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Jeon J, He X, Shinde A, Meister M, Barnett L, Zhang Q, Black M, Shannahan J, Wright C. The role of puff volume in vaping emissions, inhalation risks, and metabolic perturbations: a pilot study. Sci Rep 2024; 14:18949. [PMID: 39147784 PMCID: PMC11327287 DOI: 10.1038/s41598-024-69985-1] [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: 06/06/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024] Open
Abstract
Secondhand vaping exposure is an emerging public health concern that remains understudied. In this study, saliva and exhaled emissions from ENDS users (secondhand) and non-ENDS users (baseline) were collected, firsthand emissions were generated using an automated ENDS aerosol generation system programmed to simulate puffing topography profiles collected from ENDS users. Particulate concentrations and sizes along with volatile organic compounds were characterized. We revealed puffing topography metrics as potential mediators of firsthand and secondhand particle and chemical exposures, as well as metabolic and respiratory health outcomes. Particle deposition modeling revealed that while secondhand emissions displayed smaller deposited mass, total and pulmonary particle deposition fractions were higher than firsthand deposition levels, possibly due to smaller secondhand emission particle diameters. Lastly, untargeted metabolomic profiling of salivary biomarkers of lung injury due to firsthand ENDS exposures revealed potential early indicators of respiratory distress that may also be relevant in bystanders exposed to secondhand vaping scenarios. By leveraging system toxicology, we identified 10 metabolites, including leukotriene D4, that could potentially serve as biomarkers for ENDS use, exposure estimation, and the prediction of vaping-related disease. This study highlights characterization of vaping behavior is an important exposure component in advancing our understanding of potential health effects in ENDS users and bystanders.
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Affiliation(s)
- Jennifer Jeon
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Xiaojia He
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Akshada Shinde
- School of Health Sciences, Purdue University, West Lafayette, IN, 47907, USA
| | - Maureen Meister
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Lillie Barnett
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Qian Zhang
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Marilyn Black
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA
| | - Jonathan Shannahan
- School of Health Sciences, Purdue University, West Lafayette, IN, 47907, USA.
| | - Christa Wright
- Chemical Insights Research Institute of UL Research Institutes, Marietta, GA, 30367, USA.
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Heywood J, Abele G, Langenbach B, Litvin S, Smallets S, Paustenbach D. Composition of e-cigarette aerosols: A review and risk assessment of selected compounds. J Appl Toxicol 2024. [PMID: 39147402 DOI: 10.1002/jat.4683] [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: 06/20/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/17/2024]
Abstract
The potential harms and benefits of e-cigarettes, or electronic nicotine delivery systems (ENDS), have received significant attention from public health and regulatory communities. Such products may provide a reduced risk means of nicotine delivery for combustible cigarette smokers while being inappropriately appealing to nicotine naive youth. Numerous authors have examined the chemical complexity of aerosols from various open- and closed-system ENDS. This body of literature is reviewed here, with the risks of ENDS aerosol exposure among users evaluated with a margin of exposure (MoE) approach for two non-carcinogens (methylglyoxal, butyraldehyde) and a cancer risk analysis for the carcinogen N-nitrosonornicotine (NNN). We identified 96 relevant papers, including 17, 13, and 5 reporting data for methylglyoxal, butyraldehyde, and NNN, respectively. Using low-end (minimum aerosol concentration, low ENDS use) and high-end (maximum aerosol concentration, high ENDS use) assumptions, estimated doses for methylglyoxal (1.78 × 10-3-135 μg/kg-bw/day) and butyraldehyde (1.9 × 10-4-66.54 μg/kg-bw/day) corresponded to MoEs of 227-17,200,000 and 271-280,000,000, respectively, using identified points of departure (PoDs). Doses of 9.90 × 10-6-1.99 × 10-4 μg/kg-bw/day NNN corresponded to 1.4-28 surplus cancers per 100,000 ENDS users, relative to a NNN-attributable surplus of 7440 per 100,000 cigarette smokers. It was concluded that methylglyoxal and butyraldehyde in ENDS aerosols, while not innocuous, did not present a significant risk of irritant effects among ENDS users. The carcinogenic risks of NNN in ENDS aerosols were reduced, but not eliminated, relative to concentrations reported in combustible cigarette smoke.
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Affiliation(s)
- Jonathan Heywood
- Paustenbach and Associates, Denver, Colorado, USA
- Insight Exposure & Risk Sciences Group, Boulder, Colorado, USA
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3
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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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4
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Hamon R, Thredgold L, Wijenayaka A, Bastian NA, Ween MP. Dual Exposure to E-Cigarette Vapour and Cigarette Smoke Results in Poorer Airway Cell, Monocyte, and Macrophage Function Than Single Exposure. Int J Mol Sci 2024; 25:6071. [PMID: 38892256 PMCID: PMC11173218 DOI: 10.3390/ijms25116071] [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: 04/03/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
E-cigarette users predominantly also continue to smoke cigarettes. These Dual Users either consume e-cigarettes in locations where smoking is not allowed, but vaping is, or to reduce their consumption of cigarettes, believing it will lead to harm reduction. Whilst it is known that e-cigarette vapour is chemically less complex than cigarette smoke, it has a distinct chemical profile, and very little is known about the health impacts of exposure to both chemical profiles vs. either alone. We simultaneously exposed cells in vitro to non-toxic levels of e-cigarette vapour extract (EVE) and cigarette smoke extract (CSE) to determine their effects on 16HBE14o- airway epithelial cell metabolism and inflammatory response, as well as immune cell (THP-1 cells and monocyte-derived macrophages (MDM) from healthy volunteers) migration, phagocytosis, and inflammatory response. We observed increased toxicity, reduced metabolism (a marker of proliferation) in airway epithelial cells, and reduced monocyte migration, macrophage phagocytosis, and altered chemokine production after exposure to either CSE or EVE. These cellular responses were greater after dual exposure to CSE and EVE. The airway epithelial cells from smokers showed reduced metabolism after EVE (the Switcher model) and dual CSE and EVE exposure. When EVE and CSE were allowed to interact, the chemicals were found to be altered, and new chemicals were also found compared to the CSE and EVE profiles. Dual exposure to e-cigarette vapour and cigarette smoke led to worse functional outcomes in cells compared to either single exposure alone, adding to limited data that dual use may be more dangerous than smoking only.
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Affiliation(s)
- Rhys Hamon
- Centre for Cancer Biology, SA Pathology and the University of South Australia, Adelaide, SA 5000, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Leigh Thredgold
- Department of Occupational and Environmental Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - Asiri Wijenayaka
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nicole Anne Bastian
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Miranda P. Ween
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
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Ogburn T, Chaudhry I, Knight LD. When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice. Am J Forensic Med Pathol 2024:00000433-990000000-00190. [PMID: 38833354 DOI: 10.1097/paf.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.
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Affiliation(s)
- Timothy Ogburn
- From the University of Nevada-Reno School of Medicine, Reno, NV
| | - Irfan Chaudhry
- Washoe County Regional Medical Examiner's Office, and Department of Pathology, University of Nevada-Reno School of Medicine, Reno, NV
| | - Laura D Knight
- Washoe County Regional Medical Examiner's Office, and Departments of Pathology and Pediatrics, University of Nevada-Reno School of Medicine, Reno, NV
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Cui T, Lu R, Liu C, Wu Z, Jiang X, Liu Y, Pan S, Li Y. Characteristics of second-hand exposure to aerosols from e-cigarettes: A literature review since 2010. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171829. [PMID: 38537812 DOI: 10.1016/j.scitotenv.2024.171829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
In recent years, the use of electronic vaping products (also named e-cigarettes) has increased due to their appealing flavors and nicotine delivery without the combustion of tobacco. Although the hazardous substances emitted by e-cigarettes are largely found to be much lower than combustible cigarettes, second-hand exposure to e-cigarette aerosols is not completely benign for bystanders. This work reviewed and synthesized findings on the second-hand exposure of aerosols from e-cigarettes and compared the results with those of the combustible cigarettes. In this review, different results were integrated based upon sampling locations such as residences, vehicles, offices, public places, and experimental exposure chambers. In addition, the factors that influence the second-hand exposure levels were identified by objectively reviewing and integrating the impacts of combustible cigarettes and e-cigarettes on the environment. It is a challenge to compare the literature data directly to assess the effect of smoking/vaping on the indoor environment. The room volume, indoor air exchange rate, puffing duration, and puffing numbers should be considered, which are important factors in determining the degree of pollution. Therefore, it is necessary to calculate the "emission rate" to normalize the concentration of pollutants emitted under various experimental conditions and make the results comparable. This review aims to increase the awareness regarding the harmful effects of the second-hand exposure to aerosols coming from the use of cigarettes and e-cigarettes, identify knowledge gaps, and provide a scientific basis for future policy interventions with regard to the regulation of smoking and vaping.
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Affiliation(s)
- Tong Cui
- School of Civil Engineering, Chang'an University, Xi'an 710054, China; School of Water and Environment, Chang'an University, Xi'an 710054, China; Key Laboratory of Subsurface Hydrology and Ecology Effects in Arid Region, Ministry of Education, Xi'an 710054, China
| | - Rui Lu
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, China.
| | - Chuan Liu
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, China
| | - Zehong Wu
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, China
| | - Xingtao Jiang
- RELX Science Center, Shenzhen RELX Tech. Co., Ltd., Shenzhen, China
| | - Yiqiao Liu
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Song Pan
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing 100124, China
| | - Yanpeng Li
- School of Water and Environment, Chang'an University, Xi'an 710054, China; Key Laboratory of Subsurface Hydrology and Ecology Effects in Arid Region, Ministry of Education, Xi'an 710054, China.
