of the Global Youth Tobacco Survey in 2019 and 2021. A three-stage cluster sampling design was applied. Eighty-two schools in 14 districts (counties) in Jiangsu Province were surveyed. All computations were performed using the SPSS 21.0 complex samples procedure. Multivariate logistic regression was used to explore the factors influencing e-cigarette experimentation and use.

Results

A total of 12,410 and 12,880 students were surveyed in 2019 and 2021, respectively. E-cigarette experimentation increased from 9.34% in 2019 to 13.07% in 2021 (P < 0.001). E-cigarette use increased from 2.23% in 2019 to 3.74% in 2021 (P < 0.001). The main factors associated with e-cigarette use were cigarette experimentation (OR = 2.700, P < 0.001); male gender (OR = 1.416, P = 0.011); junior high school students (OR = 1.551, P = 0.005) and vocational high school students (OR = 1.644, P = 0.001); more pocket money per week (OR1 = 1.214, P = 0.187; OR2 = 1.686, P = 0.001); exposure to second-hand smoke (SHS) at home (OR = 1.239, P < 0.001); exposure to e-cigarette advertising (OR = 1.855, P < 0.001); believe SHS is harmful (OR = 0.933, P = 0.026); closest friends smoking (OR = 2.501, P < 0.001); believe smoking makes youth look more attractive (OR1 = 1.469, P = 0.040; OR2 = 1.305, P = 0.049); believe tobacco helps youth feel more comfortable in social situations (OR1 = 2.161, P < 0.001; OR2 = 1.635, P = 0.001); will use an e-cigarette product if offered by best friends (OR = 1.322, P < 0.001); intend to use an e-cigarette product in the next 12 months (OR = 1.486, P < 0.001).

Conclusion

E-cigarette use among adolescents has been on the rise in recent years. E-cigarette use is associated with past cigarette use and a strong desire to smoke. It is crucial to take health education and tobacco control efforts to reduce adolescents' e-cigarette use rate.

Cigarettes smoking and e-cigarettes using among university students: a cross-section survey in Guangzhou, China, 2021

BACKGROUND

There is an increase in the use of cigarettes and e-cigarettes worldwide, and the similar trends may be observed in young adults. Since 2014, e-cigarettes have become the most commonly used nicotine products among young adults (Sun et al., JAMA Netw Open 4:e2118788, 2021). With the increase in e-cigarette use and the decrease in use of cigarettes and other tobacco products, however, there is limited information about Chinese smokers, e-cigarettes users and trends in cigarettes and e-cigarettes use among university students. Therefore, our objective was to investigate the using status of cigarettes, e-cigarettes and smoking behavior among the students from 7 universities in Guangzhou, China.

METHODS

Students at 7 different universities in Guangzhou were investigated online in 2021 through a cross-sectional survey. A total of 10,008 students were recruited and after screening, 9361 participants were adopted in our statistics. Descriptive analysis, Chi-square analysis, and multiple logistic regression analysis were used to explore the smoking status and influencing factors.

RESULTS

The average age of the 9361 university students was 22.4 years (SD = 3.6). 58.3% of participants were male. 29.8% of the participants smoked or used e-cigarettes. Among the smokers and users of e-cigarettes, 16.7% were e-cigarettes only users, 35.0% were cigarettes only users, and 48.3% were dual users. Males were more likely to smoke or use e-cigarettes. Medical students, students from prestigious Chinese universities, and students with higher levels of education were less likely. Students with unhealthy lifestyles (e.g., drinking alcohol frequently, playing video games excessively, staying up late frequently) were more likely to smoke or use e-cigarettes. Emotion can have significant impacts on both cigarettes and e-cigarettes dual users when choosing cigarettes or e-cigarettes to use. More than half of dual users said they would choose cigarettes when they were depressed and e-cigarettes when they were happy.

CONCLUSION

We identified factors influencing the use of cigarettes and e-cigarettes among university students in Guangzhou, China. Gender, education level background, specialization, lifestyle habits and emotion all influenced the use of cigarettes and e-cigarettes among university students in Guangzhou, China. Male, low education level, from non-prestigious Chinese universities or vocational schools, non-medical specialization, and presence of unhealthy lifestyles were influencing factors for the use of cigarettes and e-cigarettes among university students in Guangzhou and students with these factors were more likely to smoke or use e-cigarettes. Besides, emotions can influence dual users' choice of products. This study provides more information to better understand young people's preferences for cigarettes and e-cigarettes by elucidating the characteristics of cigarettes and e-cigarettes use, as well as related influencing factors, among university students in Guangzhou. Further research involving more variables connected to the use of cigarettes and e-cigarettes will be required in our future study.

Factors that influence cannabis vaping habits of college students: A qualitative study

Objective: The purpose of this study is to examine the attitudes and perceptions of college undergraduates regarding cannabis vaping. Participants: Twenty-one, predominantly male (71.4%; Mage = 22, SD = 2.09), undergraduate college students who reported vaping cannabis in the past 30 days. Methods: Participants were interviewed to determine their attitudes and perceptions regarding cannabis vaping. Findings: Thematic analysis uncovered six primary themes and eighteen subthemes. Main themes included (1) Convenience, (2) Discreetness, (3) Mood-Altering Experience, (4) Social Acceptability, (5) Health and Safety, and (6) COVID-19 Pandemic Impact. Conclusion: College students who use cannabis tend to both vape and use combustible methods, depending upon social and physical environment. This population tends to vaporize cannabis for its perceived mood-altering properties. Additional research is needed to further examine the behaviors and attitudes surrounding cannabis vaping among college undergraduates, as well as the development of interventions specific to this demographic.

What Are the Effects of Electronic Cigarettes on Lung Function Compared to Non-Electronic Cigarettes? A Systematic Analysis

Objective: The effects of e-cigarettes on lung function were compared between the e-cigarette and the non-e-cigarette group, as well as self-changes after inhaling e-cigarettes.

Method: From March 1st, 2022, relevant literature was selected from four databases through a predefined retrieval strategy. Strict literature screening and quality evaluation were conducted. The study followed PRISMA guidelines.

Results: Our results showed that CO (SMD: −1.48, 95%: −2.82–0.15) and FeNO (SMD: −0.66, 95%: −1.32, −0.01) were significantly decreased after e-cigarette usage. Only asthmatic smokers showed a statistically significant increase in flow resistance after inhaling e-cigarettes. Conversely, the decrease of FEV1/FVC% in the non-e-cigarette groups exceeded that in the e-cigarette group (SMD:1.18, 95%: 0.11–2.26). The degree of O₂ saturation decrease was also less than that for the cigarette groups (SMD:0.32, 95%: 0.04–0.59), especially when compared to the conventional cigarette group (SMD:0.56, 95%: 0.04–1.08).

