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Effects of theatrical smokes and fogs on respiratory health in the entertainment industry

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Abstract

Background Theatrical fogs (glycol or mineral oil aerosols) are widely used in the entertainment industry to create special effects and make lighting visible.Methods We studied 101 employees at 19 sites using fogs and measured personal fog exposures, across work shift lung function, and acute and chronic symptoms. Results were also compared to an external control population, studied previously.ResultsChronic work-related wheezing and chest tightness were significantly associated with increased cumulative exposure to fogs (mineral oil and glycols) over the previous 2 years. Acute cough and dry throat were associated with acute exposure to glycol-based fogs; increased acute upper airway symptoms were associated with increased fog aerosol overall. Lung function was significantly lower among those working closest to the fog source.Conclusions Mineral oil- and glycol-based fogs are associated with acute and chronic adverse effects on respiratory health among employees. Reducing exposure, through controls, substitution, and elimination where possible, is likely to reduce these effects. Am. J. Ind. Med. 47:411–418, 2005. © 2005 Wiley-Liss, Inc.

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... Besides the toxicities specific to nicotine salts, there are various toxic effects of almost all the components in the e-liquids [15][16][17][18][19][20][21][22][23][24]. The most abundant chemicals, propylene glycol, and vegetable glycerin, can negatively affect cell viability as they can cause decreases in cell growth to a similar degree to dimethyl sulfoxide [15]. ...
... Propylene glycol is known to cause respiratory arrest in rats after administration of 25 mg/kg/day for 3 days [16]. Chronic propylene glycol exposures are associated with reported symptoms of chronic wheezing, chest tightness, and weaker lung function, while acute exposures are associated with coughs and other upper airway symptoms as well as ocular irritations [17,18]. Heating vegetable glycerin in the presence of other acids may cause it to undergo pyrolysis reactions, releasing acrolein, which can cause nasal cavity irritations, lung lining damage, and even contribute to the onset of cardiovascular diseases [19][20][21]. ...
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... Physicochemical analysis was the most common study subject (n = 59, 37.8%), followed by in vitro (48,30.8%), human (31,19.9%), ...
... 45 Such substances include propylene glycol and glycerol 45 ; little is known regarding the clinical effects of inhalation of these substances on human health. [46][47][48] For example, multiple cases of acute eosinophilic pneumonia related to HTP use have been reported in Japan [49][50][51] ; however, the exact causative agents remain to be determined. In their advertisement, tobacco companies described that their HTPs are "more than 90% reduced" or "99% free" of harmful substances compared to CC. ...
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... Only a few previous studies focused on the inhalation risks of artificial fogs, particularly those based on glycols. Varughese et al. 16 found that stage actors are more likely to suffer from respiratory complications, likely due to inhalation of glycols. It has been found that many glycol compounds may cause high cell cytotoxicity and will potentially influence the voice of stage performers. ...
... 23 Increasing cases of E-cigarette and Vaping Use Associated Lung Injury (EVALI) were observed, and the vaping crisis in the US before the COVID pandemic has caused more than 2800 cases of EVALI due to vaping. [24][25][26][27] Given that Varughese et al. 16 have mentioned the risks of glycol inhalation to the voice and health of stage actors, this paper was referred by numerous vaping studies because glycols are employed as the solvent of e-liquids. However, as mentioned earlier, very few studies have investigated the composition and impact of artificial fogs. ...
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Artificial fog is commonly employed in the entertainment industry and indoor household celebrations. The fog is generated from glycol‐based solvents, which can also be found in e‐cigarettes and personal care products. Although potential health impacts of glycol inhalation are frequently cited by studies of e‐cigarette smoking, the dynamics and the chemical composition of glycol‐based aerosols have never been studied systematically. The objective of this work is to investigate the impact of glycol‐based aerosol on indoor air quality. Specifically, we targeted artificial fogs generated with common glycols, including propylene glycol (PG) and triethylene glycol (TEG). With the aid of a novel aerosol collecting and monitoring instrument setup, we obtained time‐resolved aerosol profiles and their chemical compositions in an experimental room. Artificial fog has given rise to a significant amount of ultra‐fine particulate matter, demonstrating its negative impact on indoor air quality. Additionally, we found a high concentration (9.75 mM) of formaldehyde and other carbonyls in fog machine fluids stored for months. These compounds are introduced to the indoor air upon artificial fog application. We propose that carbonyls have accumulated from the oxidative decomposition of glycols, initiated by OH radicals and singlet oxygens (1O2) and likely sustained by autooxidation. Oxidation of glycols by indoor oxidants has never been reported previously. Such chemical processes can represent an unrecognized source of toxic carbonyl compounds which is also applicable to other glycol‐based solvents.
... Many groups have also studied the impact of e-cigarette use on lung function [103][104][105]. One study looked at the impact of theatrical smokes and fogs, which have similar additives to the liquid nicotine cartridge (glycol derivatives), on lung function [106,107]. A total of 27 healthy people without asthma were exposed to propylene glycol for 1 min. ...
... In a separate study, the lung function of 101 staff members working at sites using theatrical fog (usually working < 10 feet from foggenerating machines) was measured. A 5% reduction in FEV1 and FVC was noted in comparison to staff working further away [106]. While this data cannot be generalised to e-cigarette users, it highlights the acute effects of vapours similar to those from ecigarettes [35]. ...
Article
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Since commercial development in 2003, the usage of modern electronic cigarette (e-cigarette) continues to increase amongst people who have never smoked, ex-smokers who have switched to e-cigarettes, and dual-users of both conventional cigarettes and e-cigarettes. With such an increase in use, knowledge of the irritative, toxic and potential carcinogenic effects on the lungs is increasing. This review article will discuss the background of e-cigarettes, vaping devices and explore their popularity. We will further summarise the available literature describing the mechanism of lung injury caused by e-cigarette or vaping use.
... While chemical studies of high-voltage vapor indicate the presence of potentially toxic compounds, whether e-cigarette aerosols produce deleterious effects in users has not been sufficiently explored. Research investigating health consequences of theater fog, a propylene glycolbased aerosol like those produced by ecigarettes, showed significant correlation between increased exposure and chronic wheezing, chest tightness, and decreased lung function (Varughese et al., 2005). While theater fog is produced in a different system, their study supports our hypothesis that understanding the cytotoxicity and inflammatory response to e-cigarette exposure may play an important role in determining the safety of high-voltage vaping. ...
... A significant difference in cellular viability was also found between the vegetable glycerin and the propylene glycolexposed cells (Steel-Dwass All pairs, a = 0.05, p = 0.0310; Fig. 1). These results are consistent with the findings of Jensen et al. (2015) and Varughese et al. (2005) that indicated the potential dangers of high-voltage vaping with propylene glycol-based e-liquids. ...
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The increased prevalence of high-voltage vaping options, where e-liquids are aerosolized at higher battery voltages, has raised concerns regarding the potential health consequences of e- cigarette usage. In this study, rat alveolar type II cells were exposed to vapor generated from unflavored propylene glycol (with and without 24 mg/mL nicotine) and vegetable glycerin e- liquids. Over 30 minutes, L2 cells were exposed to 1800 mL vapor generated at 4.7 V. Cytotoxicity was determined through changes in endocytosis (NRU) and metabolic activity (MTT assay). Level of inflammatory response was determined by prostaglandin E2 (PGE2) secreted into the basolateral cell media post exposure. All values were normalized against control replicates mock-exposed and processed in parallel with experimental replicates. Only cells exposed to propylene glycol without nicotine exhibited significant decreases in cell viability, as measured by NRU.
... A generally recognized occupational guideline for airborne exposures to PG mists and vapors is the AIHA Workplace Environmental Exposure Level (WEEL), which recommends a maximum 8-h TWA for total vapor and aerosol of 50 parts per million (ppm) (156 mg/m 3 ); for aerosol alone, the TWA is 10 mg/m 3 (46). However, in a study of the health effects of theatrical fogs, it was determined that exposure to these fogs at concentrations as low as from 0.02 to 4.11 mg/m 3 may contribute to both acute and chronic health issues, such as asthma, wheezing, chest tightness, decreased lung function, respiratory irritation, and airway obstruction (47). Particularly, irritated mucous membrane symptoms as well as acute headache, dizziness, and drowsiness were associated with exposures to glycol-based fogs (47). ...
... However, in a study of the health effects of theatrical fogs, it was determined that exposure to these fogs at concentrations as low as from 0.02 to 4.11 mg/m 3 may contribute to both acute and chronic health issues, such as asthma, wheezing, chest tightness, decreased lung function, respiratory irritation, and airway obstruction (47). Particularly, irritated mucous membrane symptoms as well as acute headache, dizziness, and drowsiness were associated with exposures to glycol-based fogs (47). ...
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The use of electronic cigarettes (e-cigarettes or “vaping”) has seen an unprecedented increase worldwide. Vaping has been promoted as a beneficial smoking cessation tool and an alternative nicotine delivery device that contains no combustion by-products. However, nicotine is highly addictive, and the increased use of nicotine-containing e-cigarettes among teens and individuals who are not in need of smoking cessation may lead to overall greater nicotine dependence in the population. Furthermore, available research indicates that vaping solutions and their emissions may contain much more than just nicotine, including aerosolized flavorings, propylene glycol (PG), and other intentional and unintentional contaminants. These materials could present undefined potential health hazards to both e-cigarette users and bystanders, the full extent of which is not well understood at this time. Whereas e-cigarette usage and exposures may lower some or most of the risks associated with conventional cigarette use, the health effects of nicotine and aerosol exposures from e-cigarettes are not well understood. Research indicates that vaping aerosols are not benign, especially for nearby people in areas with limited ventilation and people with compromised health conditions. In addition, e-juice liquids have already been responsible for an increase in accidental poisonings in children. Because the magnitude of health and safety hazards that vaping may present to nonusers remains unclear, it is prudent to manage and control vaping in indoor locations where smoking is currently restricted. Based on a review of current scientific information, the American Industrial Hygiene Association (AIHA) recommends that e-cigarettes should be considered a source of aerosols, volatile organic compounds (VOCs), and particulates in the indoor environment that have not been thoroughly characterized or evaluated for health risk or safety.
... Epigenetic changes resulting in reduced PPAR-gamma (mesenchymal peroxisome proliferator-activated receptor gamma) receptor expression results in an asthmatic phenotype. Lung nicotine levels are more than 200 times the systemic peak in both conventional smokers and vapers [46][47][48]. ...
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The harmful effects of smoking cigarettes on human health are well documented; thus various smoking cessation methods have been assessed and new options are currently under development to provide a “better’ alternative to the “worse” one, namely smoking. However, no ideal method of ending or replacing conventional smoking has been developed so far, and actually, none of them has been proven entirely effective or safe. The laxity, or rather the absence of regulations in the first decade of existence of electronic nicotine delivery systems (ENDS) allowed their use with prohibited substances instead of nicotine or other substances with detrimental effect, with the emergence of a severe syndrome - e-cigarette and vaping-associated lung injury (EVALI), whose treatment required even lung transplantation in young people without any prior underlying lung disease. This narrative review aims to provide a brief overview of concerns about medical issues associated with e-cigarette use, particularly cardiovascular and respiratory panels. We organized the data in several micro-sections varying from practical aspects of understanding ENDS to clinical issues. To combat tobacco addiction, electronic cigarettes are increasingly widely accepted. A global regulatory framework is required to prevent the emergence of an illicit e-cigarette business with detrimental impacts on health.
... There are several types of microenvironments which have scarcely been measured with LCS, as far as the authors can tell, and these include restaurants and bars, gyms and fitness facilities, concert venues, galleries, and other cultural spaces. To identify various types of pollutant-generating activities and substances-for instance, theatrical smoke/fog in concert venues and clubs (Varughese et al 2005)-and quantify their contributions to IAQ, more representative LCS studies in these microenvironments would be useful. Figure 5(b) reports the pollutants measured in the studies, with PM 2.5 and CO 2 the most-measured pollutants, followed by PM 10 and VOCs. ...