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7
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Tackett AP, Urman R, Barrington-Trimis J, Liu F, Hong H, Pentz MA, Islam TS, Eckel SP, Rebuli M, Leventhal A, Samet JM, Berhane K, McConnell R. Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults. Thorax 2024; 79:163-168. [PMID: 37582630 PMCID: PMC11062480 DOI: 10.1136/thorax-2022-218670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
RATIONALE Electronic cigarette (e-cigarette) aerosol contains volatile aldehydes, including flavourings and oxidant metals with known pulmonary toxicity. OBJECTIVES To evaluate the associations of e-cigarette use with symptoms of wheeze, bronchitic symptoms and shortness of breath (SOB) across 4 years of prospective data. METHODS Participants completed questionnaires on respiratory symptoms and past 30-day e-cigarette, cigarette and cannabis use in 2014 (wave 1; N=2094; mean age 17.3 years, SD=0.6 years). Follow-up information was collected in 2015 (wave 2; n=1609), 2017 (wave 3; n=1502) and 2018 (wave 4; n=1637) using online surveys. Mixed-effects logistic regression models evaluated associations of e-cigarette use with respiratory symptoms. MEASUREMENTS AND MAIN RESULTS Participants were mostly Hispanic white (51.8%) and evenly representative by sex (49.6% female; 50.4% male). Compared with never e-cigarette users, past 30-day e-cigarette users reported increased odds of wheeze (OR 1.81; 95% CI 1.28, 2.56), bronchitic symptoms (OR 2.06; 95% CI 1.58, 2.69) and SOB (OR 1.78; 95% CI 1.23, 2.57), adjusting for study wave, age, sex, race, lifetime asthma diagnosis and parental education. Effect estimates were attenuated (wheeze (OR 1.41; 95% CI 0.99, 2.01), bronchitic symptoms (OR 1.55; 95% CI 1.18, 2.05), SOB (OR 1.48; 95% CI 1.01, 2.18)), after adjusting additionally for current cigarette use, cannabis use and secondhand exposure to e-cigarettes/cigarettes/cannabis. CONCLUSIONS E-cigarette use in young adults was associated with respiratory symptoms, independent of combustible cannabis and cigarette exposures.
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Affiliation(s)
- Alayna P Tackett
- Department of Internal Medicine, Division of Medical Oncology, Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert Urman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jessica Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Feifei Liu
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Hanna Hong
- Division of Pulmonology, Children's Hospital of Orange County, Orange, California, USA
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Talat S Islam
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Meghan Rebuli
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jonathan M Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Kiros Berhane
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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8
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Ngambo G, Hanna EG, Gannon J, Marcus H, Lomazzi M, Azari R. A scoping review on e-cigarette environmental impacts. Tob Prev Cessat 2023; 9:30. [PMID: 37789930 PMCID: PMC10542855 DOI: 10.18332/tpc/172079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION The use of e-cigarettes has grown in popularity worldwide. From their manufacturing, use, and disposal, the environmental impacts of e-cigarettes present a novel public health concern that needs to be urgently investigated. However, very limited studies have focused on the subject matter. The present study aims to review available studies to identify the environmental impacts of e-cigarettes. METHODS In this scoping review, we undertook a search in two databases (PubMed and Web of Science) from inception until 21 March 2023, and a gray literature search in Google Scholar. Reference lists of publications included in the scoping review were screened manually for additional relevant publications. Scientific publications that were in English and focused on the potential impacts of e-cigarettes on the environment were included. RESULTS A total of 693 publications were identified, of which 33 were subjected to full-text review and 9 publications were finally included in the review. The impacts on air quality, water, land use, and animals, water and energy consumption, with associated environmental impacts, increased pollution and emissions due to greater e-cigarette production, having harmful and toxic components, creating pollution and waste issues, and global environmental impacts due to manufacturing and importing ingredients and components from low- and middle-income countries, were identified as the environmental impacts of e-cigarettes. CONCLUSIONS Despite the emphasis on the environmental threat of e-cigarettes, there are limited scientific studies on the environmental impacts of the e-cigarette life cycle. Considering the rapid expansion of e-cigarette usage, there is an urgent need for a rigorous assessment of their life-cycle environmental burden of the various potential health, environmental, and other consequences.
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Affiliation(s)
- Gabrielle Ngambo
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Elizabeth G. Hanna
- Fenner School of Environment and Society, Australian National University, Canberra, Australia
- World Federation of Public Health Associations, Geneva, Switzerland
| | - John Gannon
- World Federation of Public Health Associations, Geneva, Switzerland
| | - Hannah Marcus
- World Federation of Public Health Associations, Geneva, Switzerland
| | - Marta Lomazzi
- World Federation of Public Health Associations, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Razieh Azari
- World Federation of Public Health Associations, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Translation and Interpreting, University of Geneva, Geneva, Switzerland
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9
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Close A, Blackerby J, Tunnell H, Pender J, Soule E, Sousan S. Effects of E-Cigarette Liquid Ratios on the Gravimetric Filter Correction Factors and Real-Time Measurements. AEROSOL AND AIR QUALITY RESEARCH 2023; 23:230011. [PMID: 38500670 PMCID: PMC10947168 DOI: 10.4209/aaqr.230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Electronic cigarettes (ECIGs) generate high concentrations of particulate matter (PM), impacting the air quality inhaled by humans through secondhand exposure. ECIG liquids are available commercially and some users create their own "do-it-yourself" liquids, and these liquids often vary in the amounts of their chemical ingredients, including propylene glycol (PG) and vegetable glycerin (VG). Previous studies have quantified PM concentrations in ECIG aerosol generated from liquids containing different PG/VG ratios. However, the effects of these ratios on aerosol instrument filter correction factors needed to measure PM concentrations accurately have not been assessed. Thus, ECIG aerosol filter correction factors for multiple aerosol instruments (SMPS + APS, MiniWRAS, pDR, and SidePak) were determined for five different PG/VG ratios 1) 0PG/100VG, 2) 15PG/85VG, 3) 50PG/50VG, 4) 72PG/28VG, and 5) 90PG/10VG and two different PM sizes, PM1 (1 μm and smaller) and PM2.5 (2.5 μm and smaller). ECIG aerosols were generated inside a controlled exposure chamber using a diaphragm pump and a refillable ECIG device for all the ratios. In addition, the aerosol size distribution and mass median diameter were measured for all five ECIG ratios. PM2.5 correction factors (5-7.6) for ratios 1, 2, 3, and 4 were similar for the SMPS + APS combined data, and ratios 1, 2, 3 were similar for the MiniWRAS (~2), pDR (~0.5), and SidePak (~0.24). These data suggest different correction factors may need to be developed for aerosol generated from ECIGs with high PG content. The higher correction factor values for the 90PG/10VG ratio may have resulted from greater PG volatility relative to VG and sensor losses. The correction factors (ratios 1-4) for PM2.5 were SMPS + APS data (4.96-7.62), MiniWRAS (2.02-3.64), pDR (0.50-1.07), and SidePak (0.22-0.40). These data can help improve ECIG aerosol measurement accuracy for different ECIG mixture ratios.
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Affiliation(s)
- Austin Close
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Jane Blackerby
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Heather Tunnell
- Department of Chemistry, East Carolina University, Greenville, NC 27858, USA
| | - Jack Pender
- Department of Chemistry, East Carolina University, Greenville, NC 27858, USA
| | - Eric Soule
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858
| | - Sinan Sousan
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
- North Carolina Agromedicine Institute, Greenville, NC 27834, USA
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10
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Lee J, Su WC, Han I. Understanding the influence of atomizing power on electronic cigarette aerosol size and inhalation dose estimation. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2023; 57:633-644. [PMID: 37997608 PMCID: PMC10665025 DOI: 10.1080/02786826.2023.2202753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/24/2023] [Indexed: 11/25/2023]
Abstract
Although many studies have estimated the inhalation dose of aerosols emitted from electronic cigarettes (e-cigs), the association between the atomizing power and inhalation dose of e-cig aerosols has not been fully examined. The aim of this study was to determine the mass and inhalation doses of e-cig aerosols and their association with the atomizing power of vaping devices. Size-segregated aerosol masses were collected using an 11-stage cascade impactor and the deposition dose in the human respiratory tract was estimated using the size-segregated aerosol mass. The results showed that an increase in atomizing power was positively associated with the amount of aerosol mass generated (p-value < 0.001). The mass median aerodynamic diameter and mass mean diameter of aerosol were 0.91 μm and 0.84 μm, respectively. The average deposition fractions of aerosols in the head airway, tracheobronchial region, and alveolar region were 67.2, 6.2, and 26.6%, respectively. In conclusion, vaping with a higher atomizing power increases the e-cig aerosol inhalation dose in the airway.
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Affiliation(s)
- Jinho Lee
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Texas USA
| | - Wei-Chung Su
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Texas USA
- Southwest Center for Occupational and Environmental Health (SWCOEH), School of Public Health, University of Texas Health Science Center at Houston, Texas, USA
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Pennsylvania, USA
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11
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Liu CW, Le HHT, Denaro P, Dai Z, Shao NY, Ong SG, Lee WH. E-cigarettes Induce Dysregulation of Autophagy Leading to Endothelial Dysfunction in Pulmonary Arterial Hypertension. Stem Cells 2023; 41:328-340. [PMID: 36640125 PMCID: PMC10128958 DOI: 10.1093/stmcls/sxad004] [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: 06/20/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Given the increasing popularity of electronic cigarettes (e-cigs), it is imperative to evaluate the potential health risks of e-cigs, especially in users with preexisting health concerns such as pulmonary arterial hypertension (PAH). The aim of the present study was to investigate whether differential susceptibility exists between healthy and patients with PAH to e-cig exposure and the molecular mechanisms contributing to it. Patient-specific induced pluripotent stem cell-derived endothelial cells (iPSC-ECs) from healthy individuals and patients with PAH were used to investigate whether e-cig contributes to the pathophysiology of PAH and affects EC homeostasis in PAH. Our results showed that PAH iPSC-ECs showed a greater amount of damage than healthy iPSC-ECs upon e-cig exposure. Transcriptomic analyses revealed that differential expression of Akt3 may be responsible for increased autophagic flux impairment in PAH iPSC-ECs, which underlies increased susceptibility upon e-cig exposure. Moreover, knockdown of Akt3 in healthy iPSC-ECs significantly induced autophagic flux impairment and endothelial dysfunction, which further increased with e-cig treatment, thus mimicking the PAH cell phenotype after e-cig exposure. In addition, functional disruption of mTORC2 by knocking down Rictor in PAH iPSC-ECs caused autophagic flux impairment, which was mediated by downregulation of Akt3. Finally, pharmacological induction of autophagy via direct inhibition of mTORC1 and indirect activation of mTORC2 with rapamycin reverses e-cig-induced decreased Akt3 expression, endothelial dysfunction, autophagic flux impairment, and decreased cell viability, and migration in PAH iPSC-ECs. Taken together, these data suggest a potential link between autophagy and Akt3-mediated increased susceptibility to e-cig in PAH.