Conclusion: The current findings indicate that short-term e-cigarette inhalation has a similar (but not significant) effect on lung function, as compared with non-e-cigarettes. More clinical studies are needed to explore the safety of inhaling e-cigarettes, especially in vulnerable populations.

The Impact of Tobacco Cigarettes, Vaping Products and Tobacco Heating Products on Oxidative Stress

Cells constantly produce oxidizing species because of their metabolic activity, which is counteracted by the continuous production of antioxidant species to maintain the homeostasis of the redox balance. A deviation from the metabolic steady state leads to a condition of oxidative stress. The source of oxidative species can be endogenous or exogenous. A major exogenous source of these species is tobacco smoking. Oxidative damage can be induced in cells by chemical species contained in smoke through the generation of pro-inflammatory compounds and the modulation of intracellular pro-inflammatory pathways, resulting in a pathological condition. Cessation of smoking reduces the morbidity and mortality associated with cigarette use. Next-generation products (NGPs), as alternatives to combustible cigarettes, such as electronic cigarettes (e-cig) and tobacco heating products (THPs), have been proposed as a harm reduction strategy to reduce the deleterious impacts of cigarette smoking. In this review, we examine the impact of tobacco smoke and MRPs on oxidative stress in different pathologies, including respiratory and cardiovascular diseases and tumors. The impact of tobacco cigarette smoke on oxidative stress signaling in human health is well established, whereas the safety profile of MRPs seems to be higher than tobacco cigarettes, but further, well-conceived, studies are needed to better understand the oxidative effects of these products with long-term exposure.

Predictors of electronic cigarette use and its association with respiratory health and obesity in young adulthood in Sweden; findings from the population-based birth cohort BAMSE

Despite the growing popularity of electronic cigarettes (e-cigarettes) over the last decade, few epidemiological studies have examined the influence on respiratory health in young adulthood. The aim of this study was to identify factors associated with e-cigarette use in young adulthood in Sweden, and to examine associations between e-cigarette use and lung function, respiratory symptoms, and obesity. This cross-sectional study included 3055 young adults from Sweden and used questionnaire and clinical data obtained at age 22-25 years. The prevalence of current e-cigarette use was 3.9% (n = 120). Few participants reported daily (0.4%) or exclusive (0.8%) use of e-cigarettes. In a multivariable adjusted logistic regression model, e-cigarette use was significantly associated with male gender (OR:3.2; 95% CI:1.5-6.7) and cigarette smoking (OR:14.7; 95% CI:5.5-39.0 for daily smoking). Prevalence of cough (15.0% vs. 8.5%) and mucus production (22.3% vs. 14.8%) was significantly higher among e-cigarette users compared to non-users, while no difference in lung function was observed. In addition, the prevalence of overweight/obesity was higher among e-cigarette users compared to non-users (36.7% vs. 22.3% with BMI≥25 kg/m²). In conclusion, cigarette smokers and males used e-cigarette more often compared to females and non-cigarette smokers. Attention should be given to respiratory symptoms among e-cigarette users, although our results may be explained by the concurrent use of conventional cigarettes, as the group of exclusive e-cigarette users were too small to allow firm conclusions.

Influence of E-Liquid Humectants, Nicotine, and Flavorings on Aerosol Particle Size Distribution and Implications for Modeling Respiratory Deposition

Electronic cigarette, or vaping, products are used to heat an e-liquid to form an aerosol (liquid droplets suspended in gas) that the user inhales; a portion of this aerosol deposits in their respiratory tract and the remainder is exhaled, thereby potentially creating opportunity for secondhand exposure to bystanders (e.g., in homes, automobiles, and workplaces). Particle size, a critical factor in respiratory deposition (and therefore potential for secondhand exposure), could be influenced by e-liquid composition. Hence, the purposes of this study were to (1) test the influence of laboratory-prepared e-liquid composition [ratio of propylene glycol (PG) to vegetable glycerin (VG) humectants, nicotine, and flavorings] on particle size distribution and (2) model respiratory dosimetry. All e-liquids were aerosolized using a second-generation reference e-cigarette. We measured particle size distribution based on mass using a low-flow cascade impactor (LFCI) and size distribution based on number using real-time mobility sizers. Mass median aerodynamic diameters (MMADs) of aerosol from e-liquids that contained only humectants were significantly larger compared with e-liquids that contained flavorings or nicotine (p = 0.005). Humectant ratio significantly influenced MMADs; all aerosols from e-liquids prepared with 70:30 PG:VG were significantly larger compared with e-liquids prepared with 30:70 PG:VG (p = 0.017). In contrast to the LFCI approach, the high dilution and sampling flow rate of a fast mobility particle sizer strongly influenced particle size measurements (i.e., all calculated MMAD values were &lt; 75 nm). Dosimetry modeling using LFCI data indicated that a portion of inhaled particles will deposit throughout the respiratory tract, though statistical differences in aerosol MMADs among e-liquid formulations did not translate into large differences in deposition estimates. A portion of inhaled aerosol will be exhaled and could be a source for secondhand exposure. Use of laboratory-prepared e-liquids and a reference e-cigarette to standardize aerosol generation and a LFCI to measure particle size distribution without dilution represents an improved method to characterize physical properties of volatile aerosol particles and permitted determination of MMAD values more representative of e-cigarette aerosol in situ, which in turn, can help to improve dose modeling for users and bystanders.

