The emerging phenomenon of electronic cigarettes

Centro per la Prevenzione e Cura del Tabagismo, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, Università di Catania, Catania, Italy.
Expert Review of Respiratory Medicine 02/2012; 6(1):63-74. DOI: 10.1586/ers.11.92
Source: PubMed


The need for novel and more effective approaches to tobacco control is unquestionable. The electronic cigarette is a battery-powered electronic nicotine delivery system that looks very similar to a conventional cigarette and is capable of emulating smoking, but without the combustion products accountable for smoking's damaging effects. Smokers who decide to switch to electronic cigarettes instead of continuing to smoke would achieve large health gains. The electronic cigarette is an emerging phenomenon that is becoming increasingly popular with smokers worldwide. Users report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms due to workplace smoking restrictions and to continue to have a 'smoking' experience but with reduced health risks. The focus of the present article is the health effects of using electronic cigarettes, with consideration given to the acceptability, safety and effectiveness of this product to serve as a long-term substitute for smoking or as a tool for smoking cessation.

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Available from: Pasquale Caponnetto, Oct 23, 2014
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    • "Electronic cigarettes have become increasingly popular (Ayers et al., 2011;Caponnetto et al., 2012) in the last years. Due to the absence of combustion and the associated formation of carcinogenic compounds, they are frequently advertised as a healthier alternative to traditional tobacco smoking (Hutzler et al., 2014). "
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    ABSTRACT: E-liquids generally contain four main components: nicotine, flavours, water and carrier liquids. The carrier liquid dissolves flavours and nicotine and vaporizes at a certain temperature on the atomizer of the e-cigarette. Propylene glycol and glycerol, the principal carriers used in e-liquids, undergo decomposition in contact with the atomizer heating-coil forming volatile carbonyls. Some of these, such as formaldehyde, acetaldehyde and acrolein, are of concern due to their adverse impact on human health when inhaled at sufficient concentrations. The aim of this study was to correlate the yield of volatile carbonyls emitted by e-cigarettes with the temperature of the heating coil. For this purpose, a popular commercial e-liquid was machine-vaped on a third generation e-cigarette which allowed the variation of the output wattage (5-25 watt) and therefore the heat generated on the atomizer heating-coil. The temperature of the heating-coil was determined by infrared thermography and the vapour generated at each temperature underwent subjective sensorial quality evaluation by an experienced vaper. A steep increase in the generated carbonyls was observed when applying a battery-output of at least 15 watt corresponding to 200-250 °C on the heating coil. However, when considering concentrations in each inhaled puff, the short-term indoor air guideline value for formaldehyde was already exceeded at the lowest wattage of 5 watt, which is the wattage applied in most 2nd generation e-cigarettes. Concentrations of acetaldehyde in each puff were several times below the short-term irritation threshold value for humans. Acrolein was only detected from 20 watts upwards. The negative sensorial quality evaluation by the volunteering vaper of the vapour generated at 20 watt demonstrated the unlikelihood that such a wattage would be realistically set by a vaper. This study highlights the importance to develop standardised testing methods for the assessment of carbonyl-emissions and emissions of other potentially harmful compounds from e-cigarettes. The wide variety and variability of products available on the market make the development of such methods and the associated standardised testing conditions particularly demanding.
    Full-text · Article · Jan 2016 · International Journal of Hygiene and Environmental Health
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    • "CE marking, there are no standard regulations relating to characterisation of the emissions and their impact on biological systems. E-cigarettes appear to be much safer than cigarettes, but further studies are required to fully assess their safety for long-term use (Caponnetto et al., 2012). Concerns regarding the possible adverse effects have been raised (Etter, 2010; McQueen et al., 2011; Chen, 2013; Goniewicz et al., 2013). "
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    ABSTRACT: Development of physiologically relevant test methods to analyse potential irritant effects to the respiratory tract caused by e-cigarette aerosols is required. This paper reports the method development and optimization of an acute in vitro MTT cytotoxicity assay using human 3D reconstructed airway tissues and an aerosol exposure system. The EpiAirway(TM) tissue is a highly differentiated in vitro human airway culture derived from primary human tracheal/bronchial epithelial cells grown at the air-liquid interface, which can be exposed to aerosols generated by the VITROCELL(®) smoking robot. Method development was supported by understanding the compatibility of these tissues within the VITROCELL(®) system, in terms of airflow (L/min), vacuum rate (mL/min) and exposure time. Dosimetry tools (QCM) were used to measure deposited mass, to confirm the provision of e-cigarette aerosol to the tissues. EpiAirway(TM) tissues were exposed to cigarette smoke and aerosol generated from two commercial e-cigarettes for up to 6 hrs. Cigarette smoke reduced cell viability in a time dependent manner to 12% at 6 hrs. E-cigarette aerosol showed no such decrease in cell viability and displayed similar results to that of the untreated air controls. Applicability of the EpiAirway(TM) model and exposure system was demonstrated, showing little cytotoxicity from e-cigarette aerosol and different aerosol formulations when compared directly with reference cigarette smoke, over the same exposure time. Copyright © 2015. Published by Elsevier Ltd.
    Preview · Article · Jun 2015 · Toxicology in Vitro
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    • "Electronic cigarettes are a relatively new form of nicotine delivery and their popularity is increasing worldwide (Regan et al. 2011; Caponnetto et al. 2012; Brown et al. 2014; King et al. 2014). However, due in part to the absence of appropriate product regulations, there are concerns about the accuracy of product labelling with the nicotine concentration varying from product to product, including being present Received 27 March 2015; accepted 28 April 2015. "
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    ABSTRACT: Electronic cigarettes (e-cigarettes) are a new form of nicotine delivery device and their popularity is increasing rapidly. One key concern about the safety of e-cigarette use is the quality control during their manufacturing and whether the nicotine content in e-cigarette matches the label claim. We developed an assay to evaluate nicotine content in e-cigarettes. For nicotine extraction, the e-cigarette cartridge consisting of fibrous pad was removed from the cartridge chamber. Ten microlitres of deuterated nicotine (nicotine-d4; 1 μg) solution, used as external standard, was spiked onto the fibrous pad and allowed to penetrate into the matrix. The pad was placed in an Erlenmeyer flask with 50 mL of 50% (v/v) methanol in deionised water as extraction solvent. The flask was placed in an ultra-sound bath for 15 min at ambient temperature. After sonication, the extract was further diluted in Milli-Q water and then analysed using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The recovery of nicotine-d4 extracted from the e-cigarette cartridge was 81.5% ± 3.7 (mean ± SD). Taking into account recovery, nicotine amount in the e-cigarette cartridge samples was 11.9 ± 1.3 mg (mean ± SD), which was lower than the content claimed by the manufacture (16 mg). The nicotine amount did not vary significantly between cartridges within one pack or between packs. The content of nicotine in the e-cigarette cartridges can be effectively determined by UPLC-MS/MS assay. Differences between content and the label claimed for nicotine in e-cigarette could be a potential determinant of clinical trials.
    Full-text · Article · Jun 2015 · Analytical Letters
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