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Affiliation(s)
- Chen-wei Liu
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Hoai Huong Thi Le
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Philip Denaro
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Zhiyu Dai
- Translational Cardiovascular Research Center, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Ning-Yi Shao
- Health Sciences, University of Macau, Macau, People’s Republic of China
| | - Sang-Ging Ong
- Department of Pharmacology and Regenerative Medicine, University of Illinois College of Medicine, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Won Hee Lee
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ, USA
- Translational Cardiovascular Research Center, University of Arizona College of Medicine, Phoenix, AZ, USA
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12
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Lin E, Fuentes AL, Patel A, Crotty Alexander LE. E-Cigarette: Friend or Foe? Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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13
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Love M, Gierer S. Electronic Cigarettes and Vaping in Allergic and Asthmatic Disease. Immunol Allergy Clin North Am 2022; 42:787-800. [DOI: 10.1016/j.iac.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Abstract
Widespread uptake of vaping has signaled a sea change in the future of nicotine consumption. Vaping has grown in popularity over the past decade, in part propelled by innovations in vape pen design and nicotine flavoring. Teens and young adults have seen the biggest uptake in use of vape pens, which have superseded conventional cigarettes as the preferred modality of nicotine consumption. Relatively little is known, however, about the potential effects of chronic vaping on the respiratory system. Further, the role of vaping as a tool of smoking cessation and tobacco harm reduction remains controversial. The 2019 E-cigarette or Vaping Use-Associated Lung Injury (EVALI) outbreak highlighted the potential harms of vaping, and the consequences of long term use remain unknown. Here, we review the growing body of literature investigating the impacts of vaping on respiratory health. We review the clinical manifestations of vaping related lung injury, including the EVALI outbreak, as well as the effects of chronic vaping on respiratory health and covid-19 outcomes. We conclude that vaping is not without risk, and that further investigation is required to establish clear public policy guidance and regulation.
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Affiliation(s)
- Andrea Jonas
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Stanford University, Stanford, CA, USA
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15
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Efficacy of Prednisolone/Zn Metal Complex and Artemisinin Either Alone or in Combination on Lung Functions after Excessive Exposure to Electronic Cigarettes Aerosol with Assessment of Antibacterial Activity. CRYSTALS 2022. [DOI: 10.3390/cryst12070972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of transition metal complexes as therapeutic compounds has become more and more pronounced. These complexes offer a great diversity of uses in their medicinal applications. Electronic cigarettes (ECs) are an electronic nicotine delivery system that contain aerosol (ECR). The ligation behavior of prednisolone, which is a synthetic steroid that is used to treat allergic diseases and asthma arthritis, and its Zn (II) metal complex were studied and characterized based on elemental analysis, molar conductance, Fourier-transform infrared (FT-IR) spectra, electronic spectra, XRD, scanning electron microscopy (SEM), energy dispersive x-ray (EDX), and transmission electron microscopy (TEM). The FT-IR spectral data revealed that PRD acts as a mono-dentate ligand via oxygen atoms of the carbonyl group. Electronic and FT-IR data revealed that the PRD/Zn (II) metal complexes have square planner geometry. Artemisinin (ART) is the active main constituent of Artemisia annua extract, and it has been demonstrated to exert an excellent antimalarial effect. The experiment was performed on 40 male mice that were divided into the following 7 groups: Control, EC group, PRD/Zn, ART, EC plus PRD/Zn, EC plus ART, and PRD plus combination of PRD/Zn and ART. Serum CRP, IL-6, and antioxidants biomarkers were determined. Pulmonary tissue histology was evaluated. When in combination with Zn administration, PRD showed potent protective effects against pulmonary biochemical alterations induced by ECR and suppressed severe oxidative stress and pulmonary structure alterations. Additionally, PRD/Zn combined with ART prevented any stress on the pulmonary tissues via antioxidant regulation, reducing inflammatory markers CRP and Il-6 and improving antioxidant enzymatic levels more than either PRD or ART alone. Therefore, PRD/Zn combined with ART produced a synergistic effect against any sort of oxidative stress and also improved the histological structure of the lung tissues. These findings are of great importance for saving pulmonary function, especially during pandemic diseases, such as during the COVID-19 pandemic.
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16
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Islam T, Braymiller J, Eckel SP, Liu F, Tackett AP, Rebuli ME, Barrington-Trimis J, McConnell R. Secondhand nicotine vaping at home and respiratory symptoms in young adults. Thorax 2022; 77:663-668. [PMID: 35013000 PMCID: PMC9203939 DOI: 10.1136/thoraxjnl-2021-217041] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/03/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Despite high prevalence of e-cigarette use (vaping), little is currently known regarding the health effects of secondhand nicotine vape exposure. OBJECTIVE To investigate whether exposure to secondhand nicotine vape exposure is associated with adverse respiratory health symptoms among young adults. METHOD We investigated the effect of secondhand nicotine vape exposure on annually reported wheeze, bronchitic symptoms and shortness of breath in the prospective Southern California Children Health Study cohort. Data were collected from study participants (n=2097) with repeated annual surveys from 2014 (average age: 17.3 years) to 2019 (average age: 21.9). We used mixed effect logistic regression to evaluate the association between secondhand nicotine vape and respiratory symptoms after controlling for relevant confounders. RESULTS Prevalence of secondhand nicotine vape increased from 11.7% to 15.6% during the study period in this population. Prevalence of wheeze, bronchitic symptoms and shortness of breath ranged from 12.3% to 14.9%, 19.4% to 26.0% and 16.5% to 18.1%, respectively, during the study period. Associations of secondhand nicotine vape exposure with bronchitic symptoms (OR 1.40, 95% CI 1.06 to 1.84) and shortness of breath (OR 1.53, 95% CI 1.06 to 2.21) were observed after controlling for vaping, active and passive exposure to tobacco or cannabis, and demographic characteristics (age, gender, race/ethnicity and parental education). Stronger associations were observed when analysis was restricted to participants who were neither smokers nor vapers. There were no associations with wheezing after adjustment for confounders. CONCLUSION Secondhand nicotine vape exposure was associated with increased risk of bronchitic symptoms and shortness of breath among young adults.
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Affiliation(s)
- Talat Islam
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Jessica Braymiller
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Feifei Liu
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Alayna P Tackett
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Meghan E Rebuli
- Department of Pediatrics, Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jessica Barrington-Trimis
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Rob McConnell
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
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17
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In-situ TD-GCMS measurements of oxidative products of monoterpenes at typical vaping temperatures: implications for inhalation exposure to vaping products. Sci Rep 2022; 12:11019. [PMID: 35773373 PMCID: PMC9247066 DOI: 10.1038/s41598-022-14236-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022] Open
Abstract
Vaping is gaining in popularity. However, there is still much that remains unknown about the potential risk and harms of vaping. Formation of oxidative products is one of such areas that are not well understood. In this study, we used an in-situ thermal desorption GC/MS method to investigate the formation of oxidative products of several monoterpenes at or below typical vaping temperatures. Among the five tested monoterpenes, the unchanged portion of the parent compound in the vapour varied from 97 to 98% for myrcene to 11–28% for terpinolene. The majority of formed oxidative products in the vapour have a molecular weight of 134 (loss of two hydrogens), 150 (insertion of one oxygen and loss of two hydrogen atoms) or 152 (insertion of one oxygen atom). Three products, likely to be p-(1-propenyl)-toluene, β-pinone and fenchol were also observed. This is the first in-situ thermal desorption GC/MS study to investigate the possible formation of oxidative products of monoterpenes, one of the major components in vaping liquids, at temperatures that are relevant to the vaping process. Although the toxicity of inhaling these oxidative products is not clear yet, allergic and irritation reactions associated with oxidized monoterpene oils are well documented. Therefore, potential adverse effects of inhaling these oxidative products during vaping could be investigated to help support human risk assessment.
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18
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Stefaniak AB, Ranpara AC, Virji MA, LeBouf RF. Influence of E-Liquid Humectants, Nicotine, and Flavorings on Aerosol Particle Size Distribution and Implications for Modeling Respiratory Deposition. Front Public Health 2022; 10:782068. [PMID: 35372219 PMCID: PMC8968757 DOI: 10.3389/fpubh.2022.782068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2022] [Indexed: 01/10/2023] Open
Abstract
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 < 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.
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19
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Abstract
The use of electronic (e)-cigarettes was initially considered a beneficial solution to conventional cigarette smoking cessation. However, paradoxically, e-cigarette use is rapidly growing among nonsmokers, including youth and young adults. In 2019, this rapid growth resulted in an epidemic of hospitalizations and deaths of e-cigarette users (vapers) due to acute lung injury; this novel disease was termed e-cigarette or vaping use-associated lung injury (EVALI). Pathophysiologic mechanisms of EVALI likely involve cytotoxicity and neutrophilic inflammation caused by inhaled chemicals, but further details remain unknown. The undiscovered mechanisms of EVALI are a barrier to identifying biomarkers and developing therapeutics. Furthermore, adverse effects of e-cigarette use have been linked to chronic lung diseases and systemic effects on multiple organs. In this comprehensive review, we discuss the diverse spectrum of vaping exposures, epidemiological and clinical reports, and experimental findings to provide a better understanding of EVALI and the adverse health effects of chronic e-cigarette exposure.