Effect of Puffing Behavior on Particle Size Distributions and Respiratory Depositions From Pod-Style Electronic Cigarette, or Vaping, Products

The current fourth generation ("pod-style") electronic cigarette, or vaping, products (EVPs) heat a liquid ("e-liquid") contained in a reservoir ("pod") using a battery-powered coil to deliver aerosol into the lungs. A portion of inhaled EVP aerosol is estimated as exhaled, which can present a potential secondhand exposure risk to bystanders. The effects of modifiable factors using either a prefilled disposable or refillable pod-style EVPs on aerosol particle size distribution (PSD) and its respiratory deposition are poorly understood. In this study, the influence of up to six puff profiles (55-, 65-, and 75-ml puff volumes per 6.5 and 7.5 W EVP power settings) on PSD was evaluated using a popular pod-style EVP (JUUL® brand) and a cascade impactor. JUUL® brand EVPs were used to aerosolize the manufacturers' e-liquids in their disposable pods and laboratory prepared "reference e-liquid" (without flavorings or nicotine) in refillable pods. The modeled dosimetry and calculated aerosol mass median aerodynamic diameters (MMADs) were used to estimate regional respiratory deposition. From these results, exhaled fraction of EVP aerosols was calculated as a surrogate of the secondhand exposure potential. Overall, MMADs did not differ among puff profiles, except for 55- and 75-ml volumes at 7.5 W (p < 0.05). For the reference e-liquid, MMADs ranged from 1.02 to 1.23 μm and dosimetry calculations predicted that particles would deposit in the head region (36-41%), in the trachea-bronchial (TB) region (19-21%), and in the pulmonary region (40-43%). For commercial JUUL® e-liquids, MMADs ranged from 0.92 to 1.67 μm and modeling predicted that more particles would deposit in the head region (35-52%) and in the pulmonary region (30-42%). Overall, 30-40% of the particles aerosolized by a pod-style EVP were estimated to deposit in the pulmonary region and 50-70% of the inhaled EVP aerosols could be exhaled; the latter could present an inhalational hazard to bystanders in indoor occupational settings. More research is needed to understand the influence of other modifiable factors on PSD and exposure potential.

Role of Extracellular Vesicles in Compromising Cellular Resilience to Environmental Stressors

Extracellular vesicles (EVs), like exosomes, are nanosized membrane-enveloped vesicles containing different bioactive cargo, such as proteins, lipids, mRNA, miRNA, and other small regulatory RNAs. Cell-derived EVs, including EVs originating from stem cells, may capture components from damaged cells or cells impacted by therapeutic treatments. Interestingly, EVs derived from stem cells can be preconditioned to produce and secrete EVs with different therapeutic properties, particularly with respect to heat-shock proteins and other molecular cargo contents. This behavior is consistent with stem cells that also respond differently to various microenvironments. Heat-shock proteins play roles in cellular protection and mediate cellular resistance to radiotherapy, chemotherapy, and heat shock. This review highlights the possible roles EVs play in mediating cellular plasticity and survival when exposed to different physical and chemical stressors, with a special focus on the respiratory distress due to the air pollution.

An Evaluation of the Knowledge and Perceptions of Pharmacy Staff and Pre-Registration Students of E-Cigarettes Use: A Systematic Review

INTRODUCTION

Pharmacy staff are a trusted source of advice on the safe and appropriate use of medicines and devices. Retail pharmacies deliver smoking cessation services and sell e-cigarettes in the UK. This review asks 'what knowledge, experience and ability do staff have to support e-cigarette users to quit smoking'.

METHODS

A systematic literature search was undertaken drawn on predefined eligibility criteria and a comprehensive search strategy following the PRISMA guideline. Eligible papers reported survey-research published in English from 2015 to 2020. PubMed, Google Scholar, OVID, EMBASE and MEDLINE Databases were searched. No restrictions on study design or language were applied. Two reviewers independently screened for inclusion/exclusion and then extracted the relevant information from the articles for synthesis.

RESULTS

Of 12 potentially eligible full-text studies, 1 was a duplicate, 7 were excluded as per eligibility criteria. Four papers were finally included in this literature review. Two studies indicated that pharmacy staff are less confident in giving advice on e-cigarette use. Knowledge on the adverse effects of e-cigarettes compared to traditional smoking cessation aids remain unclear. In one study, 42% of community pharmacists did not believe that e-cigarettes could be used for smoking cessation. Three studies identified need for specific regulations and professional support. The overall certainty of the evidence is 'low' or 'very low', with moderate levels of bias.

CONCLUSION

Pharmacists may be well placed to implement e-cigarette smoking cessation interventions, but most practitioners lacked knowledge and ability to support these customers citing unclear risk of harm. Pharmacists felt secure in recommending traditional cessation tools. Further regulation, guidelines and training is needed. Findings may be less generalizable in countries where e-cigarettes are banned. Their extent of knowledge, experience and ability to support users of e-cigarettes within their community to quit smoking is lacking.

Diversity in Chemical Structures and Biological Properties of Plant Alkaloids

Phytochemicals belonging to the group of alkaloids are signature specialized metabolites endowed with countless biological activities. Plants are armored with these naturally produced nitrogenous compounds to combat numerous challenging environmental stress conditions. Traditional and modern healthcare systems have harnessed the potential of these organic compounds for the treatment of many ailments. Various chemical entities (functional groups) attached to the central moiety are responsible for their diverse range of biological properties. The development of the characterization of these plant metabolites and the enzymes involved in their biosynthesis is of an utmost priority to deliver enhanced advantages in terms of biological properties and productivity. Further, the incorporation of whole/partial metabolic pathways in the heterologous system and/or the overexpression of biosynthetic steps in homologous systems have both become alternative and lucrative methods over chemical synthesis in recent times. Moreover, in-depth research on alkaloid biosynthetic pathways has revealed numerous chemical modifications that occur during alkaloidal conversions. These chemical reactions involve glycosylation, acylation, reduction, oxidation, and methylation steps, and they are usually responsible for conferring the biological activities possessed by alkaloids. In this review, we aim to discuss the alkaloidal group of plant specialized metabolites and their brief classification covering major categories. We also emphasize the diversity in the basic structures of plant alkaloids arising through enzymatically catalyzed structural modifications in certain plant species, as well as their emerging diverse biological activities. The role of alkaloids in plant defense and their mechanisms of action are also briefly discussed. Moreover, the commercial utilization of plant alkaloids in the marketplace displaying various applications has been enumerated.