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Understanding of the various sources of indoor air pollution requires indoor air quality (IAQ) data that is usually lacking. Such data can be obtained using unobtrusive, low-cost sensors (LCS). The aim of this review is to examine the recent literature published on LCS for IAQ measurements and to determine whether these studies employed any methods to identify or quantify sources of indoor air pollution. Studies were reviewed in terms of whether any methods of source apportionment were employed, as well as the microenvironment type, geographical location, and several metrics relating to the contribution of outdoor pollutant ingress versus potential indoor pollutant sources. We found that out of 60 relevant studies, just four employed methods for source apportionment, all of which utilised receptor models. Most studies were undertaken in residential or educational environments. There is a lack of data on IAQ in other types of microenvironments and in locations outside of Europe and North America. There are inherent limitations with LCS in terms of producing data which can be utilised in source apportionment models. This applies to external pollution data, however IAQ can be even more challenging to measure due to its characteristics. The indoor environment is heterogeneous, with significant variability within the space as well as between different microenvironments and locations. Sensor placement, occupancy, and activity reports, as well as measurements in different microenvironments and locations, can contribute to understanding this variability. Outdoor pollutants can ingress into the space via the building envelope, however measurement of external pollution and environmental conditions, as well as recording details on the building fabric and ventilation conditions, can help apportion external contributions. Whether or not source apportionment models are employed on indoor data from LCS, there are parameters which, if carefully considered during measurement campaigns, can aid in source identification of pollutants.
... Since the early 2000s, a few studies have proposed that stage actors may experience adverse health effects due to high exposure to glycols in articial fog. 16,17 Wieslander et al. discovered that exposure to propylene glycol mist during aviation training would cause respiratory systemrelated symptoms. 18 However, not many studies have addressed the origin of the health impact of glycol exposure in the following decade. ...
Article
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The use of glycols is seen in various industries and occupations. In the past few decades, the health implications of inhalable glycols have gained public attention. Inhalable glycols may cause adverse health effects, especially for workers in occupations receiving frequent exposure and consumers of glycol-based daily products. Our previous work highlighted the rapid accumulation of formaldehyde and glycolaldehyde in fog juice, thus proposing the occurrence of glycol autoxidation. However, the fundamentals of glycol autoxidation remained unclear and unexplored. Our goal is to investigate the autoxidation of common glycols during indoor storage. Carbonyls were quantified using liquid chromatography-mass spectrometry (LC-MS), and peroxides from autoxidation were monitored via iodometry and UV-Vis spectrometry. The impact of certain factors such as the water mixing ratio and antioxidants (vitamin C) was also investigated. Formation of aldehydes in many glycols was weekly monitored, such as e-cigarette juice and triethylene glycol (TEG). Occurrence of autoxidation was confirmed by the increase in the total peroxide concentration. Additionally, we highlighted the dependence of the carbonyl formation rate on the TEG-water mixing ratio, demonstrating the complex role of water in glycol autoxidation. We have also tested the effectiveness of vitamin C and made suggestions for minimizing the formation of toxic carbonyls in consumer products.
... Indeed, both compounds are widely used in products around the world (e.g., shampoo, skincare products, ketchup, oral medications, etc.). It is interesting to note, even before E-cigs were widely available for recreational use in North American and European markets (early 2007), that there were early indications from the entertainment industry that mineral oils and glycols (e.g., VG and PG used in 'fog-machines') were associated with adverse respiratory symptoms, such as wheezing, coughing, dry mouth, and chest tightness) [53]. Our study extends this knowledge to the vascular effects from acute exposure, and also provides clear evidence that exposure to nicotine-free PG and VG (i.e., PG-0, VG-0), even without flavorings, trigger vasoconstriction in peripheral arterioles. ...
Article
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Despite claims of safety or harm reduction for electronic cigarettes (E-cig) use (also known as vaping), emerging evidence indicates that E-cigs are not likely safe, or necessarily safer than traditional cigarettes, when considering the user’s risk of developing vascular dysfunction/disease. E-cigs are different from regular cigarettes in that E-cig devices are highly customizable, and users can change the e-liquid composition (such as the base solution, flavors, and nicotine level). Since the effects of E-cigs on the microvascular responses in skeletal muscle are poorly understood, we used intravital microscopy with an acute (one-time 10 puff) exposure paradigm to evaluate the individual components of e-liquid on vascular tone and endothelial function in the arterioles of the gluteus maximus muscle of anesthetized C57Bl/6 mice. Consistent with the molecular responses seen with endothelial cells, we found that the peripheral vasoconstriction response was similar between mice exposed to E-cig aerosol or cigarette smoke (i.e., 3R4F reference cigarette); this response was not nicotine dependent, and endothelial cell-mediated vasodilation was not altered within this acute exposure paradigm. We also report that, regardless of the base solution component [i.e., vegetable glycerin (VG)-only or propylene glycol (PG)-only], the vasoconstriction responses were the same in mice with inhalation exposure to 3R4F cigarette smoke or E-cig aerosol. Key findings from this work reveal that some component other than nicotine, in inhaled smoke or aerosol, is responsible for triggering peripheral vasoconstriction in skeletal muscle, and that regardless of one’s preference for an E-cig base solution composition (i.e., ratio of VG-to-PG), the acute physiological response to blood vessels appears to be the same. The data suggest that vaping is not likely to be ‘safer’ than smoking towards blood vessels and can be expected to produce and/or result in the same adverse vascular health outcomes associated with smoking cigarettes.
... Increasingly available evidence shows that vaping exerts negative effects on airway biology and, consequently, on respiratory health, and this was largely expected, as there were previous reports of respiratory symptoms caused by inhalation of substances later found in e-liquids and vape. Apart from the detrimental effects of inhalation of toxicants and irritants, it has been reported that inhalation of PG and VG causes acute dry cough and wheezing and long-term respiratory im-pairment in theater and cinema workers exposed to stage fog produced by heating these solvents, which have hygroscopic properties that cause hyperosmotic stress and the subsequent release of inflammation mediators, ciliary function alteration and bronchoconstriction (26). Furthermore, the inhalation of diacetyl (37). ...
... Consistent with this, past studies have shown that inhalation of propylene glycol vapors (e.g. theatrical smoke) is associated with acute cough and decreased lung function [68,69]. Moreover, a recent observational study found a 31% increase in the risk of respiratory disease among e-cig users compared to never users independent of past cigarette smoking [70]. ...
... While nicotine's irritant effects are well-established, PG may have irritant effects of its own. For example, exposure to PG-based vapor can cause acute eye and airway irritation, along with chronic respiratory dysfunction (Moline et al., 2000;Wieslander et al., 2001;Varughese et al., 2005). Furthermore, PG, sometimes used as a vehicle solution for intravenous drug delivery, can induce burning or stinging sensations during injection (Doenicke et al., 1999). ...
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While rates of smoking combustible cigarettes in the United States have trended down in recent years, use of electronic cigarettes (e-cigarettes) has dramatically increased, especially among adolescents. The vast majority of e-cigarette users consume “flavored” products that contain a variety of chemosensory-rich additives, and recent literature suggests that these additives have led to the current “teen vaping epidemic.” This review, covering research from both human and rodent models, provides a comprehensive overview of the sensory implications of e-cigarette additives and what is currently known about their impact on nicotine use. In doing so, we specifically address the oronasal sensory contributions of e-cigarette additives. Finally, we summarize the existing gaps in the field and highlight future directions needed to better understand the powerful influence of these additives on nicotine use.
... 117 Common carrier solutions such as propylene glycol have been associated with increased airway hyperreactivity among vape pen users, 31 118 119 and have been associated with chronic respiratory conditions among theater workers exposed to aerosolized propylene glycol used in the generation of artificial fog. 120 Nicotine salts used in pod based vape pen solutions, including Juul, have been found to penetrate the cell membrane and have cytotoxic effects. 121 The myriad available vape pen flavors correlate with an expansive list of chemical compounds with potential adverse respiratory effects. ...
Article
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.
... However, this designation is only applicable to the digestion of these flavorings at specific concentrations in specific foods, not by inhalation. In fact, propylene glycol and vegetable glycerin have been associated with increased systemic inflammation without nicotine via inhalation [51][52][53]. They not only contribute to the increase in neuroinflammatory markers such as IL-1β and TNF-α, but can also cause short-term memory deficits [54]. ...
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Electronic cigarettes (ECs) are battery-powered nicotine delivery devices that have rapidly gained popularity and attention globally. ECs work by heating a liquid to produce an aerosol that usually contains nicotine, flavoring compounds, and other chemicals, which are inhaled during vaping. EC aerosols are depicted to contain a lower number and overall quantity of harmful toxicants than conventional cigarettes (CCs). However, emerging research indicates that EC aerosols contain harmful ingredients including ultrafine particles, volatile organic compounds, and heavy metals. One common ingredient found in both CCs and ECs is nicotine, which has been shown to be both highly addictive and toxic. Particularly relevant to our current review, there is an enormous amount of literature that shows that smoking-derived nicotine exacerbates ischemic brain damage. Therefore, the question arises: will EC use impact the outcome of stroke? ECs are highly popular and relatively new in the market; thus, our understanding about the long-term effects of EC use on brain are lacking. The current review strives to extrapolate the existing understanding of the nicotine-induced effects of conventional smoking on the brain to the possible effects that ECs may have on the brain, which may ultimately have a potential for adverse stroke risk or severity.
... Portanto, a segurança do propilenoglicol e da glicerina nos níveis inalados pelos usuários de cigarro eletrônico permanece incerta (GOTTS, 2019). O que se sabe até o momento é que o glicerol tem sido relatado como causa de pneumonia lipóide (MCCAULEY; MARKIN; HOSMER, 2012), podendo provocar tosse aguda, garganta seca e diminuição da função pulmonar; sugere-se ainda que o propilenoglicol tenha potencial irritativo e inflamatório nas vias aéreas e pulmão e seja associado à obstrução leve das vias aéreas, mesmo em indivíduos não asmáticos (VARUGHESE et al., 2005). ...
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O cigarro eletrônico surgiu como uma tentativa para minimizar a dependência ao uso de tabaco, entretanto, engloba controvérsias e dúvidas acerca das reais implicações para o organismo humano. Diante disso, o presente estudo tem como objetivo realizar uma revisão da literatura a fim de relacionar o uso de cigarro eletrônico com suas consequências para os humanos. Os estudos analisados relatam experimentos in vitro e in vivo em camundongos, demonstrando menor concentração de poluentes e nocividades no cigarro eletrônico comparado ao convencional, porém, seu potencial efeito maléfico está relacionado à composição do e-líquido, à maneira do uso e à variedade de aromas presentes nos produtos. Além disso, foram verificadas lesões celulares, hiperreatividade das vias aéreas, liberação de citocinas – IL-8, IL-10 e TNF, redução da ação antimicrobiana de queratinócitos e potencial apoptose nas células alveolares. Foi observado também um aumento em até cinco vezes da concentração de carboxihemoglobina em comparação ao cigarro comum e um aumento na autorenovação de células de adenocarcinoma pulmonar de células não pequenas, devido à expressão de SOX2. Observa-se também que em casos de DPOC, o cigarro eletrônico não apresenta agravamentos na fisiologia respiratória, contrapondo outras ocorrências como asma, pneumonite, câncer de pulmão e doenças infecciosas que podem ser ocasionadas ou exacerbadas pelo seu uso. Contudo, pelo curto prazo de observação de seus efeitos, não é possível determinar com precisão a segurança dos cigarros eletrônicos, dessa forma, faz-se necessário que mais pesquisas longitudinais sejam desenvolvidas, auxiliando, assim, na construção de evidências sobre a segurança dos cigarros eletrônicos e na regulamentação futura do produto.
... The main advantage of e-cigarettes is the elimination of carcinogenic components contained in tobacco smoke, such as polycyclic aromatic hydrocarbons, carbon monoxide, and others [9]. The inhalation solution of e-cigarettes consists of propylene glycol and additives, such as glycerol, nicotine, and flavorings [10][11][12]. Both propylene glycol and glycerol are substances approved for use in the food, pharmaceutical, and cosmetic industries [1,13,14], however, heated to high temperatures may produce formaldehyde, which is a highly irritating and carcinogenic component also present in tobacco smoke [6,9,15]. ...