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Affiliation(s)
- Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA;
| | - Laura E Crotty Alexander
- University of California at San Diego, La Jolla, California, USA.,Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; .,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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20
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Berenguer C, Pereira JAM, Câmara JS. Urinary volatomic profile of traditional tobacco smokers and electronic cigarettes users as a strategy to unveil potential health issues. J Sep Sci 2022; 45:582-593. [PMID: 34741791 DOI: 10.1002/jssc.202100671] [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: 08/25/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022]
Abstract
Many harmful and potentially harmful constituents are present in tobacco products. Cigarette smoke is known to cause different forms of cancer and trigger the development of chronic diseases. In the last decade, electronic cigarettes have emerged as a healthier alternative associated to less harmful effects in comparison to traditional tobacco. However, the lack of standardization of electronic cigarettes products makes it difficult to establish and compare the real effects on health of products from different manufacturers. To better understand the impact of smoking and vaping, the volatomic composition of urine samples from traditional tobacco smokers and electronic cigarette users was established and compared with nonsmokers (control group), using headspace solid-phase microextraction combined with gas chromatography-mass spectrometry. A total of 45 urinary volatile organic metabolites belonging to different chemical families were identified in the urine of the studied groups. Benzene derivatives, terpenes, and aromatics were the chemical families that contributed the most to the urinary profile of smokers. The vapers urinary volatomic pattern was also dominated by terpenes and aromatics, in addition to alcohols. The orthogonal partial least squares-discriminant analysis of the data obtained indicated that the urinary profile of vapers is more closely related to the control group, reinforcing the hypothesis of the lowest harmfulness of electronic cigarettes. Further studies recruiting a higher number of subjects are therefore necessary to consolidate the data obtained.
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Affiliation(s)
- Cristina Berenguer
- CQM-Centro de Química da Madeira, Universidade da Madeira, Funchal, Portugal
| | - Jorge A M Pereira
- CQM-Centro de Química da Madeira, Universidade da Madeira, Funchal, Portugal
| | - José S Câmara
- CQM-Centro de Química da Madeira, Universidade da Madeira, Funchal, Portugal
- Departamento de Química, Faculdade de Ciências Exatas e Engenharia, Universidade da Madeira, Funchal, Portugal
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21
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Hensel EC, Eddingsaas NC, Saleh QM, Jayasekera S, Sarles SE, Thomas M, Myers BT, DiFrancesco G, Robinson RJ. Nominal Operating Envelope of Pod and Pen Style Electronic Cigarettes. Front Public Health 2021; 9:705099. [PMID: 34485231 PMCID: PMC8415835 DOI: 10.3389/fpubh.2021.705099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Many Electronic Nicotine Delivery Systems (ENDS) employ integrated sensors to detect user puffing behavior and activate the heating coil to initiate aerosol generation. The minimum puff flow rate and duration at which the ENDS device begins to generate aerosol are important parameters in quantifying the viable operating envelope of the device and are essential to formulating a design of experiments for comprehensive emissions characterization. An accurate and unbiased method for quantifying the flow condition operating envelope of ENDS is needed to quantify product characteristics across research laboratories. This study reports an accurate, unbiased method for measuring the minimum and maximum aerosolization puff flow rate and duration of seven pod-style, four pen-style and two disposable ENDS. The minimum aerosolization flow rate ranged from 2.5 to 23 (mL/s) and the minimum aerosolization duration ranged from 0.5 to 1.0 (s) across the ENDS studied. The maximum aerosolization flow rate was defined to be when the onset of liquid aspiration was evident, at flow rates ranging from 50 to 88 (mL/s). Results are presented which provide preliminary estimates for the effective maximum aerosolization flow rate and duration envelope of each ENDS. The variation in operating envelope observed between ENDS products of differing design by various manufacturers has implications for development of standardized emissions testing protocols and data reporting required for regulatory approval of new products.
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Affiliation(s)
- Edward C Hensel
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Nathan C Eddingsaas
- Department of Chemistry and Materials Science, Rochester Institute of Technology, Rochester, NY, United States
| | - Qutaiba M Saleh
- Department of Electrical and Computer Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Shehan Jayasekera
- Department of Mechanical and Industrial Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - S Emma Sarles
- Department of Biomedical and Chemical Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Mahagani Thomas
- Department of Chemistry and Materials Science, Rochester Institute of Technology, Rochester, NY, United States
| | - Bryan T Myers
- Department of Electrical and Computer Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Gary DiFrancesco
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Risa J Robinson
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY, United States
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22
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O'Farrell HE, Brown R, Brown Z, Milijevic B, Ristovski ZD, Bowman RV, Fong KM, Vaughan A, Yang IA. E-cigarettes induce toxicity comparable to tobacco cigarettes in airway epithelium from patients with COPD. Toxicol In Vitro 2021; 75:105204. [PMID: 34186184 DOI: 10.1016/j.tiv.2021.105204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The health effects of e-cigarettes in patients with pre-existing lung disease are unknown. The aim of this study was to investigate whether aerosols from a fourth-generation e-cigarette produces similar in-vitro cytotoxic, DNA damage and inflammatory effects on bronchial epithelial cells (BECs) from patients with COPD, as cigarette smoke. METHODS BECs from patients with COPD who underwent surgery for lung cancer and comparator (immortalised 16HBE) cells were grown at air liquid interface (ALI). BECs were exposed to aerosols from a JUUL® e-cigarette (Virginia Tobacco and Menthol pods at 5% nicotine strength) or reference 3R4F cigarette for 30 min at ALI. Cell cytotoxicity, DNA damage and inflammation were measured. RESULTS In response to the Virginia Tobacco and Menthol flavoured e-cigarette aerosols, COPD BECs showed comparable LDH release (cell cytotoxicity, p = 0.59, p = 0.67 respectively), DNA damage (p = 0.41, p = 0.51) and inflammation (IL-8, p = 0.20, p = 0.89 and IL-6, p = 0.24, p = 0.93), to cigarette smoke. 16HBE cells also showed comparable cellular responses to cigarette smoke. CONCLUSION In airway cells from patients with COPD, aerosols from a fourth-generation e-cigarette were associated with similar toxicity to cigarette smoke. These results have potential implications for the safety of e-cigarette use in patients with lung disease.
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Affiliation(s)
- Hannah E O'Farrell
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Reece Brown
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zac Brown
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Branka Milijevic
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zoran D Ristovski
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rayleen V Bowman
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Annalicia Vaughan
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ian A Yang
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
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23
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AL-Qaysi WW, Abdulla FH. Analytical methods for the identification of micro/nano metals in e-cigarette emission samples: a review. CHEMICKE ZVESTI 2021; 75:6169-6180. [PMID: 34421189 PMCID: PMC8370834 DOI: 10.1007/s11696-021-01779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/04/2021] [Indexed: 12/04/2022]
Abstract
In this review, numerous analytical methods to quantify the heavy and trace elements emitted from electronic cigarettes, cigarettes liquid and atomizer. The selection of a method was dependent upon the purpose, e.g., quantification or identification of elements only. The introductory part of this review focuses on describing the importance of setting up an electronic cigarettes- associated safety profile. The review dealt with studies that assessed elements in sizes ranging from nano to micro. The formation of different degradation chemical substances as well as impurity trends can be indicated through chemical investigation of metals in electronic cigarettes. Some studies have been covered that show the uses and benefits of. It is noticeable from all the collected sources that the minerals emitted from the smoke of e- cigs do not constitute any significant damage, as the percentage is very small, with the exception of minerals that may be emitted from the components of the device after heating it if the components of the e- cig are of poor specifications, except in the case of long-term accumulation. For this reason, an electronic cigarette can help smokers to quit smoking tobacco and replace it with electronic cigarettes smoke with distinctive flavors.
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Affiliation(s)
- Wafaa Waleed AL-Qaysi
- Institute of Analytical Chemistry, Chemo and Biosensors, University of Regensburg, Universitätsstraße 31, 93040 Regensburg, Germany
- Department of Chemistry, College of Science, University of Baghdad, Al-Jadriya campus, 10071 Baghdad, Iraq
| | - Fatma H. Abdulla
- Department of Chemistry, College of Science, University of Baghdad, Al-Jadriya campus, 10071 Baghdad, Iraq
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24
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Berenguer C, Pereira JA, Câmara JS. Fingerprinting the volatile profile of traditional tobacco and e-cigarettes: A comparative study. Microchem J 2021. [DOI: 10.1016/j.microc.2021.106196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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25
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Abstract
: Vaping, the inhalation of a nicotine or tetrahydrocannabinol (THC), cannabidiol (CBD), or non-drug infused solution delivered by vaping devices, is a growing phenomenon across many segments of the US population. Complications associated with vaping are newly emerging and relatively unstudied; little guidance exists on how clinicians may best elicit information related to vaping practices and associated medical problems. This publication, therefore, provides physicians and other treatment clinicians with direction for obtaining the medical history that can guide clinical decision-making for patients at risk for adverse effects associated with vaping.
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26
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Sangani R, Rojas E, Forte M, Zulfikar R, Prince N, Tasoglou A, Goldsmith T, Casuccio G, Boyd J, Olfert IM, Flanagan M, Sharma S. Electronic Cigarettes and Vaping-Associated Lung Injury (EVALI): A Rural Appalachian Experience. Hosp Pract (1995) 2021; 49:79-87. [PMID: 33136442 PMCID: PMC8371980 DOI: 10.1080/21548331.2020.1843282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
Background: Electronic cigarette use has increased dramatically since their introduction in 2007. Respiratory complications, particularly lipoid pneumonia, have been reported as early as 2012. An outbreak of pulmonary injury in 2019 has been reported in patients using vaping products.Research Question: To describe a rural Appalachian tertiary center's experience of EVALI and to identify novel mechanisms of pulmonary injury patterns.Study Design and Methods: We present a consecutive case series of 17 patients admitted to our rural, academic, tertiary care institution with EVALI from August 2019 to March 2020. Demographics, baseline characteristics, co-morbidities, vaping behavior, and hospital course were recorded. Broncho-alveolar lavage specimens were assessed for lipid-laden macrophages and hemosiderin-laden macrophages with stains for Oil-Red-O (n = 15) and Prussian Blue (n = 14) respectively.The patient volunteered e-liquid materials (n = 6), and vapors were analyzed using a proton transfer reaction time-of-flight mass spectrometer (PTR-TOF-MS) to describe the chemical profile. Post-discharge interviews were conducted.Results: The most common CT finding was bilateral ground-glass opacities with a predilection for lower lung zones. The most frequent pulmonary injury pattern was lipoid pneumonia. The majority of EVALI patients were critically ill requiring ventilation or ECMO. The most severely ill patients were noted to be positive for iron stains in macrophages and showed higher volatile organic compound (VOC) levels in chemical analysis.Interpretation: Based on our experience, EVALI in rural Appalachia presented with relatively severe respiratory failure. Worse outcomes appear to be correlated to high levels of VOCs, iron deposition in lungs, and concomitant infection.