More to Explore: Further Definition of Risk Factors for COPD - Differential Gender Difference, Modest Elevation in PM2.5, and e-Cigarette Use

Chronic obstructive pulmonary disease (COPD) is a severe respiratory disease with high morbidity and mortality, representing the third leading cause of death worldwide. Traditional risk factors for COPD include aging, genetic predisposition, cigarette smoking, exposure to environmental pollutes, occupational exposure, and individual or parental respiratory disease history. In addition, latest studies have revealed novel and emerging risk factors. In this review, differential gender difference as a factor for COPD development at different territories is discussed for the first time. First, women seem to have more COPD, while more women die of COPD or have more severe COPD, in Western societies. This seems different from the impression that COPD dominants in men, which is true in Eastern societies. It might be related to higher rate of cigarette smoking in women in developed countries (i.e., 12.0% of women in United States smoke vs. 2.2% in China). Nonetheless, women in Eastern societies are exposed to more biomass usage. Second, modest elevation in PM2.5 levels at >∼21.4-32.7 μg/m3, previously considered "cleaner air," is associated with incidence of COPD, indicating that more stringent goals should be set for the reduction of PM2.5 levels to prevent COPD development. Last but not least, e-cigarette use, which has become an epidemic especially among adolescents as officially declared by the United States government, has severe adverse effects that may cause development of COPD early in life. Built upon an overview of the established risk factors for COPD primarily focusing on cigarette smoking and environmental pollutions, the present review further discusses novel concepts, mechanisms, and solutions evolved around the emerging risk factors for COPD discussed above, understanding of which would likely enable better intervention of this devastating disease.

Antioxidants in smokers

Cigarette smoke (CS) is likely the most common preventable cause of human morbidity and mortality worldwide. Consequently, inexpensive interventional strategies for preventing CS-related diseases would positively impact health systems. Inhaled CS is a powerful inflammatory stimulus and produces a shift in the normal balance between antioxidants and oxidants, inducing oxidative stress in both the respiratory system and throughout the body. This enduring and systemic pro-oxidative state within the body is reflected by increased levels of oxidative stress and inflammation biomarkers seen in smokers. Smokers might benefit from consuming antioxidant supplements, or a diet rich in fruit and vegetables, which can reduce the CS-related oxidative stress. This review provides an overview of the plasma profile of antioxidants observable in smokers and examines the heterogeneous literature to elucidate and discuss the effectiveness of interventional strategies based on antioxidant supplements or an antioxidant-rich diet to improve the health of smokers. An antioxidant-rich diet can provide an easy-to-implement and cost-effective preventative strategy to reduce the risk of CS-related diseases, thus being one of the simplest ways for smokers to stay in good health for as long as possible. The health benefits attributable to the intake of antioxidants have been observed predominantly when these have been consumed within their natural food matrices in an optimal antioxidant-rich diet, while these preventive effects are rarely achieved with the intake of individual antioxidants, even at high doses.

Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army

The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.

Toxicology of flavoring- and cannabis-containing e-liquids used in electronic delivery systems

Electronic cigarettes (e-cigarettes) were introduced in the United States in 2007 and by 2014 they were the most popular tobacco product amongst youth and had overtaken use of regular tobacco cigarettes. E-cigarettes are used to aerosolize a liquid (e-liquid) that the user inhales. Flavorings in e-liquids is a primary reason for youth to initiate use of e-cigarettes. Evidence is growing in the scientific literature that inhalation of some flavorings is not without risk of harm. In this review, 67 original articles (primarily cellular in vitro) on the toxicity of flavored e-liquids were identified in the PubMed and Scopus databases and evaluated critically. At least 65 individual flavoring ingredients in e-liquids or aerosols from e-cigarettes induced toxicity in the respiratory tract, cardiovascular and circulatory systems, skeletal system, and skin. Cinnamaldehyde was most frequently reported to be cytotoxic, followed by vanillin, menthol, ethyl maltol, ethyl vanillin, benzaldehyde and linalool. Additionally, modern e-cigarettes can be modified to aerosolize cannabis as dried plant material or a concentrated extract. The U.S. experienced an outbreak of lung injuries, termed e-cigarette, or vaping, product use-associated lung injury (EVALI) that began in 2019; among 2,022 hospitalized patients who had data on substance use (as of January 14, 2020), 82% reported using a delta-9-tetrahydrocannabinol (main psychoactive component in cannabis) containing e-cigarette, or vaping, product. Our literature search identified 33 articles related to EVALI. Vitamin E acetate, a diluent and thickening agent in cannabis-based products, was strongly linked to the EVALI outbreak in epidemiologic and laboratory studies; however, e-liquid chemistry is highly complex, and more than one mechanism of lung injury, ingredient, or thermal breakdown product may be responsible for toxicity. More research is needed, particularly with regard to e-cigarettes (generation, power settings, etc.), e-liquids (composition, bulk or vaped form), modeled systems (cell type, culture type, and dosimetry metrics), biological monitoring, secondhand exposures and contact with residues that contain nicotine and flavorings, and causative agents and mechanisms of EVALI toxicity.

E-cigarettes: A novel therapy or a looming catastrophe

Electronic cigarettes (e-cigarettes) were originally developed in 2003 as healthier alternatives to conventional tobacco cigarettes. Their popularity has since significantly increased and both users and nonusers are exposed to their aerosol and product constituents. Although some evidence suggests that e-cigarette use may facilitate smoking cessation, definitive data are lacking and e-cigarettes are not approved by the Food and Drug Administration as a cessation aid. While e-cigarette aerosol contains fewer toxins than conventional cigarette smoke, studies evaluating whether e-cigarettes are less harmful are inconclusive. The health impact of e-cigarettes for both users and nonusers cannot be determined with currently available data, and there are both environmental concerns and issues regarding nonuser exposure. Most of the currently available data related to the health effects of e-cigarettes do not evaluate their effects on the general population and evidence regarding the systemic health effects of e-cigarettes is limited. In addition, there has been a recent rise in vaping-related lung injuries. Therefore, the detrimental effects of e-cigarette use should be further investigated, and every effort should be made to increase public awareness of the harmful effects of e-cigarettes.

Smoker's characteristics, general health and their perception of smoking in the social environment: a study of smokers in Rajshahi City, Bangladesh

Background

Smoking is one of the bad habits in social environment and is one of the main causes of immature death in Bangladesh. Rajshahi is one of the cleanest, most peaceful cities in Bangladesh, but the inhabitants often feel uncomfortable about smokers who smoke in public places and often on transport. Smoking frequency is very high among males compared to females, and a large number of smokers are building or road construction laborers and people involved in offering different services such as transportation, vending from vans, etc. The practice of smoking in this area is destructive for mental and physical health especially for students compared to other professionals because the city is known as the City of Education.

Methods

The study analyzes smokers’ characteristics, general health, and their (smokers) perception of smoking in public places. Cross-sectional data were collected randomly from 160 smokers through face-to-face questionnaire survey. The determinants of complexities with regard to social environment and human health were studied using frequency distribution, chi-square test, and binary and multinomial logistic regression analysis using IBM SPSS version 24.

