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Lee MSS, Eum KD, Allen JG, Onnela JP, Christiani DC. Vaping habits and respiratory symptoms using a smartphone app platform. BMC Public Health 2024; 24:2047. [PMID: 39080563 PMCID: PMC11289986 DOI: 10.1186/s12889-024-19439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 07/10/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Widespread use of e-cigarette (EC) or vaping products causes respiratory disorders including the nationwide outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in 2019. Chronic adverse health effects are now being reported as well. To address this important public health issue, an innovative approach of epidemic control and epidemiologic study is required. We aimed to assess the association between short-term and long-term use of EC products and respiratory health in adults using smartphone app data. METHODS A population-based, repeated measures, longitudinal smartphone app study that performed 8-day survey participation over 60 days for each participant from August 2020 to March 2021, including 306 participants aged 21 years and older in the US. The participants were asked to complete the respiratory health questionnaire daily, weekly, and monthly on their smartphone app. We analyzed the association between vaping habits and respiratory health using generalized linear mixed models (GLMMs). RESULTS EC use in the previous 7 days was associated with frequent cough (OR: 5.15, 95% CI: 2.18, 12.21), chronic cough (OR: 3.92, 95% CI: 1.62, 9.45), frequent phlegm (OR: 3.99, 95% CI: 1.44, 11.10), chronic phlegm (OR: 3.55, 95% CI: 1.41, 8.96), episodes of cough and phlegm (OR: 4.68, 95% CI: 1.94, 11.28), mMRC grade 3-4 dyspnea (OR: 3.32, 95% CI: 1.35 to 8.13), chest cold (OR: 3.07, 95% CI: 1.29, 7.33), eye irritation (OR: 2.94, 95% CI: 1.34, 6.47) and nose irritation (OR : 2.02, 95% CI: 0.95, 4.30). Relatively long-term effects of the past 90 days EC use was associated with an increased risk of wheeze (OR: 3.04, 95% CI: 1.31, 7.03), wheeze attack (OR: 2.78, 95% CI: 1.07, 7.24), mMRC grade 3-4 dyspnea (OR: 2.54, 9% CI: 1.05 to 6.18), eye irritation (OR: 3.16, 95% CI: 1.49, 6.68), and eye irritation during the past month (OR: 3.50, 95% CI: 1.52, 8.04). CONCLUSIONS In this smartphone app-based repeated measures study, short-term and relatively long-term use of EC increased the risk of respiratory symptoms.
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Affiliation(s)
- Mi-Sun S Lee
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1406A, Boston, MA, 02115, USA.
| | - Ki-Do Eum
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | - Joseph G Allen
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David C Christiani
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Building I Room 1406A, Boston, MA, 02115, USA
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lenski M, Zarcone G, Maallem S, Garçon G, Lo-Guidice JM, Allorge D, Anthérieu S. Metabolomics Provides Novel Insights into the Potential Toxicity Associated with Heated Tobacco Products, Electronic Cigarettes, and Tobacco Cigarettes on Human Bronchial Epithelial BEAS-2B Cells. TOXICS 2024; 12:128. [PMID: 38393223 PMCID: PMC10893046 DOI: 10.3390/toxics12020128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Smoking is an established risk factor for various pathologies including lung cancer. Electronic cigarettes (e-cigs) and heated tobacco products (HTPs) have appeared on the market in recent years, but their safety or, conversely, their toxicity has not yet been demonstrated. This study aimed to compare the metabolome of human lung epithelial cells exposed to emissions of e-cigs, HTPs, or 3R4F cigarettes in order to highlight potential early markers of toxicity. BEAS-2B cells were cultured at the air-liquid interface and exposed to short-term emissions from e-cigs set up at low or medium power, HTPs, or 3R4F cigarettes. Untargeted metabolomic analyses were performed using liquid chromatography coupled with mass spectrometry. Compared to unexposed cells, both 3R4F cigarette and HTP emissions affected the profiles of exogenous compounds, one of which is carcinogenic, as well as those of endogenous metabolites from various pathways including oxidative stress, energy metabolism, and lipid metabolism. However, these effects were observed at lower doses for cigarettes (2 and 4 puffs) than for HTPs (60 and 120 puffs). No difference was observed after e-cig exposure, regardless of the power conditions. These results suggest a lower acute toxicity of e-cig emissions compared to cigarettes and HTPs in BEAS-2B cells. The pathways deregulated by HTP emissions are also described to be altered in respiratory diseases, emphasizing that the toxicity of HTPs should not be underestimated.
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Affiliation(s)
- Marie Lenski
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59037 Lille, France
| | - Gianni Zarcone
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
| | - Saïd Maallem
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
| | - Guillaume Garçon
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
| | - Jean-Marc Lo-Guidice
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
| | - Delphine Allorge
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59037 Lille, France
| | - Sébastien Anthérieu
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483, IMPECS—IMPact de l’Environnement Chimique sur la Santé Humaine, F-59000 Lille, France; (M.L.); (G.Z.); (S.M.); (G.G.); (J.-M.L.-G.); (D.A.)
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Marrocco A, Singh D, Christiani DC, Demokritou P. E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs. Crit Rev Toxicol 2022; 52:188-220. [PMID: 35822508 PMCID: PMC9716650 DOI: 10.1080/10408444.2022.2082918] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.
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Affiliation(s)
- Antonella Marrocco
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - David C. Christiani
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
- Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, 170 Piscataway, NJ 08854, USA
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Esquer C, Echeagaray O, Firouzi F, Savko C, Shain G, Bose P, Rieder A, Rokaw S, Witon-Paulo A, Gude N, Sussman MA. Fundamentals of vaping-associated pulmonary injury leading to severe respiratory distress. Life Sci Alliance 2021; 5:5/2/e202101246. [PMID: 34810278 PMCID: PMC8616545 DOI: 10.26508/lsa.202101246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/29/2022] Open
Abstract
Vaping of flavored liquids has been touted as safe alternative to traditional cigarette smoking with decreased health risks. The popularity of vaping has dramatically increased over the last decade, particularly among teenagers who incorporate vaping into their daily life as a social activity. Despite widespread and increasing adoption of vaping among young adults, there is little information on long-term consequences of vaping and potential health risks. This study demonstrates vaping-induced pulmonary injury using commercial JUUL pens with flavored vape juice using an inhalation exposure murine model. Profound pathological changes to upper airway, lung tissue architecture, and cellular structure are evident within 9 wk of exposure. Marked histologic changes include increased parenchyma tissue density, cellular infiltrates proximal to airway passages, alveolar rarefaction, increased collagen deposition, and bronchial thickening with elastin fiber disruption. Transcriptional reprogramming includes significant changes to gene families coding for xenobiotic response, glycerolipid metabolic processes, and oxidative stress. Cardiac systemic output is moderately but significantly impaired with pulmonary side ventricular chamber enlargement. This vaping-induced pulmonary injury model demonstrates mechanistic underpinnings of vaping-related pathologic injury.
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Affiliation(s)
- Carolina Esquer
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Oscar Echeagaray
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Fareheh Firouzi
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Clarissa Savko
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Grant Shain
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Pria Bose
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Abigail Rieder
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Sophie Rokaw
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Andrea Witon-Paulo
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Natalie Gude
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
| | - Mark A Sussman
- San Diego State University Integrated Regenerative Research Institute and Biology Department, San Diego State University, San Diego, CA, USA
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