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(1) Background: Electronic cigarettes are gaining more popularity not only among cigarettes smokers. Firstly, e-cigarettes were perceived as less harmful than traditional cigarettes, however, nowadays, they are arousing more controversy. The aim of this study was to assess the impact of e-cigarette usage on selected physicochemical properties of saliva. (2) Methods: The study population included 128 patients: 40 patients using e-cigarettes, 39 patients smoking traditional cigarettes, and 49 non-smoking patients (non-smokers). Laboratory tests involved verification of saliva values of pH and concentration of total protein, calcium, and phosphates. (3) Results: Among e-cigarette users, the value of pH was lower and the concentration of total protein, calcium, and phosphates was higher than in the group of non-smokers. Statistically significant differences were observed in relation to calcium. Among traditional cigarette smokers, the value of pH was lower, concentrations of total protein and phosphates were higher than in the group of non-smokers. Statistically significant differences were observed in relation to total protein. (4) Conclusions: Saliva of e-cigarette users presents changes in physicochemical composition in comparison to traditional cigarette smokers and non-smokers, however, statistically significant differences were observed only in calcium concentration. Further longitudinal studies on a larger study group should be conducted to assess the effect of observed changes in oral health.
... Heated PG and VG are used in fog production for theatrical and entertainment purposes, and fog exposure is associated with the acute development of a cough and throat dryness. Long-term exposure has been linked with more severe respiratory complaints such as chest tightness, wheezing, and reduced lung function [35]. Flavoring chemicals that provide a clove or cinnamon aroma to the vapor are known skin irritants and potential generators of asthma when inhaled [27,36]. ...
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Adolescence is a period characterized by developmental, psychological, and psychosocial alterations, with a major impact on youths’ attitudes and perceptions. Adolescents with asthma may not comply with treatment and may develop risky behaviors, including smoking, vaping, and other substance use, leading to unanticipated exacerbations and consequences. Vaping has become extremely popular in this age group, and studies have suggested that it has potential adverse effects on asthmatic airways. More well-designed studies are needed to confirm the initial worrying data, and action must be taken by both medical officers and health authorities to deal with the elephant in the room and curb the vaping pandemic. The aim of this paper is to provide a review of the current knowledge regarding the effect of vaping on adolescents with asthma and to propose actions to restrain this fast-growing trend.
... Moreover, despite being considered as safe food additives, PG and VG are hygroscopic molecules and thus their inhalation may cause the release of inflammation mediators in the airway mucosa. Interestingly, entertainment industry workers exposed to fog produced by heating VG and PG often complain of dry cough in the short term, whereas chronic exposure has been shown to cause chest tightness and wheezing, as well as lung function impairment [10]. Even EC flavouring additives are widely used in the food industry, but the inhalation of diacetyl (2,3-butanedione), commonly used to provide a 'buttery' or 'creamy/sweet' flavour, has been reported to cause bronchiolitis obliterans in factory workers involved in the production of microwave popcorn who are exposed to its aerosol ('popcorn worker's lung') [11,12]. ...
Article
Purpose of review: Electronic nicotine delivery systems such as e-cigarettes are commonly felt to be harmless devices when compared to traditional cigarettes. However, an increasing number of studies support the biological plausibility for the potential detrimental effects of vaping on the respiratory mucosa. To date, few human studies have been carried out on adult vapers showing a reduction in lung function testing, especially in those with asthma, whereas the effects of vaping on children and adolescents have not been elucidated so far. Recent findings: Several cross-sectional, national, population-based studies on large groups of adolescents have been carried out showing an association between vape exposure and self-reported asthma diagnosis and/or respiratory symptoms in this age group. The effects of second and third-hand exposure together with those of active and passive exposure in pregnancy, are almost completely unknown. Summary: This review outlines recent data on the potential effects of vaping on asthma, focusing on vape composition, reported effects on the respiratory mucosa, available data in adolescents, and reasons behind the current vaping epidemic. The evidence so far available both in animals and humans suggests that vaping is not harmless, and its exposure should be limited in children and adolescents, especially when affected by asthma.
... Consistent with this, past studies have shown that inhalation of propylene glycol vapors (e.g. theatrical smoke) is associated with acute cough and decreased lung function [68,69]. Moreover, a recent observational study found a 31% increase in the risk of respiratory disease among e-cig users compared to never users independent of past cigarette smoking [70]. ...
Article
Background Electronic cigarettes (e-cigs) are widely used devices that were initially created to aid in smoking cessation. However, their acute physiological effects are unclear and there have been a number of E-cig and Vaping Acute Lung Injury (EVALI) events reported. Research question What are the immediate physiological effects (i.e. cardiovascular, respiratory or blood-based responses) of acute e-cig usage in humans? Study Design and Methods PubMed, Web of Science, Cochrane and Scopus databases were searched for English or French peer-reviewed articles published until 20th May 2021 and measuring at least one physiological parameter before and after using an e-cig. The study followed PRISMA guidelines and assessed article quality using the Downs and Black checklist. Independent extraction was conducted by two reviewers. Data were pooled using random-effect models. Sensitivity analysis and meta-regressions were performed to explore heterogeneity. Main outcomes Systolic and diastolic blood pressure, heart rate, augmentation index (AIx75), fraction of exhaled nitric oxide (FeNO), and spirometry were the most frequently assessed parameters and were therefore chosen for meta-analyses. Results Of 19823 articles screened, 45 articles were included for the qualitative synthesis, and 27 articles (919 patients) were included in meta-analyses. Acute use of nicotine e-cig was associated with increased heart rate(SMD=0.71; 95%CI 0.46-0.95), systolic blood pressure (SMD=0.38; 95%CI 0.18-0.57), diastolic blood pressure (SMD=0.52; 95%CI 0.33-0.70), and augmentation index AIx75 (SMD=0.580; 95%CI 0.220- 0.941), along with decreased FeNO (SMD=-0.26; 95%CI -0.49- -0.04). E-cig exposure wasn't associated with significant changes in any spirometry measure. Interpretation Acute use of nicotine e-cigs was associated with statistically significant cardiovascular and respiratory responses. These devices have a physiological impact that could be clinically relevant, especially in terms of cardiovascular morbidity. However, the direct consequences of long-term e-cig use needs to be further explored.
... When inhaled, PG is a respiratory and mucous membrane irritant, [77][78][79] and even passive exposure to mist-containing PG may contribute to slight airway obstruction, upper respiratory irritation and eye irritation. 80 Three studies measured PG in ENDS users, or in smokers who switched to ENDS. ...
Article
Full-text available
Objective This scoping review provides an overview of the existing literature on biomarkers of exposure from electronic nicotine delivery systems (ENDS) use and identifies gaps in existing knowledge. Data sources We searched two international databases (PubMed and Web of Science) to identify relevant studies published from August 2013 to February 2021. Data selection Studies were included if they assessed and compared biomarkers of exposure between exclusive ENDS users, non-users, exclusive cigarette smokers, dual users of ENDS and cigarettes or cigarette smokers who switch to ENDS. Data extraction and synthesis Of the 5074 studies identified, 188 studies met criteria and were selected for full-text screening. Of these, 27 studies were selected for inclusion and data extraction. Conclusions Consistent, although limited, evidence shows that exclusive ENDS users have elevated levels of biomarkers of certain volatile organic compounds (VOCs; eg, acrylamide and acrylonitrile), metals (eg, cadmium and selenium) and propylene glycol compared with non-users; however, evidence for biomarkers of other toxicants (eg, acrolein, benzene and chromium) is mixed. Biomarkers of most VOCs are lower in ENDS users compared with cigarette smokers, and cigarette smokers who switch to ENDS consistently show reductions in VOC biomarkers. Evidence comparing metal exposures from exclusive ENDS use, cigarette smoking and dual use is mixed and depends on the metal. ENDS and e-liquid characteristics as well as use patterns may be associated with elevated exposure to VOCs and metals. Additional rigorous, controlled studies can assess biomarker exposures from ENDS use and inform the overall risk–benefit of ENDS use for different user populations.
... The bulk of e-liquids (i.e., PG and GLY) are carriers for nicotine and flavors in the generation of the vaping aerosol (54). Although these chemicals, used in food and pharmaceuticals due to their hygroscopic and solvent properties (55,56), have received a GRAS designation for ingestion (57,58), research has shown that PG can alter physiological processes (59) and produce acute toxicity (60) and dermal (61) and airway irritation (62). ...
Article
Since the spread of tobacco from the Americas hundreds of years ago, tobacco cigarettes and, more recently, alternative tobacco products have become global products of nicotine addiction. Within the evolving alternative tobacco product space, electronic cigarette (e-cigarette) vaping has surpassed conventional cigarette smoking among adolescents and young adults in the United States and beyond. This review describes the experimental and clinical evidence of e-cigarette toxicity and deleterious health effects. Adverse health effects related to e-cigarette aerosols are influenced by several factors, including e-liquid components, physical device factors, chemical changes related to heating, and health of the e-cigarette user (e.g., asthmatic). Federal, state, and local regulations have attempted to govern e-cigarette flavors, manufacturing, distribution, and availability, particularly to underaged youths. However, the evolving e-cigarette landscape continues to impede timely toxicological studies and hinder progress made toward our understanding of the long-term health consequence of e-cigarettes. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Instruct patients to take the drugs at regular intervals that are as spaced out as possible. Recommended analgesic doses for adults • For dental pain in adults, an appropriate 5-day AFTER PATIENT TREATMENT[30][31][32][33][34][35] Following patient treatment, use the following protocol, in the order given, for cleaning-up: 1. Complete all entries in the computer. 2. Remove gloves. ...
Article
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The outbreak of coronavirus disease 2019 (COVID-19) rapidly escalated into a worldwide pandemic, creating a global health and economic crisis. It is a novel virus which is distinct from SARS-CoV and MERS-CoV, with Chinese horseshoe bats being the most probable origin. Transmission occurs primarily through droplet spread or contact routes. Due to the characteristics of dental settings, the risk of cross infection between dental health care personnel (DHCP) and patients can be very high. In the present review, we aim to summarize some of the important aspects of dentistry in relation to COVID 19.
... While they are considered safe to ingest [9], the consequences of propylene glycol and glycerol inhalation remain unknown despite worldwide availability of e-cigarettes. Earlier reports indicated increased upper airway symptoms and lower lung functions for entertainment workers chronically exposed to theatrical fogs, composed of propylene glycol and other glycols [10]. The next sections will focus on the impact of propylene glycol and glycerol exposure alone, without nicotine or flavourings. ...
Article
Full-text available
Vaping has become increasingly popular over the past decade. This pragmatic review presents the published biological effects of electronic cigarette vapour inhalation with a focus on the pulmonary effects. Special attention has been devoted to providing the documented effects specific to each major ingredient, namely propylene glycol/glycerol, nicotine and flavouring agents. For each ingredient, findings are divided according to the methodology used, being in vitro studies, animal studies and clinical studies. Finally, we provide thoughts and insights on the current state of understanding of the pulmonary effects of vaping, as well as novel research avenues and methodologies.
... Employees in the entertainment industry, who are regularly exposed to propylene glycol-containing aerosols such as theatrical mist, suffer more often from respiratory irritations and restricted lung function than unexposed persons. 11 Nebulized propylene glycol triggers irritation of the eyes and the respiratory tract, even after only short-term exposure. 12 It is due in particular to the widespread application of the compound in e-cigarettes that an indoor guideline value was derived by the German Committee on Indoor Guide Values. ...
... evaLi seems to be linked to the use of e-liquids containing tHc and vitamin e acetate Heat-not-burn devices electronic devices which generate aerosol, heating up tobacco without burning it JUUL Pod-mod resembling a USB flash drive, particularly appreciated by young people Juuling the act of using the JUUL pod-mod device; some people use this term as a synonym for vaping Pod-mods Miniaturized USB rechargeable vape devices, delivering high concentration of nicotine Smoker combustible cigarette user vape the aerosol produced by endS, usually appearing denser than that produced by combustible cigarettes vaper electronic cigarette user vaping the act of inhaling and exhaling the vapor produced by an electronic cigarette 38 interestingly, theatrical and other entertainment industry workers exposed to fog produced by heating vG and PG often complain of acute cough and dry throat in the short term, while chronic exposure has been shown to cause chronic work-related chest tightness and wheezing, as well as a lung function reduction in the long term. 39 as far as flavors are concerned, evidence of lung damage has been reported in relation to the inhalation of diacetyl (2,3-butanedione), which is one the most prevalent of the flavoring chemicals found in ec, 38 commonly used to provide a "buttery" or "creamy/sweet" flavor. This compound has been linked to the pathogenesis of irreversible bronchiolitis obliterans in microwave pop-corn producing factory workers exposed to its aerosol ("popcorn worker's lung"). ...