Results

Frequency distributions reveal that 93.8% of smokers believe that smoking creates public health hazards, 51.3% of smokers think it causes breathing complexities for non-smokers, 48.8% of smokers feel smoking causes air pollution, 68.8% of smokers think smoking causes gastric problems, 24.4% of smokers had headache problems due to smoking and cigarette fumes, 86.3% of smokers learnt smoking from friends, 48.8% of smokers smoke due to their addiction and 25.6% for depression, and 80.6% usually smoke after having a meal. The chi-square test reveals that class of smokers was significantly associated with frequency of heartbeat rate, starting smoking at specific age level was significantly associated with suffering from diseases, category of smoking articles was significantly associated with suffering from disease, class of smokers was significantly associated with causes for smoking, and starting smoking at specific age level was significantly associated with profession of the smokers at 1% level of significance respectively. A significant odds ratio was found (OR = 6.363, 95% CI 1.918–21.104, p < 0.01) for the profession group of students/labour at 1% level; their outcomes for suffering from diseases such as gastric problem and fever/headache/others were 6.363 times those for the profession group of service/other smokers.

Conclusion

Smoking in public places should be restricted because non-smokers cannot breathe freely and it is not healthy for them to inhale smoke indirectly, which has many adverse effects on public health. The study also reveals that the majority of the smokers have gastric problems, abnormal heartbeat rates, frequent headaches, depression and addiction problems, etc., and that they believe that smoking causes significant health hazard on human health and social environment. Therefore, necessary interventions should be taken immediately by policy-makers to prevent smoking in public places.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-020-01413-w.

Electronic Smoking Behavior Among Adult Males in Jordan

The use of Electronic cigarettes (E-cigarettes) has considerably expanded especially among adults. This paper highlights the behavior regarding E-cigarettes uses among adult males in Jordan. Moreover, we studied the electronic cigarette devices, the electronic cigarette liquids used in them, and the health-related complaints associated with e-smoking. Among smokers, we studied the association between E-cigarette use and their interest in smoking cessation. A questionnaire-based study regarding electronic cigarette prevalence and awareness among Jordanian individuals was conducted with a total sample size of 1536 participants. The questionnaire was distributed using Facebook and WhatsApp social groups. In this study, we included data of a total of 254 adult male participants after excluding non-E-cigarettes smokers, female smokers, and male smokers younger than 18 years old from the previously published study (Electronic Cigarettes Prevalence and Awareness among Jordanian Individuals) to describe electronic smoking behavior among adult males in Jordan. We described smoking behavior, electronic smoking technologies and materials, source of knowledge, and believe regarding electronic smoking among participants. A total of 254 E-cigarette smokers have participated in this study. 104 participants (40.9%) were found to smoke both traditional and electronic cigarettes, 111 (43.7%) quit traditional cigarette smoking and switched to E-cigarettes, and 39 (15.3%) individuals are exclusively e-smokers. More than half of the participants (n = 144; 56.7%) believe E-smoking is not addictive, and 213 (83.8%) suppose that the overall health effects attributable to E-smoking are less severe and not as serious as those related to traditional smoking. The use of E-cigarettes increased both nationally and globally in the past few years and is considered an emerging modality of smoking among non-smokers. Social media and other internet websites are the main sources of knowledge regarding E-cigarettes. Health-related issues and addiction are thought to be less than traditional smoking in considerable percentages of E-smokers. A more comprehensive conception of E-smoking patterns in Jordan is required to approach this phenomenon. Health authorities in collaboration with governmental policymakers are obligate to adopt strict recommendations to control the promotion of E-smoking through social media and other internet websites to limit its distribution among people especially youths.

Air pollutant emission characteristics and HYSPLIT model analysis during heating period in Shenyang, China

To find out the characteristics and sources of atmospheric pollutants during heating period in Shenyang, the study investigated the temporal and spatial distribution of pollutants, using data of six typical atmospheric pollutants (SO₂, NO₂, PM₁₀, PM_2.5, O₃, and CO) from November 2017 to March 2018 in 11 monitoring stations in Shenyang. These features were combined with the HYSPLIT model for backward trajectory simulation of heavily polluted weather. PM₁₀ and PM_2.5 are the main pollutants during heating period in Shenyang, with average concentrations of 90.26 μg/m³ and 56.92 μg/m³, respectively. The concentrations of various types of contaminants at the Taiyuan Street station were relatively high. PM₁₀ and PM_2.5 were relatively high in the southwestern area of Shenyang, gradually decreasing to the northeast. Only one heavy pollution event occurred during heating period in 2018. The results of the backward trajectory analysis of this heavy pollution event using HYSPLIT show that air masses from inland areas such as the southwest and northwest brought some particulate matter and atmospheric pollutants, which exacerbated Shenyang Air pollution in the city.

Vaping disrupts ventilation-perfusion matching in asymptomatic users

Inhalation of e-cigarette's aerosols (vaping) has the potential to disrupt pulmonary gas exchange, but the effects in asymptomatic users are unknown. We assessed ventilation-perfusion (V̇_A/Q̇) mismatch in asymptomatic e-cigarette users, using magnetic resonance imaging (MRI). We hypothesized that vaping induces V̇_A/Q̇ mismatch through alterations in both ventilation and perfusion distributions. Nine young, asymptomatic "Vapers" with >1-yr vaping history, and no history of cardiopulmonary disease, were imaged supine using proton MRI, to assess the right lung at baseline and immediately after vaping. Seven young "Controls" were imaged at baseline only. Relative dispersion (SD/means) was used to quantify the heterogeneity of the individual ventilation and perfusion distributions. V̇_A/Q̇ mismatch was quantified using the second moments of the ventilation and perfusion versus V̇_A/Q̇ ratio distributions, log scale, LogSDV̇, and LogSDQ̇, respectively, analogous to the multiple inert gas elimination technique. Spirometry was normal in both groups. Ventilation heterogeneity was similar between groups at baseline (Vapers, 0.43 ± 0.13; Controls, 0.51 ± 0.11; P = 0.13) but increased after vaping (to 0.57 ± 0.17; P = 0.03). Perfusion heterogeneity was greater (P = 0.04) in Vapers at baseline (0.53 ± 0.06) compared with Controls (0.44 ± 0.10) but decreased after vaping (to 0.42 ± 0.07; P = 0.005). Vapers had greater (P = 0.01) V̇_A/Q̇ mismatch at baseline compared with Controls (LogSDQ̇ = 0.61 ± 0.12 vs. 0.43 ± 0.12), which was increased after vaping (LogSDQ̇ = 0.73 ± 0.16; P = 0.03). V̇_A/Q̇ mismatch is greater in Vapers and worsens after vaping. This suggests subclinical alterations in lung function not detected by spirometry.NEW & NOTEWORTHY This research provides evidence of vaping-induced disruptions in ventilation-perfusion matching in young, healthy, asymptomatic adults with normal spirometry who habitually vape. The changes in ventilation and perfusion distributions, both at baseline and acutely after vaping, and the potential implications on hypoxic vasoconstriction are particularly relevant in understanding the pathogenesis of vaping-induced dysfunction. Our imaging-based approach provides evidence of potential subclinical alterations in lung function below thresholds of detection using spirometry.