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Affiliation(s)
- Rahul Sangani
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Edward Rojas
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michael Forte
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Rafia Zulfikar
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nicole Prince
- C. Eugene Bennett Department of Chemistry, West Virginia University, Morgantown, WV, USA
- Department of Orthopedics, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Travis Goldsmith
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Jonathan Boyd
- Department of Orthopedics, West Virginia University School of Medicine, Morgantown, WV, USA
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA
- Occupational and Environmental Health, West Virginia University School of Public Health, Morgantown, WV, USA
- Center of Inhalation Toxicology (Itox, WVU Robert C. Byrd Health Science Center, Morgantown, USA
| | - I. Mark Olfert
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA
- Center of Inhalation Toxicology (Itox, WVU Robert C. Byrd Health Science Center, Morgantown, USA
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, USA
| | - Melina Flanagan
- Department of Pathology, Anatomy, and Laboratory Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Sunil Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
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Rusy DA, Honkanen A, Landrigan-Ossar MF, Chatterjee D, Schwartz LI, Lalwani K, Dollar JR, Clark R, Diaz CD, Deutsch N, Warner DO, Soriano SG. Vaping and E-Cigarette Use in Children and Adolescents: Implications on Perioperative Care From the American Society of Anesthesiologists Committee on Pediatric Anesthesia, Society for Pediatric Anesthesia, and American Academy of Pediatrics Section on Anesthesiology and Pain Medicine. Anesth Analg 2021; 133:562-568. [PMID: 33780391 DOI: 10.1213/ane.0000000000005519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Electronic cigarettes (e-cigarettes) or vaping use in adolescents has emerged as a public health crisis that impacts the perioperative care of this vulnerable population. E-cigarettes have become the most commonly used tobacco products among youth in the United States. Fruit and mint flavors and additives such as marijuana have enticed children and adolescents. E-cigarette, or vaping, product use-associated lung injury (EVALI) is a newly identified lung disease linked to vaping. Clinical presentation of EVALI can be varied, but most commonly includes the respiratory system, gastrointestinal (GI) tract, and constitutional symptoms. Clinical management of EVALI has consisted of vaping cessation and supportive therapy, including supplemental oxygen, noninvasive ventilation, mechanical ventilation, glucocorticoids, and empiric antibiotics, until infectious causes are eliminated, and in the most severe cases, extracorporeal membrane oxygenation (ECMO). Currently, although there is an insufficient evidence to determine the safety and the efficacy of e-cigarettes for perioperative smoking cessation, EVALI clearly places these patients at an increased risk of perioperative morbidity. Given the relatively recent introduction of e-cigarettes, the long-term impact on adolescent health is unknown. As a result, the paucity of postoperative outcomes in this potentially vulnerable population does not support evidence-based recommendations for the management of these patients. Clinicians should identify "at-risk" individuals during preanesthetic evaluations and adjust the risk stratification accordingly. Our societies encourage continued education of the public and health care providers of the risks associated with vaping and nicotine use and encourage regular preoperative screening and postoperative outcome studies of patients with regard to smoking and vaping use.
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Affiliation(s)
- Deborah A Rusy
- From the Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anita Honkanen
- Department of Anesthesia, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Mary F Landrigan-Ossar
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Lawrence I Schwartz
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Kirk Lalwani
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Jennifer R Dollar
- Pediatric Anesthesia Associates, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Randall Clark
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Christina D Diaz
- Department of Anesthesiology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nina Deutsch
- Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington School of Medicine and Health Sciences, Washington, DC
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Sulpicio G Soriano
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Xiao L, Yin X, Di X, Nan Y, Lyu T, Wu Y, Li X. Awareness and prevalence of e-cigarette use among Chinese adults: policy implications. Tob Control 2021; 31:498-504. [PMID: 33608465 PMCID: PMC9234419 DOI: 10.1136/tobaccocontrol-2020-056114] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
Objective To assess the awareness and prevalence of electronic cigarettes (e-cigarettes) and associated factors among Chinese adults (15 years and older). Method This study examined data from Global Adults Tobacco Survey China Project, which was nationally representative and used stratified multiphase cluster randomised sampling design. Data were collected in 2018 through a household survey with in-person interviews using tablet computers. Complex sampling weighted analysis method was used. Results 48.5% of Chinese adults had heard of e-cigarettes. The proportions of Chinese adults who had ever used, had used in the last 12 months, and currently used e-cigarettes were 5.0%, 2.2% and 0.9%, respectively; people in the 15–24 years group showed the highest rates of ever use, last 12-month use and current use at 7.6%, 4.4%, and 1.5%, respectively. Among males, higher e-cigarette use was associated with 15–24 years age group, college/university or above education, and daily use of combustible cigarettes. Among all e-cigarette users, 90.6% also used combustible cigarettes. The most common reason for e-cigarette use was smoking cessation (46.2%) while among ever smokers, 9.5% of ever e-cigarette users had quit smoking and 21.8% of never e-cigarette users had quit smoking (adjusted OR 0.454, 95% CI 0.290 to 0.712). Conclusion Prevalence of e-cigarettes among Chinese adults had increased since 2015, especially among young people aged 15–24. The high level of dual use and lower quit rate among e-cigarette users indicated e-cigarettes had not shown cessation utility at the population level in China. Regulation of e-cigarettes is needed to protect youth and minimise health risks.
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Affiliation(s)
- Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Xi Yin
- China office, World Health Organization, Geneve, GE, Switzerland
| | - Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Yi Nan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Tianchu Lyu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Yiqun Wu
- ThinkTank Research Center for Health Development, Beijing, Beijing, China
| | - Xinhua Li
- Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
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Heldt NA, Reichenbach N, McGary HM, Persidsky Y. Effects of Electronic Nicotine Delivery Systems and Cigarettes on Systemic Circulation and Blood-Brain Barrier: Implications for Cognitive Decline. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 191:243-255. [PMID: 33285126 DOI: 10.1016/j.ajpath.2020.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
Electronic nicotine delivery systems (often known as e-cigarettes) are a novel tobacco product with growing popularity, particularly among younger demographics. The implications for public health are twofold, as these products may represent a novel source of tobacco-associated disease but may also provide a harm reduction strategy for current tobacco users. There is increasing recognition that e-cigarettes impact vascular function across multiple organ systems. Herein, we provide a comparison of evidence regarding the role of e-cigarettes versus combustible tobacco in vascular disease and implications for blood-brain barrier dysfunction and cognitive decline. Multiple non-nicotinic components of tobacco smoke have been identified in e-cigarette aerosol, and their involvement in vascular disease is discussed. In addition, nicotine and nicotinic signaling may modulate peripheral immune and endothelial cell populations in a highly context-dependent manner. Direct preclinical evidence for electronic nicotine delivery system-associated neurovascular impairment is provided, and a model is proposed in which non-nicotinic elements exert a proinflammatory effect that is functionally antagonized by the presence of nicotine.
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Affiliation(s)
- Nathan A Heldt
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania; Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
| | - Nancy Reichenbach
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Hannah M McGary
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Yuri Persidsky
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania; Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
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Shinbashi M, Rubin BK. Electronic cigarettes and e-cigarette/vaping product use associated lung injury (EVALI). Paediatr Respir Rev 2020; 36:87-91. [PMID: 32653465 DOI: 10.1016/j.prrv.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022]
Abstract
Electronic cigarettes (e-cigarettes) are noncombustible tobacco products that have been promoted as safer alternatives to conventional cigarettes and beneficial tools for smoking cessation. However, e-cigarettes have been shown to produce aerosols with high concentrations of propylene glycol, glycerol, volatile organic compounds, and free radicals, which can lead to lung damage. Furthermore, e-cigarettes can deliver nicotine at concentrations higher than traditional combustibles, making them highly addictive. As delivery devices became smaller, less expensive, and refillable, the use of e-cigarettes dramatically increased, especially among adolescents and young adults in the United States. This rise in popularity of noncombustible products led to an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the fall of 2019. In this article, we review the history of e-cigarettes and its prevalence among American youth, the EVALI outbreak and clinical presentation of EVALI patients, and recent legislative efforts to regulate e-cigarette use.
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Affiliation(s)
- Meagan Shinbashi
- Virginia Commonwealth University, Department of Pediatrics and the Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Bruce K Rubin
- Virginia Commonwealth University, Department of Pediatrics and the Children's Hospital of Richmond at VCU, Richmond, VA, United States.
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Pearce K, Gray N, Gaur P, Jeon J, Suarez A, Shannahan J, Pappas RS, Watson-Wright C. Toxicological analysis of aerosols derived from three electronic nicotine delivery systems using normal human bronchial epithelial cells. Toxicol In Vitro 2020; 69:104997. [PMID: 32896591 DOI: 10.1016/j.tiv.2020.104997] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 12/19/2022]
Abstract
Electronic nicotine delivery systems (ENDS) are a rapidly growing global market advertised as a safer alternative to combustible cigarettes. However, comprehensive investigations of END aerosol physicochemical and toxicological properties have not been fully explored across brands to assess relative safety. In this study, we evaluated aerosols collected from three ENDS - Juul Fruit Medley (5% nicotine), Logic Power (2.4% nicotine), and Mistic (1.8% nicotine). ENDS aerosols were generated using standard machine puffing regimen and collected with a novel fluoropolymer condensation trap. Triple quadrupole-inductively coupled plasma-mass determined the presence of heavy metals in collected aerosols. The toxicological effects of ENDS aerosols on normal human bronchial epithelial cells (NHBE) were investigated using cellular viability, reactive oxygen species, oxidative stress assays, along with DNA damage assessments using the CometChip©. Results indicated the total metal concentrations within collected ENDS aerosols were higher for Mistic and Logic compared to Juul. Logic Power aerosols elicited higher reactive oxygen species levels than Mistic and Juul in NHBE after 24-h exposure. Similar dose-dependent reductions of cellular viability and total glutathione were found for each exposure. However, Logic and Juul aerosols caused greater single stranded DNA damage compared to Mistic. Our study indicates that regardless of brand, ENDS aerosols are toxic to upper airway epithelial cells and may pose a potential respiratory hazard to occasional and frequent users.