Article
Full-text available
Introduction: Asthma is the most common chronic disease in childhood and exposure to tobacco smoke has been long recognized as a risk factor for its onset as well as for exacerbations and poor disease control. Since the early 2000s, electronic cigarettes have been marketed worldwide as a non-harmful electronic alternative to combustible cigarettes and as a device likely to help stop smoking, and their use is continuously rising, particularly among adolescents. However, several studies have shown that vape contains many different well-known toxicants, causing significant cytotoxic and pro-inflammatory effects on the airways in-vitro and in animal models. In humans, a variety of harmful lung effects related to vaping, ranging from bronchoconstriction to severe respiratory distress has been already reported. Evidence acquisition: To investigate the potential effects of vaping in pediatric asthma, we searched relevant published studies in the MEDLINE/PubMed database by combining the adequate Medical Subject Headings terms and keywords. Evidence synthesis: At the end of our study selection process, 5 cross-sectional studies focusing on electronic cigarettes use in adolescents and self-reported asthma and/or other respiratory symptoms, 1 study focusing on the effects of electronic cigarettes second-hand exposure and 1 case report were retrieved. These preliminary data support a likely detrimental effect of vaping in asthmatic adolescents. Conclusions: Currently available evidence supports that electronic cigarettes are a potential threat to respiratory health, particularly in adolescents with asthma. High-quality studies on larger population assessing the long-term effects of vape exposure, are urgently needed.
... While propylene glycol is widely considered safe for oral ingestion by the food industry, the safety of inhaling heated propylene glycol products has been called into question. The CDC cites reports of propylene glycol-containing fogs causing respiratory irritation among theater workers 30,31 and nuclear magnetic resonance studies have demonstrated the presence of formaldehyde as a byproduct of heating propylene glycol in vape pens 32 . Additional studies of thermal decomposition of propylene glycol under the conditions present in a vape pen have shown generation of multiple potentially carcinogenic compounds including acrolein, acetaldehyde, and glycidol. ...
Article
The ongoing U.S. outbreak of vaping-related acute lung injury, recently 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 reveals 216 patient cases spanning 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, pathologic patterns of lung injury attributable to vaping, as well as provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most common vaped substance and Vitamin E acetate was found in bronchoalveolar lavage specimens from many affected individuals, however no specific component or contaminant has conclusively been identified as the cause for the injury to date. Patients present with cough, dyspnea, constitutional symptoms, and gastrointestinal symptoms. Radiology and histopathology demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the key to an accurate diagnosis. Treatment is supportive, mortality 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 treating vaping related lung injury.
... There is a significant association between chronic bronchitis symptoms (daily cough for 3 months in a row, congestion, or phlegm production other than accompanied by a cold in the preceding 12 months) and e-cigarette use [169] [154] as well as a self-reported clinical diagnosis of asthma [170]. In addition, employees from the entertainment industry chronically exposed to glycerin and mineral oil-containing fog machines reported more chronic work-related wheezing and chest tightness [171]. Nonetheless, in contrast to previous studies, Bouley et al. report that both healthy and asthmatic volunteers had no difference in cough, chest tightness, breathlessness, respiratory secretions, and wheezing after acute exposure, e.g., 1 h session of vaping, to a laboratory made mixture of PG:VG [119]. ...
Article
Full-text available
E-cigarettes have a liquid that may contain flavors, solvents, and nicotine. Heating this liquid generates an aerosol that is inhaled into the lungs in a process commonly referred to as vaping. E-cigarette devices can also contain cannabis-based products including tetrahydrocannabinol (THC), the psychoactive component of cannabis (marijuana). E-cigarette use has rapidly increased among current and former smokers as well as youth who have never smoked. The long-term health effects are unknown, and emerging preclinical and clinical studies suggest that e-cigarettes may not be harmless and can cause cellular alterations analogous to traditional tobacco smoke. Here, we review the historical context and the components of e-cigarettes and discuss toxicological similarities and differences between cigarette smoke and e-cigarette aerosol, with specific reference to adverse respiratory outcomes. Finally, we outline possible clinical disorders associated with vaping on pulmonary health and the recent escalation of acute lung injuries, which led to the declaration of the vaping product use-associated lung injury (EVALI) outbreak. It is clear there is much about vaping that is not understood. Consequently, until more is known about the health effects of vaping, individual factors that need to be taken into consideration include age, current and prior use of combustible tobacco products, and whether the user has preexisting lung conditions such as asthma and chronic obstructive pulmonary disease (COPD).
... E-cigarette aerosols in general use PG/VG as the vehicle for the nicotine and flavorings (Wagner et al. 2018). Although some of these substances are deemed safe at low exposure levels, reports have noted adverse effects at higher exposures following commercial use in the entertainment and aviation industry (Varughese et al. 2005;Wieslander et al. 2001) and in preclinical toxicological studies (Suber et al. 1989;Werley et al. 2011). Assessments of PG/VG inhalation in e-cigarette use, particularly in low or no-nicotine liquids, are estimated to result in higher levels of PG near the acceptable threshold limit (Burstyn 2014). ...
Article
Background: In an effort to decrease the rates of smoking conventional tobacco cigarettes, electronic cigarettes (e-cigarettes) have been proposed as an effective smoking cessation tool. However, little is known about their toxicological impacts. This is concerning given that e-cigarette use is perceived as less harmful than conventional tobacco cigarettes during pregnancy for both the mother and fetus. Objective: The goal of this study was to test the neurodevelopmental consequences of maternal e-cigarette use on adult offspring behavior and neuroimmune outcomes. Methods: Pregnant female CD-1 mice were randomly assigned to one of three treatment groups ( n = 8 - 10 per group ) and exposed daily to either filtered air, propylene glycol and vegetable glycerol (50:50 PG/VG vehicle), or to PG/VG with 16 mg / mL nicotine ( + Nic ). Whole-body exposures were carried out for 3 h/d, 7 d/week, from gestational day (GD)0.5 until GD17.5. Adult male and female offspring (8 weeks old) were assessed across a battery of behavioral assessments followed by region-specific quantification of brain cytokines using multiplex immunoassays. Results: Adult offspring of both sexes exposed to + Nic exhibited elevated locomotor activity in the elevated plus maze and altered stress-coping strategies in the forced swim task. Moreover, male and female offspring exposed to PG/VG with and without nicotine had a 5.2% lower object discrimination score in the novel object recognition task. In addition to differences in offspring behavior, maternal e-cigarette exposure with nicotine led to a reduction in interleukin (IL)-4 and interferon-gamma ( IFN γ ) in the diencephalon, as well as lower levels of hippocampal IFN γ (females only). E-cigarette exposure without nicotine resulted in a 2-fold increase of IL-6 in the cerebellum. Discussion: These findings support previous adverse findings of e-cigarette exposure on neurodevelopment in a mouse model and provide substantial evidence of persistent adverse behavioral and neuroimmunological consequences to adult offspring following maternal e-cigarette exposure during pregnancy. https://doi.org/10.1289/EHP6067.
... 45 It is, therefore, possible that in vivo, following the inhalation of nicotinecontaining e-vapor, nicotine is quickly absorbed and removed from the small airways, leaving the viscous nicotine-free e-cig components including propylene glycol on the small airway mucosa, which may then contribute to a lowgrade and persistent pro-inflammatory response. Indeed, studies have demonstrated wheezing and chest tightness in subjects with acute inhalation of propylene glycol or vegetable glycerin, [46][47][48] indicating that these e-cig constituents are detrimental to lung health. Further, the very recent surge in cases of acute lung injury induced by e-cig vaping suggests that certain e-cig formulation may produce exuberant inflammatory responses in the small airway epithelium and lung parenchyma. ...
Article
Full-text available
Purpose Electronic cigarettes (e-cigs) are relatively new devices that allow the user to inhale a heated and aerosolized solution. At present, little is known about their health effects in the human lung, particularly in the small airways (<2 mm in diameter), a key site of airway obstruction and destruction in chronic obstructive pulmonary disease and other acute and chronic lung conditions. The aim of this study was to investigate the effect of e-cigarettes on human distal airway inflammation and remodeling. Methods We isolated primary small airway epithelial cells from donor lungs without known lung disease. Small airway epithelial cells were cultured at air–liquid interface and exposed to 15 puffs vapor obtained by heating a commercially available e-cigarette solution (e-vapor) with or without nicotine. After 24 hrs of e-vapor exposure, basolateral and apical media as well as cell lysates were collected to measure the pleiotropic cytokine interleukin 6 (IL6) and MUC5AC, one of the major components in mucus. Results Unlike the nicotine-containing e-vapor, nicotine-free e-vapor significantly increased the amount of IL6, which was coupled with increased levels of intracellular MUC5AC protein. Importantly, a neutralizing IL6 antibody (vs an IgG isotype control) significantly inhibited the production of MUC5AC induced by nicotine-free e-vapor. Conclusion Our results suggest that human small airway epithelial cells exposed to nicotine-free e-vapor increase the inflammatory response and mucin production, which may contribute to distal lung airflow limitation and airway obstruction.
... For glycerin and its pure form glycerol, animal studies have shown relatively low toxicity both in acute and chronic exposures (Gad et al., 2006), also via inhalation (Renne et al., 1992), and toxic effects have been observed only due to dramatic overdose (Andresen et al., 2009;Traudt et al., 2014). For PG, a solvent widely applied in the pharmaceutical, cosmetic and food industry, an airway and ocular irritability from occupational exposure have been reported (Varughese et al., 2005;Wieslander et al., 2001). PG exposure has been associated with toxic effects on the peripheral system (LaKind et al., 1999;Levy et al., 1995) and the CNS disturbances, such as drowsiness and confusion (Arulanantham and Genel, 1978;Lim et al., 2014). ...
Article
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.
... Propylene glycol is often used for fog effects during concerts and theatre performances. It has, however, been shown that employees in the entertainment industry who are regularly exposed to propylene glycol-containing aerosols are more prone to respiratory irritation than non-exposed individuals are (Varughese et al., 2005). It is due in particular to the widespread gain in popularity of the e-cigarette that an indoor guide value was derived within a short time for Table 3 Concentrations of emerging SVOCs and chemicals of concern in house dust. ...
Article
Full-text available
There is an increasing use of so-called emerging substances or substances of emerging concern. These terms describe, inter alia, the replacement of commonly used chemicals in formulations by supposedly less harmful chemicals. A well-known example is the shift from DEHP to higher molecular weight phthalates and later the shift from phthalates to DINCH, adipates, terephthalates, etc. Similar trends can be observed in the case of solvents and flame retardants. Over the years, new compound groups such as perfluorocarbons, UV-filters, synthetic musks, parabens, siloxanes, neonicotinoids and drug residues also appeared on the scene. Today, however, the term “emerging substances” has to be defined much more broadly as regards the indoor environment. As a result of the extensive measures for energy-related renovation, contaminated waste products such as asbestos, PCBs, PAHs and PCNs are once again forming the focus of attention as re-emerging chemicals. Many relevant compounds, in particular reaction products, were unknown until recently due to the fact, that they can only now be detected using highly sensitive methods. Furthermore, already known chemicals attract scientific and public interest through reclassification or through the derivation of indoor guideline and reference values. The classical way of monitoring emerging compounds is air and dust analysis and therefore, the spectrum of analytical techniques needs to be continuously broadened. However, there is also a demand for human biomarkers, preferably in urine. A further important aspect is the post-hoc analysis of house dust and urine samples, which are stored in environmental specimen banks. The identification and temporal tracking of emerging chemicals is thereby enabled. It is strongly recommended to take advantage of the possibilities resulting from the combination of classical interior analytics and human biomonitoring to promptly detect emerging pollutants and chemicals of concern.
... Studies from the entertainment industry describe respiratory symptoms and decreased lung function in those working in close proximity to theatrical smoke machines that aerosolize similar glycol compounds. 10 We describe a middle-aged man who reported acute onset of marked dyspnea on exertion and cough associated with findings of severe fixed airways obstruction whose respiratory symptoms began 9 months after he quit smoking traditional cigarettes and transitioned solely to heavy vaping. His symptoms and severe obstructive lung disease persisted despite vaping cessation and aggressive medical treatment. ...