Prevention of Chronic Obstructive Pulmonary Disease

Governments could help prevent chronic obstructive pulmonary disease (COPD) by reducing smoking rates; for example, through tobacco sale restriction, increasing tobacco prices, reducing nicotine content, and banning smoking in public areas and workplaces. Smoking cessation in general, and in particular among patients with COPD, could be achieved through specific programs, including behavior modification and the use of nicotine replacement therapy, bupropion, or varenicline. Prevention and/or slowed COPD progression could be achieved by occupational exposure prevention; improved indoor/outdoor air quality; reduced cooking and heating pollutants; use of better stoves and chimneys, and alternative energy sources; and influenza and pneumococcal vaccination.

Smoking and Endothelial Dysfunction

Cigarette smoking is one of the most important health concerns worldwide. Even though the rate of smoking is declining in developed countries, it is still experiencing growth in developing regions. Many studies have examined the relationship between smoking, as an established risk factor, and cardiovascular diseases. We provide an updated review of the underlying mechanisms of smokinginduced cardiovascular diseases, with a focus on the relationship between smoking and oxidative stress, particularly from the perspective of endothelial cell dysfunction. We review smoking-induced oxidative stress as a trigger for a generalized vascular inflammation associated with cytokine release, adhesion of inflammatory cells and, ultimately, disruption of endothelial integrity as a protective barrier layer. We also briefly discuss the harms related to the vaping of electronic cigarettes, which many erroneously consider as a safe alternative to smoking. We conclude that even though e-cigarette could be a helpful device during the transition period of cigarette quitting, it is by no means a safe substitute.

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline

Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.

Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.

Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.

Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

Addictions Causing Head-and-Neck Cancers

Head-and-neck cancers pose a serious economic burden, with most countries investing significant resources to reduce the incidence, primarily focusing on understanding addictive etiologies. The traditional literature focused on tobacco and alcohol use, with few studies on contemporary factors such as e-cigarette, waterpipe smoking, and human papillomavirus. This article attempts to collate and present an update on the globally identified etiologic factors.

The aim of this study was to identify and review the addictive etiologic factors causing head-and-neck cancers.

An electronic search was performed on Medline, Embase, and Google Scholar to identify the etiologies causing head-and-neck cancers and narrowed down on those driven by addiction. Further, we identified their constituents, mechanism of action, and the risks attributable to various forms of products.

Substances identified included smoked and chewed tobacco, alcohol, mate, marijuana, areca nut and betel quid, and viruses. An alarming majority of youth are now utilizing these substances. Furthermore, migrant movements have led to the spread of traditional practices across the regions, especially from the Asian subcontinent.

Ironically, despite modern advances and technology, we still see that a large proportion of population succumb to these cancers, emphasizing the need for more effective and targeted policies to combat this menace at the grassroots level.

Health Hazards and Complications Associated with Electronic Cigarettes: A Review

Electronic cigarettes (ECs) are devices that vaporize and release a sweetened liquid containing nicotine as a substitute for burning tobacco. EC manufacturers have suggested that "vaping" is a safer alternative to conventional smoking because of the potential reduction of exposure to toxic substances. In 2019, National Youth Tobacco Survey reported that 10.5% and 27.5% of middle and high school students used ECs in the previous 30 days (0.6% and 1.5% in 2011, 3.3% and 11.7% in 2017, and 4.9% and 20.8 in 2018), respectively. Increased EC use among younger individuals is mainly because of the widespread perception that ECs are relatively less harmful than conventional cigarettes as they do not involve smoking tobacco and contain little or no nicotine. This review suggests that ECs may not be completely harmless. There are increasing number of case reports on various complications arising from using ECs, which are especially popular among young individuals and could negatively affect their health. Reported complications include lipoid pneumonia, acute eosinophilic pneumonia, hypersensitivity pneumonia, organizing pneumonia, diffuse alveolar hemorrhage, multiple reactive pulmonary nodules, subacute bronchiolitis, mouth and tongue injuries, dental injuries, complex facial fractures, thermal injuries, nickel contact allergy, C1 and C2 fractures, and fatal intoxication after ingesting liquids. Complications that develop directly from the substances in the devices and those resulting from device explosion and burning are being reported with increasing frequency. There is an urgent need for legislation and restriction regarding the sale of these devices considering their increasing frequency of use by younger individuals.

Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways

The use of electronic cigarettes has increased exponentially since its introduction onto the global market in 2006. However, short- and long-term health effects remain largely unknown due to the novelty of this product. The present study examines the acute effects of e-cigarette aerosol inhalation, with and without nicotine, on vascular and pulmonary function in healthy volunteers. Seventeen healthy subjects inhaled electronic cigarette aerosol with and without nicotine on two separate occasions in a double-blinded crossover fashion. Blood pressure, heart rate, and arterial stiffness measured by pulse wave velocity and pulse wave analysis were assessed at baseline, and then at 0 h, 2 h, and 4 h following exposure. Dynamic spirometry and impulse oscillometry were measured following vascular assessments at these time points, as well as at 6 h following exposure. e-Cigarette aerosol with nicotine caused a significant increase in heart rate and arterial stiffness. Furthermore, e-cigarette aerosol-containing nicotine caused a sudden increase in flow resistance as measured by impulse oscillometry, indicating obstruction of the conducting airways. Both aerosols caused an increase in blood pressure. The present study indicates that inhaled e-cigarette aerosol with nicotine has an acute impact on vascular and pulmonary function. Thus, chronic usage may lead to long-term adverse health effects. Further investigation is warranted.

