Electronic Cigarettes: Do They Have a Role in Smoking Cessation?
ABSTRACT Electronic cigarettes have gained popularity among patients as a smoking cessation aid despite not being approved or supported for this purpose by the United States Food and Drug Administration due to concerns with poor manufacturing practices and the presence of known carcinogens in the limited products that they tested. A few studies have evaluated the effects of electronic cigarettes on plasma nicotine levels and heart rate but found negligible effects. Safety data are mainly limited to surveys in which patients report only minor side effects, such as mouth and throat irritation, headache, vertigo, and nausea. The efficacy of electronic cigarettes has been evaluated in studies in which patients report great success with being able to cut back or stop tobacco cigarette consumption. However, many of these studies introduce bias due to recruiting on e-cigarette Web sites and having tobacco cigarette use self-reported by the participant rather than objectively tested. A few studies have formally evaluated nicotine craving when using electronic cigarettes with mixed results. Although patients support the use of electronic cigarettes in smoking cessation, more formal studies on safety and efficacy should be completed in order to determine whether these products have a role in smoking cessation.
SourceAvailable from: Marli Knorst[Show abstract] [Hide abstract]
ABSTRACT: The electronic nicotine delivery system, also known as the electronic cigarette, is generating considerable controversy, not only in the general population but also among health professionals. Smokers the world over have been increasingly using electronic cigarettes as an aid to smoking cessation and as a substitute for conventional cigarettes. There are few available data regarding the safety of electronic cigarettes. There is as yet no evidence that electronic cigarettes are effective in treating nicotine addiction. Some smokers have reported using electronic cigarettes for over a year, often combined with conventional cigarettes, thus prolonging nicotine addiction. In addition, the increasing use of electronic cigarettes by adolescents is a cause for concern. The objective of this study was to describe electronic cigarettes and their components, as well as to review the literature regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use.Jornal Brasileiro de Pneumologia 10/2014; 40(5):564-72. DOI:10.1590/S1806-37132014000500013 · 1.27 Impact Factor
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ABSTRACT: Electronic cigarettes (e-cigarettes) are advertised to tobacco users as a tool to decrease cigarette consumption and to reduce toxic exposure associated with conventional tobacco smoking. Little is known about the compounds contained in such products, their exposure and long-term health effects. NMR spectroscopy was used to ascertain the content of several constituents of e-cigarette liquids including nicotine, solvents and some bioactive flavour compounds. Risk assessment was based on probabilistic exposure estimation and comparison with toxicological thresholds using the margin of exposure (MOE) approach. In 54 samples of e-cigarette liquids, the average nicotine content was 11 mg/ml. Only 18 from 23 samples were confirmed as nicotine-free samples and in one e-cigarette liquid nicotine was not detected while being declared on the labelling. Major compounds of e-cigarette liquids include glycerol (average 37 g/100 g), propylene glycol (average 57 g/100 g) and ethylene glycol (average 10 g/100 g). Furthermore, 1,3-propanediol, thujone and ethyl vanillin were detected in some samples. The average exposure for daily users was estimated as 0.38 mg/kg bw/day for nicotine, 8.9 mg/kg bw/day for glycerol, 14.5 mg/kg bw/day for 1,2-propanediol, 2.1 mg/kg bw/day for ethylene glycol, and below 0.2 mg/kg bw/day for the other compounds. The MOE was below 0.1 for nicotine, but all other compounds did not reach MOE values below 100 except ethylene glycol and 1,2-propanediol. NMR spectroscopy is a useful and rapid method to simultaneously detect several ingredients in e-cigarette liquids. From all compounds tested, only nicotine may reach exposures that fall into a high risk category with MOE <1. Therefore, e-cigarette liquid products should be subjected to regulatory control to ensure consistent nicotine delivery. Solvents with more favourable toxicological profiles should be used instead of ethylene glycol and 1,2-propanediol, which may fall into a risk category with MOE < 100.Tobacco Induced Diseases 12/2014; 12(1):23. DOI:10.1186/s12971-014-0023-6 · 1.50 Impact Factor
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ABSTRACT: Peripheral arterial disease (PAD) is primarily caused by progressive systemic atherosclerosis manifesting in the lower extremities. This review addresses the epidemiology, clinical presentation and evaluation, and medical management of PAD, with a focus on intermittent claudication. Key advances in the recognition of cardiovascular risk in asymptomatic individuals with mildly abnormal ankle-brachial index, newer reflections on exercise therapy, and a review of established and investigational agents for the treatment of symptomatic PAD, such as cilostazol, statins, and angiotensin-converting enzyme inhibitors, are highlighted. Copyright © 2015 Elsevier Inc. All rights reserved.Cardiology Clinics 11/2014; 33(1). DOI:10.1016/j.ccl.2014.09.010 · 1.06 Impact Factor