Article
Electronic Nicotine Delivery Systems (ENDS), commonly referred to as “e-cigs,” were first introduced in the United States in 2007. Since then, their use has grown substantially, with the largest market among adolescents and young adults. ENDS are often perceived by the public as safe alternatives to traditional cigarettes and as aids in smoking cessation. Little is known about inhalational hazards of e-cigs. We describe the case of a 45-year-old man who developed acute respiratory symptoms associated with onset of severe fixed airways obstruction 9 months after he quit traditional cigarettes and began high-dose vaping. Lung biopsy showed respiratory bronchiolitis. Analysis of his heated e-cigarette solution identified a mixture containing vanillin, aldehydes, alcohols and other chemicals, the inhalation effects of which have not been well-studied. This case report adds to the growing literature describing potentially severe lung health effects of vaping and provides a framework for taking a clinical vaping history so that the health consequences of e-cigarettes may be better understood.
... Nicotine has many immunosuppressive effects, including impairing antibacterial defences against S. pneumoniae and Legionella pneumophilia [178,179], and alteration of macrophage activation that suppresses adherence, chemotaxis, phagocytosis and killing of bacteria [180][181][182]. The effects of other components on pulmonary function are less clear but constituents such as propylene glycol are known to elicit detrimental effects on lung function of workers exposed to theatrical smoke machines [183]. In a small study, acute exposure to nicotine-rich aerosols in healthy naïve subjects affected the biology of small airway epithelium, alveolar macrophages and the alveolar capillary endothelium. ...
Article
Chronic respiratory diseases are among the leading causes of mortality worldwide, with the major contributor, chronic obstructive pulmonary disease (COPD) accounting for approximately 3 million deaths annually. Frequent acute exacerbations (AEs) of COPD (AECOPD) drive clinical and functional decline in COPD and are associated with accelerated loss of lung function, increased mortality, decreased health-related quality of life and significant economic costs. Infections with a small subgroup of pathogens precipitate the majority of AEs and consequently constitute a significant comorbidity in COPD. However, current pharmacological interventions are ineffective in preventing infectious exacerbations and their treatment is compromised by the rapid development of antibiotic resistance. Thus, alternative preventative therapies need to be considered. Pathogen adherence to the pulmonary epithelium through host receptors is the prerequisite step for invasion and subsequent infection of surrounding structures. Thus, disruption of bacterial–host cell interactions with receptor antagonists or modulation of the ensuing inflammatory profile present attractive avenues for therapeutic development. This review explores key mediators of pathogen–host interactions that may offer new therapeutic targets with the potential to prevent viral/bacterial-mediated AECOPD. There are several conceptual and methodological hurdles hampering the development of new therapies that require further research and resolution.
... In one study, 27 healthy subjects without asthma experienced a 2% reduction in forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC), an increase in FVC of 40 mL, and a decrease in FEV 1 by 30 mL as a result of acute exposure to propylene glycol for 1 min [19]. In another study on 101 individuals working in environments producing theater fog, a 5% reduction in FEV 1 and FVC was reported in those working within 10 feet of fog-producing machines [20]. These results demonstrate the effects of these substances on respiratory function. ...
Article
Full-text available
Electronic cigarettes (ECs) are devices that vaporise and release a sweetened liquid containing nicotine as a substitute for burning tobacco. Manufacturers of ECs have suggested that ‘vaping’ is a safer alternative to conventional smoking because of the potential reduction in exposure to toxic substances. In the 2018 National Youth Tobacco Survey, 4.9% of middle school students and 20.8% of high school students reported using ECs in the previous 30 days, with respective rates of 0.6% and 1.5% in 2011 and 3.3% and 11.7% in 2017. The main reason for this steady increase in use of ECs in the younger age groups is the widespread perception that ECs are less harmful than conventional cigarettes because they do not involve smoking of tobacco and contain less or no nicotine. This review suggests that ECs may not be as harmless as they seem. There are increasing numbers of case reports on the various complications arising from use of ECs, which are especially popular among young persons and could have a negative effect on their health. The reported complications are lipoid pneumonia, acute eosinophilic pneumonia, hypersensitivity pneumonia, organizing pneumonia, diffuse alveolar hemorrhage, multiple reactive pulmonary nodules, subacute bronchiolitis, mouth and tongue injuries, dental injuries, complex facial fractures, thermal injuries, nickel contact allergy, C1 and C2 fracture, and fatal intoxication after ingestion of liquids. Complications that develop directly as a result of the substances contained in the devices and the adverse events resulting from explosion and burning of the device are being reported with increasing frequency. There is an urgent need for legislation and restriction regarding the sale of these devices in view of their increasing frequency of use in the younger age groups.
Article
Full-text available
Norwegian Abstract: The cultural and creative industries, as delineated by Statistics Norway, encompass a broad spectrum of sectors, including film, theater, digital media, museums, music, and the visual arts. This industry, which employed approximately 92,000 individuals by 2022, presents unique occupational health challenges due to its diverse and complex tasks. Film productions, such as the ongoing "Troll 2" project, expose crews to environmental hazards like extreme weather and potential injuries from equipment. The rapid expansion of digital sectors, particularly gaming and 3D printing, introduces new occupational risks, including ergonomic strain, exposure to novel materials, and psychological stressors. Traditional roles, such as painters and sculptors, continue to face ergonomic challenges and chemical hazards. Systemic issues, including job insecurity, harassment, and discrimination, further exacerbate the work environment. Despite these significant risks, the industry lacks mandated occupational health services. Integrating such services is essential for identifying and mitigating workplace hazards, thereby fostering a safer, healthier, and more productive work environment. This paper underscores the necessity of comprehensive risk assessments and tailored interventions to safeguard the well-being of individuals in the cultural and creative sectors, thereby enhancing their invaluable contributions to society.
Article
The production of e-cigarette aerosols through vaping processes is known to cause the formation of various free radicals and reactive oxygen species (ROS). Despite the well-known oxidative potential and cytotoxicity of fresh vaping emissions, the effects of chemical aging on exhaled vaping aerosols by indoor atmospheric oxidants are yet to be elucidated. Terpenes are commonly found in e-liquids as flavor additives. In the presence of indoor ozone (O3), e-cigarette aerosols that contain terpene flavorings can undergo chemical transformations, further producing ROS and reactive carbonyl species. Here, we simulated the aging process of the e-cigarette emissions in a 2 m³ FEP film chamber with 100 ppbv of O3 exposure for an hour. The aged vaping aerosols, along with fresh aerosols, were collected to detect the presence of ROS. The aged particles exhibited 2- to 11-fold greater oxidative potential, and further analysis showed that these particles formed a greater number of radicals in aqueous conditions. The aging process induced the formation of various alkyl hydroperoxides (ROOH), and through iodometric quantification, we saw that our aged vaping particles contained significantly greater amounts of these hydroperoxides than their fresh counterparts. Bronchial epithelial cells exposed to aged vaping aerosols exhibited an upregulation of the oxidative stress genes, HMOX-1 and GSTP1, indicating the potential for inhalation toxicity. This work highlights the indirect danger of vaping in environments with high ground-level O3, which can chemically transform e-cigarette aerosols into new particles that can induce greater oxidative damage than fresh e-cigarette aerosols. Given that the toxicological characteristics of e-cigarettes are mainly associated with the inhalation of fresh aerosols in current studies, our work may provide a perspective that characterizes vaping exposure under secondhand or thirdhand conditions as a significant health risk.
Article
Vaping and electronic cigarette (e-cigarette) use have grown exponentially in the past decade, particularly among youth and young adults. Cigarette smoking is a risk factor for both cardiovascular and pulmonary disease. Because of their more limited ingredients and the absence of combustion, e-cigarettes and vaping products are often touted as safer alternative and potential tobacco-cessation products. The outbreak of e-cigarette or vaping product use-associated lung injury in the United States in 2019, which led to >2800 hospitalizations, highlighted the risks of e-cigarettes and vaping products. Currently, all e-cigarettes are regulated as tobacco products and thus do not undergo the premarket animal and human safety studies required of a drug product or medical device. Because youth prevalence of e-cigarette and vaping product use was as high as 27.5% in high school students in 2019 in the United States, it is critical to assess the short-term and long-term health effects of these products, as well as the development of interventional and public health efforts to reduce youth use. The objectives of this scientific statement are (1) to describe and discuss e-cigarettes and vaping products use patterns among youth and adults; (2) to identify harmful and potentially harmful constituents in vaping aerosols; (3) to critically assess the molecular, animal, and clinical evidence on the acute and chronic cardiovascular and pulmonary risks of e-cigarette and vaping products use; (4) to describe the current evidence of e-cigarettes and vaping products as potential tobacco-cessation products; and (5) to summarize current public health and regulatory efforts of e-cigarettes and vaping products. It is timely, therefore, to review the short-term and especially the long-term implications of e-cigarettes and vaping products on cardiopulmonary health. Early molecular and clinical evidence suggests various acute physiological effects from electronic nicotine delivery systems, particularly those containing nicotine. Additional clinical and animal-exposure model research is critically needed as the use of these products continues to grow.