Electronic cigarettes: Emerging trends and research hotspots

INTRODUCTION

Research on electronic cigarettes is an emerging field, with the number of articles in this field noted to have grown exponentially over recent years. We used a bibliometric analysis method (co-word analysis) to analyze the emerging trends and research hotspots in this field.

METHODS

Publication data on electronic cigarettes from 2010 to 2018 were retrieved and downloaded from the PubMed database. Theme trends and knowledge structures were analyzed on the relevant research fields of electronic cigarettes by using a biclustering analysis, strategic diagram analysis, and social network analysis methods. Research hotspots were extracted and compared from three periods.

RESULTS

Core topics that have continuously develop between the years 2010 and 2018 include: tobacco use cessation devices; tobacco products; tobacco use cessation devices/adverse effects; smoking prevention and adverse effects; electronic nicotine delivery systems/economics; and public health. Some currently undeveloped topics that could be considered as new future research directions include: tobacco use disorder/therapy; tobacco use disorder/epidemiology; students/psychology; students/statistics and numerical data; adolescent behavior/psychology; nicotine/toxicity; nicotinic agonists/administration and dosage; and electronic nicotine delivery systems/legislation and jurisprudence.

CONCLUSIONS

Results suggest that some currently immature topics in strategic coordinates and emerging hotspots in social network graphs can be used as future research directions.

Is vaping better than smoking for cardiorespiratory and muscle function?

Cigarette smoking is a risk factor for respiratory disorders, cardiovascular diseases and even decrements in muscle function. Electronic cigarette use (vaping) is considered a healthier alternative to cigarette smoking and may help in smoking cessation. However, the effects of vaping are not clear yet and particularly the long-term effects of vaping are largely unknown. Some reports suggest that vaping maybe as harmful for e.g. respiratory function, as cigarette smoking. In this narrative review the effects of vaping and cigarette smoking on respiratory, cardiovascular and muscle function are compared. Overall, vaping has been found to cause similar effects as smoking on lung function and cardiovascular function. Future studies are needed to clarify the severity of smoking- and vaping-induced decrements on muscle function.

Adult E-Cigarettes Use Associated with a Self-Reported Diagnosis of COPD

The use of electronic cigarettes (e-cigarettes) has increased in the US, but little is known about the effects of these products on lung health. The main purpose of this study was to examine the association between e-cigarette use and a participant's report of being diagnosed with chronic obstructive pulmonary disease (COPD) in a nationally representative sample of adults. Methods: The first wave of the Population Assessment of Tobacco and Health (PATH) survey adult data was used (N = 32,320). Potential confounders between e-cigarette users and non-users were balanced using propensity score matching. Odds ratios (OR) were calculated to examine the association between e-cigarette use and COPD in the propensity-matched sample, the entire sample, different age groups, and in nonsmokers. Replicate weights and balanced repeated replication methods were utilized to account for the complex survey design. Results: Of the 3642 participants who met the criteria for e-cigarette use, 2727 were propensity matched with 2727 non e-cigarette users. In the propensity-matched sample, e-cigarette users were more likely to report being diagnosed with COPD (OR 1.43, 95% confidence interval [CI] 1.12-1.85) than non-e-cigarette users after adjusting for confounders. The result was similar in the entire sample and in the different age subgroups. Among nonsmokers, the odds of reporting a COPD diagnosis were even greater among e-cigarette users (OR 2.94, 95% CI 1.73-4.99) compared to non-e-cigarette users. Conclusion: Our findings demonstrate that e-cigarette use was associated with a reported diagnosis of COPD among adults in the US. Further research is necessary to characterize the nature of this association and on the long-term effects of using e-cigarettes.

Update on management of stable chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major chronic debilitating condition with significant impact on quality of life, symptoms, comorbidity, health care utilization and longevity. The main pathophysiological hallmark of COPD is expiratory flow limitation which impairs the ability of respiratory system to adequately and properly ventilate. To be able to prognosticate and manage patients with COPD, various societies have developed classifications of disease severity. Current classification schemes combine three elements that include lung function, patient reported symptoms (shortness of breath) and frequency of exacerbations. Global Initiative for Obstructive Lung Disease (GOLD), an international guideline for diagnosis and management of COPD, started using this approach since the 2011 revision. Management according to this scheme has been developed and is in use. Comprehensive COPD management is multifaceted. It includes pharmacologic management, patient education, smoking cessation, influenza and pneumococcal vaccinations, depression and anxiety management, pulmonary rehabilitation, and if indicated, home oxygen therapy. The following chapter will review management recommendations currently in use for stable COPD. We intend to make the chapter to the point and practical and avoid an exhaustive review of the literature.

Adverse childhood experiences and electronic cigarette use among young Australian women

Researchers have identified positive relationships between childhood adversities and smoking, problem drinking and illicit drug abuse. Nonetheless, to our knowledge, in no studies has there been an examination of the association between adverse childhood experiences (ACEs) and e-cigarette use. This study aimed to investigate the association between ACEs and e-cigarette use. Data from the Australian Longitudinal Study on Women's Health were used. Study respondents (N = 8915) from the 1989-95 cohort (third wave) aged 19-26 years completed an online survey in 2015. Multivariate logistic regression analysis was used to examine the association between ACEs and e-cigarette use, adjusted for socio-demographic variables and smoking status. Participants who reported past year e-cigarette use were more likely to report childhood psychological abuse (Adjusted odds ratio (AOR) = 1.45, 99%CI: 1.11, 1.90), physical abuse (AOR = 1.30, 99%CI, 1.03, 1.82), or sexual abuse (AOR = 1.41, 99%CI, 1.02, 1.95), All abuse types associated with past year e-cigarette use were also associated with ever e-cigarette use. Ever e-cigarette use was also associated with household substance abuse (AOR = 1.35, 99%CI, 1.08, 1.68), witnessing domestic violence (AOR = 1.28, 99%CI, 1.01, 1.69), or having a mentally ill household member (AOR = 1.28, 99%CI, 1.05, 1.58) compared with those who were not. A positive dose-response relationship was observed between the number of ACEs and the odds of e-cigarette use. This study identified an association between ACEs and e-cigarette use. Improvements in supportive parenting skills and the provision of counselling services for those exposed to ACEs may help avert health-harming behaviours, including e-cigarette use.