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Affiliation(s)
- K Pearce
- School of Public Health, Georgia State University, Atlanta, GA 30030, United States of America
| | - N Gray
- Tobacco Inorganics Group, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States of America
| | - P Gaur
- School of Public Health, Georgia State University, Atlanta, GA 30030, United States of America
| | - J Jeon
- School of Public Health, Georgia State University, Atlanta, GA 30030, United States of America
| | - A Suarez
- School of Public Health, Georgia State University, Atlanta, GA 30030, United States of America
| | - J Shannahan
- School of Health Sciences, Purdue University, West Lafayette, IN 47907, United States of America
| | - R S Pappas
- Tobacco Inorganics Group, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States of America
| | - C Watson-Wright
- School of Public Health, Georgia State University, Atlanta, GA 30030, United States of America.
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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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Keith RJ, Fetterman JL, Orimoloye OA, Dardari Z, Lorkiewicz PK, Hamburg NM, DeFilippis AP, Blaha MJ, Bhatnagar A. Characterization of Volatile Organic Compound Metabolites in Cigarette Smokers, Electronic Nicotine Device Users, Dual Users, and Nonusers of Tobacco. Nicotine Tob Res 2020; 22:264-272. [PMID: 30759242 DOI: 10.1093/ntr/ntz021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/08/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Limited research exists about the possible cardiovascular effects of electronic nicotine delivery systems (ENDS). We therefore sought to compare exposure to known or potentially cardiotoxic volatile organic compounds (VOCs) in ENDS users, smokers, and dual users. METHODS A total of 371 individuals from the Cardiovascular Injury due to Tobacco Use study, a cross-sectional study of healthy participants aged 21-45 years, were categorized as nonusers of tobacco (n = 87), sole ENDS users (n = 17), cigarette smokers (n = 237), and dual users (n = 30) based on 30-day self-reported tobacco product use patterns. Participants provided urine samples for VOC and nicotine metabolite measurement. We assessed associations between tobacco product use and VOC metabolite measures using multivariable-adjusted linear regression models. RESULTS Mean (SD) age of the population was 32 (±6.8) years, 55% men. Mean urinary cotinine level in nonusers of tobacco was 2.6 ng/mg creatinine, whereas cotinine levels were similar across all tobacco product use categories (851.6-910.9 ng/mg creatinine). In multivariable-adjusted models, sole ENDS users had higher levels of metabolites of acrolein, acrylamide, acrylonitrile, and xylene compared with nonusers of tobacco, but lower levels of most VOC metabolites compared with cigarette smokers or dual users. In direct comparison of cigarettes smokers and dual users, we found lower levels of metabolites of styrene and xylene in dual users. CONCLUSION Although sole ENDS use may be associated with lower VOC exposure compared to cigarette smoking, further study is required to determine the potential health effects of the higher levels of certain reactive aldehydes, including acrolein, in ENDS users compared with nonusers of tobacco. IMPLICATIONS ENDS use in conjunction with other tobacco products may not significantly reduce exposure to VOC, but sole use does generally reduce some VOC exposure and warrants more in-depth studies.
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Affiliation(s)
- Rachel J Keith
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Jessica L Fetterman
- American Heart Association Tobacco, Regulation and Addiction Center, Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Olusola A Orimoloye
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Zeina Dardari
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Pawel K Lorkiewicz
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Naomi M Hamburg
- American Heart Association Tobacco, Regulation and Addiction Center, Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Andrew P DeFilippis
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Michael J Blaha
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Aruni Bhatnagar
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
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Ghosh B, Reyes-Caballero H, Akgün-Ölmez SG, Nishida K, Chandrala L, Smirnova L, Biswal S, Sidhaye VK. Effect of sub-chronic exposure to cigarette smoke, electronic cigarette and waterpipe on human lung epithelial barrier function. BMC Pulm Med 2020; 20:216. [PMID: 32787821 PMCID: PMC7425557 DOI: 10.1186/s12890-020-01255-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/05/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Taking into consideration a recent surge of a lung injury condition associated with electronic cigarette use, we devised an in vitro model of sub-chronic exposure of human bronchial epithelial cells (HBECs) in air-liquid interface, to determine deterioration of epithelial cell barrier from sub-chronic exposure to cigarette smoke (CS), e-cigarette aerosol (EC), and tobacco waterpipe exposures (TW). METHODS Products analyzed include commercially available e-liquid, with 0% or 1.2% concentration of nicotine, tobacco blend (shisha), and reference-grade cigarette (3R4F). In one set of experiments, HBECs were exposed to EC (0 and 1.2%), CS or control air for 10 days using 1 cigarette/day. In the second set of experiments, exposure of pseudostratified primary epithelial tissue to TW or control air exposure was performed 1-h/day, every other day, until 3 exposures were performed. After 16-18 h of last exposure, we investigated barrier function/structural integrity of the epithelial monolayer with fluorescein isothiocyanate-dextran flux assay (FITC-Dextran), measurements of trans-electrical epithelial resistance (TEER), assessment of the percentage of moving cilia, cilia beat frequency (CBF), cell motion, and quantification of E-cadherin gene expression by reverse-transcription quantitative polymerase chain reaction (RT-qPCR). RESULTS When compared to air control, CS increased fluorescence (FITC-Dextran assay) by 5.6 times, whereby CS and EC (1.2%) reduced TEER to 49 and 60% respectively. CS and EC (1.2%) exposure reduced CBF to 62 and 59%, and cilia moving to 47 and 52%, respectively, when compared to control air. CS and EC (1.2%) increased cell velocity compared to air control by 2.5 and 2.6 times, respectively. The expression of E-cadherin reduced to 39% of control air levels by CS exposure shows an insight into a plausible molecular mechanism. Altogether, EC (0%) and TW exposures resulted in more moderate decreases in epithelial integrity, while EC (1.2%) substantially decreased airway epithelial barrier function comparable with CS exposure. CONCLUSIONS The results support a toxic effect of sub-chronic exposure to EC (1.2%) as evident by disruption of the bronchial epithelial cell barrier integrity, whereas further research is needed to address the molecular mechanism of this observation as well as TW and EC (0%) toxicity in chronic exposures.
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Affiliation(s)
- Baishakhi Ghosh
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hermes Reyes-Caballero
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sevcan Gül Akgün-Ölmez
- Department of Environmental Health and Engineering, Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Present Address: Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Kristine Nishida
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lakshmana Chandrala
- Department of Mechanical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Lena Smirnova
- Department of Environmental Health and Engineering, Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shyam Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Venkataramana K Sidhaye
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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El-Hage R, El-Hellani A, Salman R, Talih S, Shihadeh A, Saliba NA. Vaped Humectants in E-Cigarettes Are a Source of Phenols. Chem Res Toxicol 2020; 33:2374-2380. [DOI: 10.1021/acs.chemrestox.0c00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rachel El-Hage
- Chemistry Department, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Ahmad El-Hellani
- Chemistry Department, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Rola Salman
- Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107-2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Soha Talih
- Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107-2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Alan Shihadeh
- Mechanical Engineering Department, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107-2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23284, United States
| | - Najat Aoun Saliba
- Chemistry Department, Faculty of Arts and Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia 23284, United States
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Messina MD, Levin TL, Conrad LA, Bidiwala A. Vaping associated lung injury: A potentially life-threatening epidemic in US youth. Pediatr Pulmonol 2020; 55:1705-1711. [PMID: 32251551 DOI: 10.1002/ppul.24755] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/26/2020] [Accepted: 03/15/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Center for Disease Control (CDC) has identified a national outbreak in the United States of over 2600 cases of e-cigarette or vaping product use-associated lung injury (EVALI), including 60 deaths as of January 2020. We describe our experience in six adolescents. MATERIAL AND METHODS We identified all pediatric patients diagnosed with EVALI by CDC guidelines over a 6-month period at our health system. Clinical presentation, hospital course, and imaging were reviewed. RESULTS Six patients were identified (three males, three females; median age 18.5 years). Presenting symptoms varied, including constitutional, gastrointestinal, neurologic, and respiratory complaints with pulmonary symptomatology becoming the dominant feature of the illness. Three patients required intensive care unit-level care, one of whom expired 36 days after presentation. Three had bronchoalveolar lavage, two with evidence of lipid-laden macrophages. Four had pulmonary function testing with various results. Admission chest radiographs in all revealed bibasilar interstitial infiltrate which rapidly progressed. Five patients had computed tomography chest imaging demonstrating: confluent pulmonary infiltrates with subpleural sparing (n = 2), generalized ground-glass opacities (n = 1), patchy ground-glass opacities (n = 1) and a reticulonodular pattern (n = 1). Brain magnetic resonance imaging (MRI) obtained in two patients was normal in one and showed a focal signal abnormality in the corpus callosum in one. CONCLUSION We describe the clinical course and radiologic findings of EVALI in our adolescent patients and present a new finding in the brain not yet described in the literature. Given the diversity of presenting symptoms, a high level of suspicion for EVALI is necessary for patients reporting vaping product use regardless of the presence of pulmonary complaints. Brain MRI should be strongly considered in patients with neurologic symptoms.