Thesis
Respiratorische Erkrankungen stellen zunehmend eine relevante globale Problematik dar. Die Erweiterung bzw. Modifizierung von Applikationswegen möglicher Arzneimittel für gezielte topische Anwendungen ist dabei von größter Bedeutung. Die Variation eines bekannten Applikationsweges durch unterschiedliche technologische Umsetzungen kann die Vielfalt der Anwendungsmöglichkeiten, aber auch die Patienten-Compliance erhöhen. Die einfache und flexible Verfahrensweise durch schnelle Verfügbarkeit und eine handliche Technologie sind heutzutage wichtige Eigenschaften im Entwicklungsprozess eines Produktes. Eine direkte topische Behandlung von Atemwegserkrankungen am Wirkort in Form einer inhalativen Applikation bietet dabei viele Vorteile gegenüber einer systemischen Therapie. Die medizinische Inhalation von Wirkstoffen über die Lunge ist jedoch eine komplexe Herausforderung. Inhalatoren gehören zu den erklärungsbedürftigen Applikationsformen, die zur Erhöhung der konsequenten Einhaltung der Verordnung so einfach, wie möglich gestaltet werden müssen. Parallel besitzen und nutzen weltweit annähernd 68 Millionen Menschen die Technologie eines inhalativen Applikators zur bewussten Schädigung ihrer Gesundheit in Form einer elektronischen Zigarette. Diese bekannte Anwendung bietet die potentielle Möglichkeit einer verfügbaren, kostengünstigen und qualitätsgeprüften Gesundheitsmaßnahme zur Kontrolle, Prävention und Heilung von Atemwegserkrankungen. Sie erzeugt ein Aerosol durch elektrothermische Erwärmung eines sogenannten Liquids, das durch Kapillarkräfte eines Trägermaterials an ein Heizelement gelangt und verdampft. Ihr Bekanntheitsgrad zeigt, dass eine beabsichtigte Wirkung in den Atemwegen eintritt. Diese Wirkung könnte jedoch auch auf potentielle pharmazeutische Einsatzgebiete übertragbar sein. Die Vorteile der pulmonalen Verabreichung sind dabei vielfältig. Im Vergleich zur peroralen Applikation gelangt der Wirkstoff gezielt zum Wirkort. Wenn eine systemische Applikation zu Arzneimittelkonzentrationen unterhalb der therapeutischen Wirksamkeit in der Lunge führt, könnte eine inhalative Darreichung bereits bei niedriger Dosierung die gewünschten höheren Konzentrationen am Wirkort hervorrufen. Aufgrund der großen Resorptionsfläche der Lunge sind eine höhere Bioverfügbarkeit und ein schnellerer Wirkungseintritt infolge des fehlenden First-Pass-Effektes möglich. Es kommt ebenfalls zu minimalen systemischen Nebenwirkungen. Die elektronische Zigarette erzeugt wie die medizinischen Inhalatoren lungengängige Partikel. Die atemzuggesteuerte Technik ermöglicht eine unkomplizierte und intuitive Anwendung. Der prinzipielle Aufbau besteht aus einer elektrisch beheizten Wendel und einem Akku. Die Heizwendel ist von einem sogenannten Liquid in einem Tank umgeben und erzeugt das Aerosol. Das Liquid beinhaltet eine Basismischung bestehend aus Propylenglycol, Glycerin und reinem Wasser in unterschiedlichen prozentualen Anteilen. Es besteht die Annahme, dass das Basisliquid auch mit pharmazeutischen Wirkstoffen für die pulmonale Applikation beladen werden kann. Aufgrund der thermischen Belastung durch die e-Zigarette müssen potentielle Wirkstoffe sowie das Vehikel eine thermische Stabilität aufweisen. Die potentielle medizinische Anwendung der Technologie einer handelsüblichen e-Zigarette wurde anhand von drei Schwerpunkten an vier Wirkstoffen untersucht. Die drei ätherischen Öle Eucalyptusöl, Minzöl und Nelkenöl wurden aufgrund ihrer leichten Flüchtigkeit und der historischen pharmazeutischen Anwendung anhand von Inhalationen bei Erkältungssymptomen bzw. im zahnmedizinischen Bereich gewählt. Das eingesetzte Cannabinoid Cannabidiol (CBD) hat einen aktuellen Bezug zu dem pharmazeutischen Markt Deutschlands zur Legalisierung von cannabishaltigen Produkten und der medizinischen Forschung zum inhalativen Konsum. Es wurden relevante wirkstoffhaltige Flüssigformulierungen entwickelt und hinsichtlich ihrer Verdampfbarkeit zu Aerosolen bewertet. In den quantitativen und qualitativen chromatographischen Untersuchungen konnten spezifische Verdampfungsprofile der Wirkstoffe erfasst und bewertet werden. Dabei stieg die verdampfte Masse der Leitsubstanzen 1,8-Cineol (Eucalyptusöl), Menthol (Minzöl) und Eugenol (Nelkenöl) zwischen 33,6 µg und 156,2 µg pro Zug proportional zur Konzentration im Liquid im Bereich zwischen 0,5% und 1,5% bei einer Leistung von 20 Watt. Die Freisetzungsrate von Cannabidiol hingegen schien unabhängig von der Konzentration im Liquid im Mittelwert bei 13,3 µg pro Zug zu liegen. Dieses konnte an fünf CBD-haltigen Liquids im Konzentrationsbereich zwischen 31 µg/g und 5120 µg/g Liquid gezeigt werden. Außerdem konnte eine Steigerung der verdampften Massen mit Zunahme der Leistung der e-Zigarette festgestellt werden. Die Interaktion der Liquids bzw. Aerosole mit den Bestandteilen des Speichels sowie weiterer gastrointestinaler Flüssigkeiten wurde über die Anwendung von zugehörigen in vitro Modellen und Einsatz von Enzymaktivitäts-Assays geprüft. In den Untersuchungen wurden Änderungen von Enzymaktivitäten anhand des oralen Schlüsselenzyms α-Amylase sowie von Proteasen ermittelt. Damit sollte exemplarisch ein möglicher Einfluss auf physiologische bzw. metabolische Prozesse im humanen Organismus geprüft werden. Das Bedampfen von biologischen Suspensionen führte bei niedriger Leistung der e-Zigarette (20 Watt) zu keiner bzw. einer leichten Änderung der Enzymaktivität. Die Anwendung einer hohen Leistung (80 Watt) bewirkte tendenziell das Herabsetzen der Enzymaktivitäten. Die Erhöhung der Enzymaktivitäten könnte zu einem enzymatischen Abbau von Schleimstoffen wie Mucinen führen, was wiederum die effektive, mechanische Abwehr gegenüber bakteriellen Infektionen zur Folge hätte. Da eine Anwendung der Applikation insbesondere bei bakteriellen Atemwegserkrankungen denkbar wäre, folgten abschließend Untersuchungen der antibakteriellen Eigenschaften der Liquids bzw. Aerosole in vitro. Es wurden sechs klinisch relevante bakterielle Krankheitserreger ausgewählt, die nach zwei Charakteristika gruppiert werden können. Die drei multiresistenten Bakterien Pseudomonas aeruginosa, Klebsiella pneumoniae und Methicillin-resistenter Staphylococcus aureus können mithilfe von üblichen Therapien mit Antibiotika nicht abgetötet werden und haben vor allem eine nosokomiale Relevanz. Die zweite Gruppe weist Eigenschaften auf, die vordergründig assoziiert sind mit respiratorischen Erkrankungen. Die Bakterien Streptococcus pneumoniae, Moraxella catarrhalis und Haemophilus influenzae sind repräsentativ beteiligt an Atemwegserkrankungen mit diverser Symptomatik. Die Bakterienarten wurden mit den jeweiligen Liquids behandelt bzw. bedampft und deren grundlegende Dosis-Wirkungsbeziehung charakterisiert. Dabei konnte eine antibakterielle Aktivität der Formulierungen ermittelt werden, die durch Zugabe eines Wirkstoffes die bereits antibakterielle Wirkung der Bestandteile Glycerin und Propylenglycol verstärkte. Die hygroskopischen Eigenschaften dieser Substanzen sind vermutlich für eine Wirkung in aerosolierter Form verantwortlich. Sie entziehen die Feuchtigkeit aus der Luft und haben einen austrocknenden Effekt auf die Bakterien. Das Bedampfen der Bakterienarten Streptococcus pneumoniae, Moraxella catarrhalis und Haemophilus influenzae hatte einen antibakteriellen Effekt, der zeitlich abhängig von der Leistung der e-Zigarette war. Die Ergebnisse der Untersuchungen führen zu dem Schluss, dass jeder Wirkstoff bzw. jede Substanzklasse individuell zu bewerten ist und somit Inhalator und Formulierung aufeinander abgestimmt werden müssen. Der Einsatz der e-Zigarette als Medizinprodukt zur Applikation von Arzneimitteln setzt stets Prüfungen nach Europäischem Arzneibuch voraus. Durch Modifizierungen könnte eine Dosierung gut kontrollierbar gemacht werden, aber auch die Partikelgrößenverteilung kann insoweit reguliert werden, dass die Wirkstoffe je nach Partikelgröße zu einem geeigneten Applikationsort wie Mund, Rachen oder Bronchien transportiert werden. Der Vergleich mit den Eigenschaften anderer medizinischer Inhalatoren führt zu dem Schluss, dass die Technologie der e-Zigarette durchaus eine gleichartige oder bessere Performance für thermisch stabile Wirkstoffe bieten könnte. Dieses fiktive Medizinprodukt könnte aus einer hersteller-unspezifisch produzierten, wieder aufladbaren Energiequelle mit Universalgewinde zum mehrfachen Gebrauch und einer hersteller- und wirkstoffspezifisch produzierten Einheit aus Verdampfer und Arzneimittel bestehen. Das Arzneimittel, ein medizinisches Liquid (Vehikel und Wirkstoff) kann in dem Tank des Verdampfers mit konstanten, nicht variablen Parametern patientenindividuell produziert werden. Inhalative Anwendungen werden perspektivisch wohl nicht zuletzt aufgrund der aktuellen COVID-19-Pandemie eine zunehmende Rolle spielen. Der Bedarf nach alternativen Therapieoptionen wird weiter ansteigen. Diese Arbeit liefert einen Beitrag zum Einsatz der Technologie der elektronischen Zigarette als electronic nicotin delivery system (ENDS) nach Modifizierung zu einem potentiellen pulmonalen Applikationssystem als electronic drug delivery system (EDDS) von inhalativen, thermisch stabilen Arzneimitteln in Form eines Medizinproduktes.
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Nicotine is an addictive drug whose popularity has recently increased, particularly among adolescents, due to the availability of electronic nicotine devices ( i . e ., “vaping”) and nicotine e-liquids containing additives with rich chemosensory properties. Some efforts to understand the role of these additives in nicotine reward suggest that they increase nicotine reward and reinforcement, but the sensory contributions of additives, especially in their vapor forms, are largely untested. Here, to better understand how a fruit-flavored ( i . e ., strawberry) additive influences nicotine reward and aversion, we used a conditioned place preference (CPP) procedure in which nicotine and a strawberry additive were delivered as a vapor to male and female adolescent mice. We found that nicotine vapor alone can lead to dose-dependent CPP when using a biased design. The strawberry additive did not produce CPP on its own, and we did not observe an effect of the strawberry additive on nicotine vapor-induced reward. Nevertheless, mice exposed to nicotine + strawberry additive vapor had higher plasma cotinine concentrations, which did not appear to reflect altered nicotine metabolism. Instead, by directly measuring vapor sampling through respiration monitoring, we uncovered an increase in the amount of sniffing toward strawberry-containing nicotine vapor compared to nicotine vapor alone. Together these data indicate that chemosensory-rich e-liquid additives may enhance the perceived sensory profile of nicotine vapors rather than the reward value per se , which leads to overall increased nicotine exposure. Significance Statement With the rise in popularity of flavored e-cigarette products, many have considered the possibility that flavor volatiles will enhance nicotine reward; however, the possibility that flavor additives have chemosensory properties that can affect nicotine intake has been largely overlooked. Here, by delivering nicotine to adolescent mice as a vapor we were able to consider both possibilities. We found that mice had increased sniffing intensity and nicotine exposure when vapors contained a strawberry additive, despite the fact that the same additive was unable to enhance Pavlovian nicotine reward using a CPP paradigm. This research highlights the importance of considering the chemosensory properties of e-cigarette additives as a mechanism for their effect on nicotine use.
Article
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
Chapter
This chapter discusses indoor air quality (IAQ) in nonindustrial buildings. Historically, the concept of IAQ has included viewpoints that the introduction of outdoor air, via passive and mechanical ventilation, is required both to prevent the buildup of contaminants and the associated adverse health effects, as well as to provide for comfort of occupants. It has been observed that airborne contagious diseases and malodor are more prominent in crowded spaces with insufficient ventilation and poor or nonexistent control of contaminant sources. The International Building Code (IBC), the International Residential Code (IRC), the International Mechanical Code (IMC), and the American Society of Heating, Refrigeration and Air‐Conditioning Engineers (ASHRAE) Standards 62.1 and 62.2 recommend approaches to the control of contaminant sources and the provision of outdoor air ventilation to lower the risk of occupant dissatisfaction and diseases. The varied approaches that can be used during IAQ evaluations reflect the multitude of different problems that can occur in buildings. In developing countries, higher morbidity and mortality have multifactorial causes, with contaminated food, water, and air as major risk factors. The chapter focuses on IAQ evaluation protocols and various guidelines.
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Introduction Beat boxing is an art of vocal percussion, which involves imitating musical instruments using oral structures. They use techniques like click rolls and trills which involves the usage of entire vocal apparatus for a longer period making use of the human body as a versatile physical instrument to recreate musical beats as well as vocal expressions. The aim and objectives of the present study were to develop a questionnaire and to profile the voice complaints, vocal and non-vocal habits among beatboxers in India. Method A cross-sectional study design was used to profile the voice complaints, vocal and non-vocal habits among beatboxers in India. Phase I involved questionnaire development and validation. Phase II involved data collection and analysis. Results Thirty-seven beatboxers from India participated of which 70.27% were trained. The beatboxers reported of beatboxing musical instruments such as; flute/trumpet, harmonica, guitar, and drums. The commonly practiced vocal techniques was bass (22.07%). Most common vocal complaints included vocal fatigue after long usage of voice (72.97%) and breathing difficulty after performance (86.49%). Further, 76.38% reported of using loud voice during performances. Poor non-vocal habits such as muscle tension during beatboxing (56.76%), breathing difficulty during beatboxing (45.94%). Two most common good non-vocal habits included food intake on time (78.38%) and use of relaxation techniques (72.97%) prior to performance. Conclusion The present study was a preliminary attempt to profile the voice complaints, vocal and non-vocal habits observed in this upcoming profession of beatboxing. Further, studies are needed to explore the voice of these professionals from a multidimensional perspective.