Beliefs, Attitudes, and Confidence to Deliver Electronic Cigarette Counseling among 1023 Chinese Physicians in 2018

Background: The use of electronic cigarettes (e-cigarettes) is gaining popularity, so it is important to evaluate physicians’ understanding of e-cigarettes. This study assessed the beliefs, attitudes, and confidence in e-cigarette counseling among Chinese physicians and explored the factors related to asking patients about e-cigarette use. Methods: Physicians from across China were invited to participate in a questionnaire survey using the platform provided by DXY (www.dxy.cn) in 2018. In total, 1023 physicians completed the online survey. Descriptive analyses were used to characterize the participants, and multivariate logistic regression analyses were applied to identify predictors of physicians’ asking about patients’ e-cigarette use. Results: Only 46.3% of respondents agreed that e-cigarettes had adverse health effects, and 66.8% indicated that e-cigarettes can be regarded as a type of smoking cessation treatment. We found that 61.3% thought it was important to discuss e-cigarettes with patients, and 71.7% reported feeling confident about their ability in counseling about e-cigarettes. Respondents who had used e-cigarettes (OR = 2.05; 95% CI: 1.16–2.63), had received training about e-cigarettes (OR = 3.13; 95% CI: 2.17–4.52), or were confident about their ability to answer patients’ question about e-cigarettes (OR = 2.45; 95% CI: 1.65–3.65) were more likely to ask patients about e-cigarette use. Physicians who showed a supportive attitude toward using e-cigarettes to quit smoking (OR = 0.79; 95% CI: 0.63–0.99) were less likely to ask about patients’ e-cigarettes use frequently. Conclusions: Chinese physicians appeared to ignore the adverse health effects of e-cigarettes, and considered e-cigarettes as a smoking cessation treatment. Comprehensive training and regulations are needed to help physicians incorporate the screening of e-cigarette use into routine practice and provide patients truthful information as new data emerge.

A survey exploring knowledge and beliefs about electronic cigarettes between health care providers and the general population in Egypt

Background

Electronic cigarettes are increasing in popularity, and they are easily accessible in a variety of locations. Despite increasing its popularity, little is known about its overall health effects. Physicians have rated the most trustful source of information about it and play also a role in disseminating information about it. Thus, this study identified the difference in knowledge and beliefs about electronic cigarettes between health care providers and the general population in Egypt.

Methods

A cross-sectional study using the self-administered questionnaire in the Arabic language was conducted between December 2018 and March 2019 in the Chest Department in Ain Shams University Hospital in Egypt. Study population (n=610) was divided into health care providers (n=260) and general population (n=350).

Result

A total of 593 respondents participated in this study and returned filled questionnaire with total response rate=97.2%, only 8.8% of all participates were smokers, none of the study population reported using electronic cigarettes, despite that, 79.3% of the participants have heard of electronic cigarettes, media advertisements were the main source of getting to know it and there was a statistically significant difference between both groups regarding most beliefs and attitudes toward electronic cigarettes.

Conclusion

There was high awareness about electronic cigarettes in Egypt and more negative attitude about it among health care providers than the general population, but still educational programs and guidelines for health care providers are needed to raise more the awareness which will aid in counseling general population appropriately.

Electronic Cigarette Advertising Impacts Adversely on Smoking Behaviour Within a London Student Cohort: A Cross-Sectional Structured Survey

Introduction

In contrast to tobacco smoking, electronic cigarette (“vaping”) advertisement had been approved in the United Kingdom (UK) in January 2013. Currently, there are an estimated 3.2 million UK e-cigarette users. The impact of e-cigarette advertisement on tobacco use has not been studied in detail. We hypothesised that e-cigarette advertisement impacts on conventional smoking behaviour.

Methods

A cross-sectional structured survey assessed the impact of e-cigarette advertising on the perceived social acceptability of cigarette and e-cigarette smoking and on using either cigarettes or e-cigarettes (on a scale of 1 to 5/‘not at all’ to ‘a lot’). The survey was administered between January to March 2015 to London university students, before and after viewing 5 UK adverts including a TV commercial.

Results

Data were collected from 106 participants (22 ± 2 years, 66% male), comprising cigarette smokers (32%), non-smokers (54%) and ex-smokers (14%). This included vapers (16%), non-vapers (77%) and ex-vapers (7%). After viewing the adverts, smokers (2.6 ± 1.0 vs. 3.8 ± 1.1, p = 0.001) and non-smokers (3.2 ± 0.7 vs. 3.7 ± 0.8, p = 0.007) felt smoking was more socially acceptable, compared to before viewing them. Participants were more likely to try both e-cigarettes (1.90 ± 1.03 to 3.09 ± 1.11, p < 0.001) and conventional cigarettes (1.73 ± 0.83 to 2.27 ± 1.13, p < 0.001) after viewing the adverts compared to before. Vapers were less likely to smoke both an e-cigarette, and a conventional cigarette after viewing the adverts.

Conclusion

E-cigarette advertising encourages both e-cigarette and conventional cigarette use in young smokers and non-smokers. The adverts increase the social acceptability of smoking without regarding the importance of public health campaigns that champion smoking cessation.

Electronic supplementary material

The online version of this article (10.1007/s00408-019-00262-z) contains supplementary material, which is available to authorized users.

Acute respiratory responses to the use of e-cigarette: an intervention study

The goal of our study was to assess acute respiratory responses to using e-cigarettes in exclusive e-cigarette users (E-Group) and dual users (T/E-Group) and to compare these effects with responses to smoking tobacco-cigarettes in tobacco smokers (T-Group). The study included 120 adults (age: 21.7 ± 2.1 years) divided into 4 groups (n = 30 each): Controls, T-, E-, T/E-Group. Spirometric status, O2 saturation, exhaled FeNO levels, exhaled CO levels, and airway temperature were assessed before the use of an e-cigarette (E-, T/E-Group) or tobacco cigarette as well as 'minute 1' and 'minute 30' after smoking. Controls used an e-cigarette without e-liquid. Lower (p < 0.05) baseline values of FeNO were found in T-Group (15.4 ppb) and in T/E-Group (15.0 ppb) than in Controls (19.6 ppb). Following exposure, and compared with Controls, T-, and T/E-Group had a significant decrease (p < 0.05) in PEF and MEF75. Mean FeNO values decreased on 'minute 1' in T-Group (by 2.1 ppb), E-Group (by 1.5 ppb) and in T/E-Group (by 2.2 ppb). Other effects included increase in temperature of exhaled air (p < 0.05). The use of e-cigarettes is associated with decreased FeNO and airflow indices (PEF, MEF75), but an increase in airway temperature. These changes are similar to those after exposure to tobacco cigarette smoke.