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Affiliation(s)
- Mark D Messina
- Division of Pediatric Radiology, Department of Radiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Terry L Levin
- Division of Pediatric Radiology, Department of Radiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Laura A Conrad
- Division Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | - Aneela Bidiwala
- Division Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
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Reilly SM, Cheng T, DuMond J. Method Validation Approaches for Analysis of Constituents in ENDS. TOB REGUL SCI 2020; 6:242-265. [PMID: 32789155 PMCID: PMC7416875 DOI: 10.18001/trs.6.4.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We assessed how many peer-reviewed publications reporting chemical quantities and/or yields from electronic nicotine delivery systems (ENDS) have included adequate method validation characteristics in the publication for appropriate interpretation of data quality for informing tobacco regulatory science. METHODS We searched 5 databases (Web of Knowledge, PubMed, SciFinder, Embase, EBSCOhost) for ENDS publications between January 2007 and September 2018. Of the 283 publications screened, 173 publications were relevant for analysis. We identified the publications that report a certain degree of control in data quality, ie, the publications that report marginally validated methods (MVMs). MVMs refer to the methods that: (1) report 3 or more International Conference on Harmonisation (ICH) method validation characteristics, (2) state the method was validated, (3) cite their own previous publication(s) that report MVMs, or (4) use a method within the accreditation scope of an accredited laboratory. RESULTS Overall, 97 publications (56%) report MVMs in their studies. This percentage also reflects the publication distribution for the majority of the 28 chemicals measured by MVMs. CONCLUSIONS This study highlights the need for reporting sufficient validation characteristics following appropriate guidance to ensure the accuracy and reliability of the published analytical data for proper data interpretations that may support policy.
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Affiliation(s)
- Samantha M Reilly
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Tianrong Cheng
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Jenna DuMond
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
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Zervas E, Matsouki N, Kyriakopoulos G, Poulopoulos S, Ioannides T, Katsaounou P. Transfer of metals in the liquids of electronic cigarettes. Inhal Toxicol 2020; 32:240-248. [PMID: 32538207 DOI: 10.1080/08958378.2020.1776801] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: E-cigarettes are electronic devices containing a liquid that usually consists of a mixture of glycerol, propylene glycol and nicotine, with or without flavorings, in various concentrations. A vapor or aerosol is produced, and inhaled from the user, when this liquid is heated by a heating coil. This work examines the impact of three parameters (e-liquid composition, nicotine content and air flow) on the transfer of metals' from the heating coils to the e-liquids.Materials and methods: A distillation unit was used, where 20ml of an e-liquid were boiled with two commercial heating elements. Four e-liquids: 100% Propylene Glycol, 100% Glycerol, 50/50% Propylene Glycol/Glycerol, 33.3/33.3/33.3% Propylene Glycol/Glycerol/Water, three nicotine contents: 0, 0.4 and 0.8% per volume and three air flows: 0, 0.5 and 1.0 L/min, were used. The liquids were analyzed by Total Reflection X-Ray Fluorescence spectrometry to determine the final content of metals.Results and discussion: Five metals, Fe, Ni, Cu, Zn, and Pb, were found to be transferred from the heating coils to the e-liquids. The transfer of those metals increases with air flow and nicotine concentration, while e-liquid composition also has a significant impact. Glycerol enhances the transfer of metals compared to propylene glycol and their mixtures. The boiling temperature of the e-liquids increases significantly the transfer of metals in the e-liquids.Conclusions: There is a transfer of metals from the heating coils to the e-liquids. This transfer depends on the e-liquid composition and on the boiling temperature.
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Affiliation(s)
- Efthimios Zervas
- School of Science and Technology, Hellenic Open University, Patras, Greece.,Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas (FORTH/ICE-HT), Patra, Greece
| | - Niki Matsouki
- School of Science and Technology, Hellenic Open University, Patras, Greece.,Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas (FORTH/ICE-HT), Patra, Greece
| | - Grigorios Kyriakopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens (NTUA), Athens, Greece
| | - Stavros Poulopoulos
- Department of Chemical and Materials Engineering Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Theophilos Ioannides
- Institute of Chemical Engineering Sciences, Foundation for Research and Technology-Hellas (FORTH/ICE-HT), Patra, Greece
| | - Paraskevi Katsaounou
- Department of Critical Care and Pulmonary Services, "Evangelismos" Hospital, Athens Medical School, University of Athens, Athens, Greece
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40
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Electronic nicotine delivery system design and aerosol toxicants: A systematic review. PLoS One 2020; 15:e0234189. [PMID: 32497139 PMCID: PMC7272070 DOI: 10.1371/journal.pone.0234189] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS; e-cigarettes), consisting of a battery, heating element and e-liquid, have evolved significantly with wide variation in design, components, operating powers, and chemical constituents. Generated aerosols have been reported to contain potentially toxic substances. We conducted a systematic review to assess what is known about the presence of toxicants in ENDS aerosols in order to inform how system design could mitigate risk. METHODS Articles reporting on or evaluating design characteristics of ENDS and aerosol constituents were included and summarized. RESULTS The search identified 2,305 articles, of which 92 were included after full-text review. Findings were grouped into 6 major categories of potentially harmful chemicals: carbonyls, volatile organic chemicals, trace elements, reactive oxygen species and free radicals, polycyclic aromatic hydrocarbons, and tobacco-specific nitrosamines. In general, higher concentrations of aerosol toxicants are associated with increased power or voltage. Aerosol toxicants are also associated with e-liquid flavoring agents existing as primary ingredients or as products of thermal degradation. CONCLUSIONS Improved ENDS design can reduce toxicant levels. Additional research is needed to develop a framework for optimizing system characteristics to minimize exposure, especially with respect to heating power and e-liquids. Both manufacturers and regulatory agencies have roles in reducing toxicants and potential health risks from ENDS.
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41
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Vaping-Related Acute Parenchymal Lung Injury: A Systematic Review. Chest 2020; 158:1555-1565. [PMID: 32442559 DOI: 10.1016/j.chest.2020.03.085] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury.
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Patterson CM, Valchanov K, Barker A, Goddard M, Yang H, Butchart AG. Severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support: a consequence of vaping. ERJ Open Res 2020; 6:00013-2020. [PMID: 32440517 PMCID: PMC7231114 DOI: 10.1183/23120541.00013-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/17/2020] [Indexed: 01/16/2023] Open
Abstract
Since the emergence of electronic cigarette products on the retail market just over a decade ago, there has been an exponential rise in their use, particularly amongst young adults [1] and the global market is now estimated by Euromonitor International to be worth $19.3 billion, up from $6.9 billion 5 years ago [1]. Despite being marketed as a safer alternative to traditional cigarettes, “vaping” generates aerosols containing a heterogenous mix of potentially harmful substances and pulmonary disease related to vaping has been identified in recent case clusters [3–5]. In the past decade, vaping has become more prevalent globally. Since mid-2019, reports have linked the use of vaping devices to lung injury (EVALI). This is the first reported adult case outside the USA to require ECMO for a severe vaping complication.https://bit.ly/39hf2ZY
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Affiliation(s)
| | - Kamen Valchanov
- Royal Papworth Hospital NHS Foundation Trust, Cambridge , UK
| | - Allanah Barker
- Royal Papworth Hospital NHS Foundation Trust, Cambridge , UK
| | - Martin Goddard
- Royal Papworth Hospital NHS Foundation Trust, Cambridge , UK
| | - Huina Yang
- Royal Papworth Hospital NHS Foundation Trust, Cambridge , UK
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Liu Q, Huang C, Chris Le X. Arsenic species in electronic cigarettes: Determination and potential health risk. J Environ Sci (China) 2020; 91:168-176. [PMID: 32172965 DOI: 10.1016/j.jes.2020.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
Human exposure to contaminants from electronic cigarettes (e-cigarettes) and the associated health effects are poorly understood. There has been no report on the speciation of arsenic in e-liquid (solution used for e-cigarettes) and aerosols. We report here determination of arsenic species in e-liquids and aerosols generated from vaping the e-liquid. Seventeen e-liquid samples of major brands, purchased from local and online stores in Canada and China, were analyzed for arsenic species using high-performance liquid chromatography and inductively coupled plasma mass spectrometry. Aerosols condensed from vaping the e-liquids were also analyzed and compared for arsenic species. Six arsenic species were detected, including inorganic arsenate (iAsV), arsenite (iAsIII), monomethylarsonic acid (MMA), and three new arsenic species not reported previously. In e-liquids, iAsIII was detected in 59%, iAsV in 94%, and MMA in 47% of the samples. In the condensate of aerosols from vaping the e-liquids, iAsIII was detected in 100%, iAsV in 88%, and MMA in 13% of the samples. Inorganic arsenic species were predominant in e-liquids and aerosols of e-cigarettes. The concentration of iAsIII in the condensate of aerosols (median 3.27 μg/kg) was significantly higher than that in the e-liquid (median 1.08 μg/kg) samples. The concentration of inorganic arsenic in the vaping air was approximately 3.4 μg/m3, which approaches to the permissible exposure limit (10 μg/m3) set by the United States Occupational Safety and Health Administration (OSHA). According to the Environmental Protection Agency's unit risk factor (4.3 × 10-3 per μg/m3) for inhalation exposure to inorganic arsenic in the air, the estimated excess lung cancer risk from lifetime exposure to inorganic arsenic in the e-cigarette vaping air (3.4 μg/m3), assuming e-cigarette vaping at 1% of the time, is as high as 1.5 × 10-4. These results raise health concerns over the exposure to arsenic from electronic cigarettes.
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Affiliation(s)
- Qingqing Liu
- Chongqing Key Laboratory of Biomedical Analysis (Southwest University), Chongqing Science & Technology Commission, College of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, China; College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Chengzhi Huang
- Key Laboratory of Luminescent and Real-Time Analytical System, Chongqing Science and Technology Bureau, College of Pharmaceutical Sciences, Southwest University, Chongqing, 400715, China.
| | - X Chris Le
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, 10-102 Clinical Sciences Building, Edmonton, Alberta T6G 2G3, Canada.