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Quantification of exposure to different chemicals from both combustible cigarettes and vaping products is important in providing information on the potential health risks of these products. To assess the exposure to tobacco products, biomarkers of exposure (BOEs) are measured in a variety of biological matrices. In this review paper, current knowledge on analytical methods applied to the analysis of biomarkers of exposure to tobacco products is discussed. Numerous sample preparation techniques are available for the extraction and sample clean up for the analysis of BOEs to tobacco and nicotine delivery products. Many tobacco products-related exposure biomarkers have been analyzed using different instrumental techniques, the most common techniques being gas and liquid chromatography coupled with mass spectrometry (GC-MS, GC-MS/MS and LC-MS/MS). To assess exposure to emerging tobacco products and study exposure in dual tobacco users, the list of biomarkers analyzed in urine samples has been expanded. Therefore, the current state of the literature can be used in preparing a preferred list of biomarkers based on the aim of each study. The information summarized in this review is expected to be a handy tool for researchers involved in studying exposures to tobacco products, as well as in risk assessment of biomarkers of exposure to vaping products.
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In the United States the recent surge of electronic cigarette (e-cig) use has raised questions concerning the safety of these devices. This study seeks to assess the pro-inflammatory and cellular stress effects of the vaped humectants propylene glycol (PG) and glycerol (GLY) on airway epithelial cells (16HBE cells and differentiated human bronchial epithelial cells) with a newly developed aerosol exposure system. This system allows for chemical characterization of e-cig generated aerosol particles as well as in vitro exposures of 16HBE cells at an air-liquid interface to vaped PG and GLY aerosol. Our data demonstrate that the process of vaping results in the formation of PG- and GLY-derived oligomers in the aerosol particles. Our in vitro data demonstrate an increase in pro-inflammatory cytokines IL-6 and IL-8 levels in response to vaped PG and GLY exposures. Vaped GLY also causes an increase in cellular stress signals HMOX1, NQO1, and carbonylated proteins when the e-cig device is operated at high wattages. Additionally, we find that the exposure of vaped PG causes elevated IL-6 expression while the exposure of vaped GLY increases These findings suggest that vaporizing PG and GLY results in the formation of novel compounds and the exposure of vaped PG and GLY are detrimental to airway cells. Since PG and/or GLY is universally contained in all e-cig liquids, we conclude that these components alone can cause harm to the airway epithelium.
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This report presents the conclusions reached and recommendations made by the members of the WHO Study Group on Tobacco Product Regulation at its ninth meeting, where the group reviewed background papers specially commissioned for the meeting and considered the following topics: 1. Heated tobacco products (section 2); 2.Clinical pharmacology of nicotine in electronic nicotine delivery systems (section 3); 3. A global nicotine reduction strategy: state of the science (section 4); 4. A regulatory strategy for reducing exposure to toxicants in cigarette smoke (section 5); 5. The science of flavour in tobacco products (section 6); 6. Sugar content of tobacco products (section 7); 7. Updated priority list of toxicants in combusted tobacco products (section 8); 8. Approa che s to measur ing and reducing toxicant concentrations in smokeless tobacco products (section 9); 9. Waterpipe tobacco smoking: prevalence, health effects and interventions to reduce use (section 10). The Study Group's recommendations in relation to each theme are set out at th e end of the relevant chapter, and overall recommen dat ions are su mmarized in the final chapter of the report. The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO's constitutional functions is to provide objective, reliable information and advice in the field of human health, a responsibility that it fulfils in part through its extensive programme of publications. The Organization seeks through its publications to support national health strategies and address the most pressing public health concerns of populations around the world. To respond to the needs of Member States at all levels of development, WHO publishes practical manuals, handbooks and training material for specific categories of health workers; internationally applicable guidelines and standards; reviews and analyses of health policies, programmes and research; and state-of-the-art consensus reports that offer technical advice and recommendations for decision-makers. These publications are closely tied to the Organization's priorities, which are to prevent and control disease and ensure equitable health systems based on primary health care and health promotion for individuals and communities. This includes strengthening implementation of the WHO Framework Convention on Tobacco Control (to meet Sustainable Development Goal 3a), thereby contributing to WHO's priority of improving the lives of one billion individuals through enjoyment of better health and well-being. Progress towards better health for all requires global dissemination and exchange of information based on the knowledge and experience of all WHO's Member States and on collaboration among world leaders in public health and the biomedical sciences. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO ensures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease throughout the world, WHO's publications contribute to achieving the Organization's principal objective-the attainment by all people of the highest possible level of health. The WHO Technical Report Series makes available the findings of international groups of experts who provide WHO with the latest scientific and technical advice on a broad range of medical and public health subjects. Members of such expert groups serve without remuneration, in their personal capacities rather than as representatives of governments or other bodies; their views do not necessarily reflect the decisions or the stated policy of WHO. For further information, please contact WHO Press, World Health Organization;
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Elektronik sigaralar (e-sigara) olarak adlandırılan sigara türü, nikotini aerosol olarak serbest bırakan, tütün yakmak yerine sıvı tatlandırıcılarla beraber nikotin çözeltisini buharlaştıran cihazlardır. Dünya sağlık örgütü verilerine göre dünyada yaklaşık 1 milyar sigara içicisi bulunmakta ve bunların %80’i düşük ya da orta gelir seviyesindeki ülkelerde yaşamaktadır (Dünya sağlık örgütü, 2017). 2004 yılından bu yana, sosyal medya kullanımının da artmasıyla e-sigara küresel çapta yaygınlaşmış ve kullanımı katlanarak artmıştır. Yasalarda yer alan boşluklar nedeniyle, hem imalat hem de e-sıvı bileşimi için yetersiz yasa ve yönetmelikler nedeniyle tüketimi daha da teşvik edilmiştir. Özellikle gençler ve hiç sigara kullanmamış kişiler tarafından daha sık tercih edilmektedir. Toplumdaki birçok kesim e-sigarayı klasik tütün sigaralarına göre zararsız bir alternatif olarak görmektedir (Dünya sağlık örgütü, 2017). İnsanlar nikotine çeşitli şekillerde maruz kalmaktadır. Bunlar arasında dumanlı tütün (yanıcı), dumansız tütün (yanmaz), veya tütün-dışı nikotin ürünleri yer almaktadır. Tütün-dışı ürünler medikal nikotin ve e-sigara gibi alternatif nikotin ürünlerini içermektedir (Tablo 1) (Rom & ark., 2014). Nikotin insan vücuduna genellikle solunum yoluyla sigara, puro, pipo ve nargile vasıtasıyla girmektedir. Buna ek olarak tablet, çeşitli burun spreyi, sakız ve enfiye gibi alternatif ürünler de bulunmaktadır. Son 20 yılda ise nikotin aktarım sistemleri geliştirilmiş ve bunlardan en sık kullanılanı e-sigara olmuştur. İngiltere Sağlık Bakanlığı, 2015 yılında e-sigara tüketiminin tütün içmekten %95 daha az zararlı olduğunu tahmin ettiğini bildirmiştir (McNeill & ark., 2015). Ancak devam eden süreçte e-sigaraya karşı olumlu tutum sergileyen tek Avrupa birliği üyesi olarak kalmış ve tartışmalara sebep olmuştur. Bir web sitesinde yapılan oylamada 5682 kullanıcıdan %67’si e-sigaranın tütün sigarasına göre daha az zararlı olduğu ve katı yönetmeliklere tabi olmaması gerektiği yönünde görüş bildirmişlerdir (Die Debatte, 2018). Ayrıca 2018 yılında Amerikan Kanser Birliği geleneksel yöntemlerle sigara bırakmaya çalışan kişilerin e-sigara kullanmasına yönelik desteği teşvik eden bir pozisyon bildirisi yayınlamıştır(Amerikan Kanser Birliği, 2018). Tüm bu görüşlere rağmen, Avrupa Federal Risk Araştırma Enstitüsü ve Alman Kanser Merkezi, e-sigaranın potansiyel tehlikelerini küçümsemeye karşı tüm ülkeleri uyarmıştır (Deutsches Krebsforschungzentrum, 2010).
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To date, no instruments exist to quantify the psychosocial consequences of voice disorders. The aim of the present investigation was the development of a statistically robust Voice Handicap Index (VHI). An 85-item version of this instrument was administered to 65 consecutive patients seen in the Voice Clinic at Henry Ford Hospital. The data were subjected to measures of internal consistency reliability and the initial 85-item version was reduced to a 30-item final version. This final version was administered to 63 consecutive patients on two occasions in an attempt to assess test-retest stability, which proved to be strong. The findings of the latter analysis demonstrated that a change between two administrations of 18 points represents a significant shift in psychosocial function.
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In this paper, narrative discourse abilities are compared across three groups—children with a moderate to severe closed head injury (CHI), children with language impairment (LI), and a group of typically developing peers— using narrative retells and generation of story morals. Narrative expression is also examined in a subset of the CHI group who manifested language problems on structured measures. Narrative retells are analyzed at multiple levels of representation, including language and information measures, using the methods described in the companion paper to this article (Chapman, this issue). The most important finding was the significant impairment on information measures in children with moderate to severe CHI, despite relatively good recovery on language measures. The children with LI performed significantly lower than the typical group on measures of both language (amount and complexity of language) and information structure (amount, preserved semantic meaning, episodic structure), as well as generating abstract story morals. The CHI group showed the greatest variability in performance, with discourse abilities overlapping both the LI and control groups. Additional analyses suggested that a subgroup of children with CHI, those with an associated language impairment, were particularly at risk for deficits on information measures. The utility of discourse tasks for differential diagnosis and treatment is discussed.
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To estimate the prevalence of work related asthma and work related wheezing in United States workers. To identify high risk industries that could be targeted for future intervention. To determine the population attributable risk of work related asthma and work related wheezing. The third national health and nutrition examination survey, 1988-1994 (NHANES III) was analyzed to determine the prevalence of work related asthma and wheezing and to identify initially defined industries at risk among United States workers aged 20 and older. Separate logistic models were developed with work related asthma and work related wheezing as outcomes. Work related asthma was defined as affirmative response to questions on self reported physician diagnosed asthma and work related symptoms of rhinitis, conjunctivitis, and asthma. Work related wheezing was defined as affirmative response to questions on self reported wheezing or whistling in the chest in the previous 12 months and work related symptoms of rhinitis, conjunctivitis, and asthma. All analyses were adjusted for age, sex, smoking, and atopy. The prevalence of work related asthma was 3.70% (95% confidence interval (95% CI) 2.88 to 4.52) and the prevalence of work related wheezing was 11.46% (95% CI 9.87 to 13.05). The main industries identified at risk of work related asthma and wheeze included the entertainment industry; agriculture, forestry, and fishing; construction; electrical machinery; repair services; and lodging places. The population attributable risk for work related asthma was 36.5% and work related wheezing was 28.5%. The findings provide impetus for further research and actions by public health professionals which prioritise occupational asthma on the public health agenda. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.
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To assess the impact of newly introduced point-of-sale glass bottle recycling on indoor air quality and employee health. Airborne exposures and both chronic and acute respiratory and somatic symptoms were surveyed among 226 employees at 36 randomly selected liquor stores with bottle recycling and in-house glass breaking. Each store was visited twice; between visits glass breaking was discontinued for one month in half the stores (selected at random), although bottles were still collected and stored on site. Rates of chronic symptoms were compared to an external, unexposed control population. Geometric mean exposure levels were 0.18 mg/m3 for inhalable particulate matter and 3.6 EU/m3 for endotoxin (270 personal samples); 1064 CFU/m3 for viable fungi (648 area samples). Fungal levels were associated with visibly mouldy bottles being broken, outdoor fungal counts, and uncovered glass bins. Exposures were not altered by the intervention of shutting down glass breaking machinery. Compared to controls, employees reported more work related chronic chest tightness and chronic nasal symptoms. Acute chest symptoms were associated with breaking visibly mouldy bottles, but not with measured fungal counts. Inhalable particulate matter levels >0.2 mg/m3 were associated with acute upper airway irritation. Somatic symptoms were associated with measures of psychosocial job strain. Results suggest that this type of recycling programme may generate fungal exposures sufficient to elicit upper airway and chest symptoms.