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44
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Abstract
With the rapid increase in electronic cigarette (e-cig) users worldwide, secondhand exposure to e-cig aerosols has become a serious public health concern. We summarize the evidence on the effects of e-cigs on indoor air quality, chemical compositions of mainstream and secondhand e-cig aerosols, and associated respiratory and cardiovascular effects. The use of e-cigs in indoor environments leads to high levels of fine and ultrafine particles similar to tobacco cigarettes (t-cigs). Concentrations of chemical compounds in e-cig aerosols are generally lower than those in t-cig smoke, but a substantial amount of vaporized propylene glycol, vegetable glycerin, nicotine, and toxic substances, such as aldehydes and heavy metals, has been reported. Exposures to mainstream e-cig aerosols have biologic effects but only limited evidence shows adverse respiratory and cardiovascular effects in humans. Long-term studies are needed to better understand the dosimetry and health effects of exposures to secondhand e-cig aerosols.
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Affiliation(s)
- Liqiao Li
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA;
| | - Yan Lin
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA;
| | - Tian Xia
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90095-1772, USA
| | - Yifang Zhu
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA;
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45
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Abstract
With the rapid increase in electronic cigarette (e-cig) users worldwide, secondhand exposure to e-cig aerosols has become a serious public health concern. We summarize the evidence on the effects of e-cigs on indoor air quality, chemical compositions of mainstream and secondhand e-cig aerosols, and associated respiratory and cardiovascular effects. The use of e-cigs in indoor environments leads to high levels of fine and ultrafine particles similar to tobacco cigarettes (t-cigs). Concentrations of chemical compounds in e-cig aerosols are generally lower than those in t-cig smoke, but a substantial amount of vaporized propylene glycol, vegetable glycerin, nicotine, and toxic substances, such as aldehydes and heavy metals, has been reported. Exposures to mainstream e-cig aerosols have biologic effects but only limited evidence shows adverse respiratory and cardiovascular effects in humans. Long-term studies are needed to better understand the dosimetry and health effects of exposures to secondhand e-cig aerosols.
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Affiliation(s)
- Liqiao Li
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA;
| | - Yan Lin
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA;
| | - Tian Xia
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90095-1772, USA
| | - Yifang Zhu
- Department of Environmental Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA;
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46
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Ruszkiewicz JA, Zhang Z, Gonçalves FM, Tizabi Y, Zelikoff JT, Aschner M. Neurotoxicity of e-cigarettes. Food Chem Toxicol 2020; 138:111245. [PMID: 32145355 PMCID: PMC7089837 DOI: 10.1016/j.fct.2020.111245] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.
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Affiliation(s)
- Joanna A Ruszkiewicz
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Ziyan Zhang
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Filipe Marques Gonçalves
- Biochemistry Graduate Program, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington DC, United States
| | - Judith T Zelikoff
- Department of Environmental Medicine, New York University School of Medicine, Manhattan, NY, United States
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States.
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47
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Affiliation(s)
- David C Christiani
- From the Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston
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48
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Abplanalp WT, Wickramasinghe NS, Sithu SD, Conklin DJ, Xie Z, Bhatnagar A, Srivastava S, O'Toole TE. Benzene Exposure Induces Insulin Resistance in Mice. Toxicol Sci 2020; 167:426-437. [PMID: 30346588 DOI: 10.1093/toxsci/kfy252] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Benzene is a ubiquitous pollutant associated with hematotoxicity but its metabolic effects are unknown. We sought to determine if and how exposure to volatile benzene impacted glucose handling. We exposed wild type C57BL/6 mice to volatile benzene (50 ppm × 6 h/day) or HEPA-filtered air for 2 or 6 weeks and measured indices of oxidative stress, inflammation, and insulin signaling. Compared with air controls, we found that mice inhaling benzene demonstrated increased plasma glucose (p = .05), insulin (p = .03), and HOMA-IR (p = .05), establishing a state of insulin and glucose intolerance. Moreover, insulin-stimulated Akt phosphorylation was diminished in the liver (p = .001) and skeletal muscle (p = .001) of benzene-exposed mice, accompanied by increases in oxidative stress and Nf-κb phosphorylation (p = .025). Benzene-exposed mice also demonstrated elevated levels of Mip1-α transcripts and Socs1 (p = .001), but lower levels of Irs-2 tyrosine phosphorylation (p = .0001). Treatment with the superoxide dismutase mimetic, TEMPOL, reversed benzene-induced effects on oxidative stress, Nf-κb phosphorylation, Socs1 expression, Irs-2 tyrosine phosphorylation, and systemic glucose intolerance. These findings suggest that exposure to benzene induces insulin resistance and that this may be a sensitive indicator of inhaled benzene toxicity. Persistent ambient benzene exposure may be a heretofore unrecognized contributor to the global human epidemics of diabetes and cardiovascular disease.
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Affiliation(s)
- Wesley T Abplanalp
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292
| | - Nalinie S Wickramasinghe
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
| | - Srinivas D Sithu
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
| | - Daniel J Conklin
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
| | - Zhengzhi Xie
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
| | - Aruni Bhatnagar
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
| | - Sanjay Srivastava
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
| | - Timothy E O'Toole
- Department of Medicine, Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky 40292.,Envirome Institute, University of Louisville, Louisville, Kentucky 40292.,University of Louisville Superfund Research Center, Louisville, Kentucky 40202
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Belushkin M, Tafin Djoko D, Esposito M, Korneliou A, Jeannet C, Lazzerini M, Jaccard G. Selected Harmful and Potentially Harmful Constituents Levels in Commercial e-Cigarettes. Chem Res Toxicol 2019; 33:657-668. [PMID: 31859484 DOI: 10.1021/acs.chemrestox.9b00470] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A broad range of commercially available electronic cigarette (e-cigarette) systems were tested for levels of emissions of harmful and potentially harmful constituents (HPHC), with a particular focus on the carbonyls: acetaldehyde, acrolein, and formaldehyde. The tobacco-specific nitrosamines N'-nitrosonornicotine and 4-(methylnitrosamino)-1-(3-bipyridyl)-1-butanone; the elements arsenic, cadmium, chromium, lead, and nickel; benzene; 1,3-butadiene; and benzo(a)pyrene were also quantified. The results show that except for the levels of carbonyls, all types of e-cigarettes performed in a similar manner, and emission levels for HPHCs were generally not quantifiable. However, levels of carbonyls, especially formaldehyde, were highly variable. Overall, the lowest levels of formaldehyde were observed in cartridge systems, which generally achieved substantial reductions in yields in comparison with cigarette smoke. Formaldehyde levels in open tank systems were variable; however, the median formaldehyde levels across different brands were substantially lower than the formaldehyde levels in cigarette smoke. The results for variable-power devices operated at the highest voltage confirmed existing literature data regardless of orientation and differences in puffing regimes. Furthermore, our results show that many products deliver consistent HPHC yields over a broad range of testing conditions (with minimal variability from one device to another, under a range of puffing conditions). However, some products exhibit high variability in emissions of HPHCs. The use of air blanks is further highlighted to assess nonproduct-related contributions to HPHC levels to avoid misrepresentation of the data. Overall, our results highlight that some but not all electronic cigarettes deliver low levels of carbonyls consistently across the full e-liquid depletion cycle under different test conditions. The need for further research and standardization work on assessment of variable-voltage electronic cigarettes is emphasized.
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Affiliation(s)
- Maxim Belushkin
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Donatien Tafin Djoko
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Marco Esposito
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Alexandra Korneliou
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Cyril Jeannet
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Massimo Lazzerini
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Guy Jaccard
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
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50
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Palmisani J, Di Gilio A, Palmieri L, Abenavoli C, Famele M, Draisci R, de Gennaro G. Evaluation of Second-Hand Exposure to Electronic Cigarette Vaping under a Real Scenario: Measurements of Ultrafine Particle Number Concentration and Size Distribution and Comparison with Traditional Tobacco Smoke. TOXICS 2019; 7:E59. [PMID: 31775282 PMCID: PMC6958336 DOI: 10.3390/toxics7040059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022]
Abstract
The present study aims to evaluate the impact of e-cig second-hand aerosol on indoor air quality in terms of ultrafine particles (UFPs) and potential inhalation exposure levels of passive bystanders. E-cig second-hand aerosol characteristics in terms of UFPs number concentration and size distribution exhaled by two volunteers vaping 15 different e-liquids inside a 49 m3 room and comparison with tobacco smoke are discussed. High temporal resolution measurements were performed under natural ventilation conditions to simulate a realistic exposure scenario. Results showed a systematic increase in UFPs number concentration (part cm-3) related to a 20-min vaping session (from 6.56 × 103 to 4.01 × 104 part cm-3), although this was one up to two order of magnitude lower than that produced by one tobacco cigarette consumption (from 1.12 × 105 to 1.46 × 105 part cm-3). E-cig second-hand aerosol size distribution exhibits a bimodal behavior with modes at 10.8 and 29.4 nm in contrast with the unimodal typical size distribution of tobacco smoke with peak mode at 100 nm. In the size range 6-26 nm, particles concentration in e-cig second-hand aerosol were from 2- (Dp = 25.5 nm) to 3800-fold (Dp = 9.31 nm) higher than in tobacco smoke highlighting that particles exhaled by users and potentially inhaled by bystanders are nano-sized with high penetration capacity into human airways.
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Affiliation(s)
- Jolanda Palmisani
- Department of Biology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (A.D.G.); (L.P.); (G.d.G.)
| | - Alessia Di Gilio
- Department of Biology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (A.D.G.); (L.P.); (G.d.G.)
| | - Laura Palmieri
- Department of Biology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (A.D.G.); (L.P.); (G.d.G.)
| | - Carmelo Abenavoli
- National Institute of Health, National Centre for Chemicals, Cosmetic products and Consumer Health Protection, Viale Regina Elena 299, 00161 Roma, Italy; (C.A.); (M.F.); (R.D.)
| | - Marco Famele
- National Institute of Health, National Centre for Chemicals, Cosmetic products and Consumer Health Protection, Viale Regina Elena 299, 00161 Roma, Italy; (C.A.); (M.F.); (R.D.)
| | - Rosa Draisci
- National Institute of Health, National Centre for Chemicals, Cosmetic products and Consumer Health Protection, Viale Regina Elena 299, 00161 Roma, Italy; (C.A.); (M.F.); (R.D.)
| | - Gianluigi de Gennaro
- Department of Biology, University of Bari, Via Orabona 4, 70125 Bari, Italy; (A.D.G.); (L.P.); (G.d.G.)
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