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Theatrical fogs are commonly used in the entertainment industry to create special atmospheric effects during filming and live productions. We examined exposures to mineral oil-and glycol-based theatrical fogs to determine what fluids and effects were commonly used, to measure the size distributions of the aerosols, and to identify factors associated with personal exposure levels. In nonperformance jobs in a range of production types (television, film, live theater, and concerts),we measured airborne concentrations of inhalable aerosol,aldehydes, and polycyclic aromatic hydrocarbons, and collected observations about the sites and tasks performed. Both mineral oil and glycols were observed in use on about one-half the production days in the study. The most common effect produced was a generalized haze over the entire set. Mean personal inhalable aerosol concentrations were 0.70 mg/m3(range 0.02 to 4.1). The mean proportion of total aerosol mass less than 3.5 microns in aerodynamic diameter was 61%. Exposures were higher when mineral oils, rather than glycols, were used to generate fogs. Higher exposures were also associated with movie and television productions, with using more than one fog machine, with increased time spent in visible fog, and for those employed as "grips." Decreased exposures were associated with increasing room temperature, with increasing distance from fog machines, and for those employed as "sound technicians." Exposures to theatrical fogs are just beginning to be measured. It is important to consider these exposures in light of any health effects observed, since existing occupational exposure limits were developed in other industries where the aerosol composition differs from that of theatrical fogs.
Article
Standardized procedures have been developed for use in epidemiological studies of relatively large population groups. Investigations of this type often require field studies carried on at a distance from traditional research laboratories. To obtain adequate data with a minimum of bias in such studies, which involve large numbers of subjects, time limitations, unavailability of sophisticated equipment, and a multiplicity of observers, simple and reliable standardized procedures are needed. In some respects, epidemiological studies serve as screening procedures. Performed initially or cross-sectionally, they determine the prevalence of symptoms, status of pulmonary function, and similar situations at one point in time. Repeated, using the same population at a later point in time, they serve as prospective or longitudinal studies and can then determine incidence of disease or give information regarding the progression of illness. Data required for epidemiological studies may differ from those required for clinical studies, which are diagnostic and directed toward individuals rather than groups. In clinical studies, much more detailed information about an individual may be required to assure correct diagnosis. This report does not deal with population selection or numbers of subjects. These topics were the subjects of an earlier report from a Committee on Standards for Epidemiological Survey in Chronic Respiratory Disease of the American Thoracic Society (ATS), published in 1969. Reference should be made to that document, which complements this presentation. Here we are concerned with how and when to use standard questionnaires on respiratory symptoms, tests of pulmonary function, and chest radiographs.
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The European Community Respiratory Health Survey (ECRHS) was planned to answer specific questions about the distribution of asthma and health care given for asthma in the European Community. Specifically, the survey is designed to estimate variations in the prevalence of asthma, asthma-like symptoms and airway responsiveness; to estimate variations in exposures to known or suspected risk factors for asthma, and assess to what extent these variations explain the variations in the prevalence of disease; and to estimate differences in the use of medication for asthma. The protocol provides specific instructions on the sampling strategy adopted by the survey teams, as well as providing instructions on the use of questionnaires, the tests for allergy, lung function measurements, tests of airway responsiveness, and blood and urine collection. The principal data collection sheets and questionnaires are provided in the appendices, together with information on coding and quality control. The protocol is published as a reference for those who wish to know more of the methods used in the study, and also to give other groups who wish to collect comparable data access to the detailed methodology.
Article
Background. – Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity.Case report. – A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5°C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak.Conclusion. – Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.
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Effects of mineral oils in animals and humans are evaluated and serve as the basis for the development of an exposure standard for fog oil. Considered are health hazards associated with fox oil purchased before and after the Military Specification was amended in April 1986 to exclude carcinogens. While repeated exposure to conventionally-refined mineral oils may cause pulmonary disease as well as severe dermatoses and cancer of the skin and scrotum, lipoid pneumonia is the major health hazard associated with highly refined mineral oils such as fog oils purchased after April 1986. While the course of lipoid pneumonia can be asymptomatic In some Individuals, In others its symptoms can range from occasional cough to severe, debilitating dyspnea and pulmonary illness, occasionally ending in death. To protect against the risk of lipoid pneumonia, an 8-hour time weighted average exposure limit of 5 mg/m3 (for the respirable fraction) should be adopted for new fog oil. Health effects, health risks, fog oil, mineral oil, exposure standard.
Article
A peroral challenge lest with 2–15 ml of propylene glycol (PG) was made in 38 patients with allergic-type epicutaneous test reactions to PG. Eight of 10 patients with a positive epicutaneous reaction to 2% PG and seven of the other 28 patients with a positive epicutaneous reaction to 10–100 % PG developed an exanthem 3–16 h after ingestion of the drug. In all hut one case the rash disappeared within 24–48 h without any medication. In one ease the exanthem was treated with prednisone for 4 days, and the symptoms disappeared gradually in 6 days. None of the 20 control patients had skin symptoms, Nausea, vertigo and a curious sensation were recorded in four PG-sensitive patients and in three control patients. These symptoms were apparently due to the general pharmacodynamic effects of PG and they were regarded as non-allergic in nature. It was concluded that PG is a potential allergen and it must he added to the list of causes of drug exuathems
Article
Contact dermatitis developed in a patient from the use of Tinactin and Lotrimin solutions. Initially, the usual 'delayed' type of allergic contact dermatitis was suspected. However, covered patch tests gave negative results after forty-eight hours. 'Open' testing revealed an 'immediate' urticarial reaction to polyethylene glycol, which is used as a solvent in both antifungal agents. It should be emphasized that after a patient scratches or irritates an urticarial contact dermatitis, the resulting eruption closely resembles contact dermatitis of the usual delayed variety. Apparently, this is the first written report of such an 'immediate' reaction to polyethylene glycol. Although the modern, elegant antifungal agents with their complex vehicles are quite effective, one sometimes becomes nostalgic for the old-fashioned, inelegant but effective Whitfield's ointment (salicylic acid and benzoic acid) with its simple, nonsensitizing petrolatum base.
Article
Groups of nineteen Sprague-Dawley rats of each sex were exposed by a nose-only inhalation to 0.0, 0.16, 1.0 or 2.2 mg propylene glycol/litre air, for 6 hr/day, 5 days/wk for 90 days. There were no significant differences in respiratory rates, minute volumes or tidal volumes between any of the groups during aerosol exposure. The uniformity of respiratory parameters between dose groups implied that the delivered doses were proportional to the exposure concentrations. The mean terminal body weights were not significantly different from controls for any group of male animals. The mean body weights of the females exposed to 2.2 mg/litre were significantly less than those of female controls from day 50 onwards. This effect, in female rats, was consistent with a decrease in feed consumption for the high-exposure female rats beginning on study day 43. Statistically significant differences between the treated and control groups in certain haematological parameters, serum enzyme activities, other serum chemistry parameters and organ weights did not show clear dose relationships. There was a significant increase in the number of goblet cells or an increase in the mucin content of the existing goblet cells in the nasal passages of the medium- and high-exposure animals. Exposure to the above concentrations of propylene glycol caused nasal haemorrhage and ocular discharge in a high proportion of animals, possibly as a result of dehydration of the nares and eyes.
Article
Forced expiratory volumes and flows were measured in 251 healthy nonsmoking men and women using techniques and equipment that meet American Thoracic Society (ATS) recommendations. Linear regression equations using height and age alone predict spirometric parameters as well as more complex equations using additional variables. Single values for 95% confidence intervals are acceptable and should replace the commonly used method of subtracting 20% to determine the lower limit of normal for a predicted value. Our study produced predicted values for forced vital capacity and forced expiratory volume in one second that were almost identical to those predicted by Morris and associates (1) when the data from their study were modified to be compatible with the back extrapolation technique recommended by the ATS. The study of Morris and colleagues was performed at sea level in rural subjects, whereas ours was performed at an altitude of 1,400 m in urban subjects. Either the present study or the study of Morris and co-workers, modified to back extrapolation, could be recommended for predicting normal values.
Article
The European Community Respiratory Health Survey (ECRHS) was planned to answer specific questions about the distribution of asthma and health care given for asthma in the European Community. Specifically, the survey is designed to estimate variations in the prevalence of asthma, asthma-like symptoms and airway responsiveness; to estimate variations in exposures to known or suspected risk factors for asthma, and assess to what extent these variations explain the variations in the prevalence of disease; and to estimate differences in the use of medication for asthma. The protocol provides specific instructions on the sampling strategy adopted by the survey teams, as well as providing instructions on the use of questionnaires, the tests for allergy, lung function measurements, tests of airway responsiveness, and blood and urine collection. The principal data collection sheets and questionnaires are provided in the appendices, together with information on coding and quality control. The protocol is published as a reference for those who wish to know more of the methods used in the study, and also to give other groups who wish to collect comparable data access to the detailed methodology.
Article
Poisoning with triethylene glycol has been rarely reported in humans. Triethylene glycol is thought to be metabolized by alcohol dehydrogenase to acidic products resulting in the production of a metabolic acidemia. Triethylene glycol metabolism has previously been shown to be inhibited by fomepizole (4-methyl pyrazole) administration. We report a case of triethylene glycol ingestion, presenting with a metabolic acidemia, treated with intravenous ethanol administration. A 23-year-old female presented to the emergency department approximately 1-1.5 hours following ingestion of a gulp of triethylene glycol (99%) brake fluid with coma (GCS-3) and metabolic acidemia (pH 7.03, PCO2 44 mm Hg, Bicarbonate 11 mmol/L, anion gap 30 mmol/L, serum creatinine 90 mumol/L). She was intubated and given 100 mmol of intravenous sodium bicarbonate. An ethanol loading dose was administered followed by an infusion to maintain serum ethanol at 100 mg/dL. Acidemia gradually resolved over the next 8 hours and she was extubated 12 hours later. The ethanol infusion was continued for a total of 22 hours. There was no recurrence of acidemia. Serum ethanol, ethylene glycol, and methanol levels were nondetectable on presentation, as was serum salicylate. Urine drug of abuse screen and thin-layer chromatography revealed no other coingested substances. The patient was discharged to a psychiatric ward 36 hours postingestion. Pure triethylene glycol poisoning results in coma and metabolic acidemia and may be treated with alcohol dehydrogenase inhibitors such as ethanol.
Article
Propylene glycol (PG) (1-2 propanediol; CAS No 57-55-6) is a low toxicity compound widely used as a food additive, in pharmaceutical preparations, in cosmetics, and in the workplace-for example, water based paints, de-icing fluids, and cooling liquids. Exposure to PG mist may occur from smoke generators in discotheques, theatres, and aviation emergency training. Propylene glycol may cause contact allergy, but there is sparse information on health effects from occupational exposure to PG. Non-asthmatic volunteers (n=27) were exposed in an aircraft simulator to PG mist over 1 minute, during realistic training conditions. Geometric mean concentration of PG was 309 mg/m3 (range 176-851 mg/m3), with the highest concentrations in the afternoon. The medical investigation was performed both before and after the exposure (within 15 minutes). It included an estimate of tear film stability break up time, nasal patency by acoustic rhinometry, dynamic spirometry, and a doctor's administered questionnaire on symptoms. After exposure to PG mist for 1 minute tear film stability decreased, ocular and throat symptoms increased, forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) was slightly reduced, and self rated severity of dyspnoea was slightly increased. No effect was found for nasal patency, vital capacity (VC), FVC, nasal symptoms, dermal symptoms, smell of solvent, or any systemic symptoms. Those exposed to the higher concentrations in the afternoon had a more pronounced increase of throat symptoms, and a more pronounced decrease of tear film stability. In four subjects who reported development of irritative cough during exposure to PG, FEV1 was decreased by 5%, but FEV1 was unchanged among those who did not develop a cough. Those who developed a cough also had an increased perception of mild dyspnoea. Short exposure to PG mist from artificial smoke generators may cause acute ocular and upper airway irritation in non-asthmatic subjects. A few may also react with cough and slight airway obstruction.
Article
The European Community Respiratory Heath Survey (ECRHS) was the first study to assess the geographical variation in asthma and allergy in adults using the same instruments and definitions. The database of the ECRHS includes information from ∼140,000 individuals from 22 countries. The aim of this review is to summarize the results of the ECRHS to date. The ECRHS has shown that there are large geographical differences in the prevalence of asthma, atopy and bronchial responsiveness, with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe. Analyses of risk factors have highlighted the importance of occupational exposure for asthma in adulthood. The association between sensitization to individual allergens and bronchial responsiveness was strongest for indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated. In conclusion, the European Community Respiratory Health Survey has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and most likely due to environmental factors.
Article
Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity. A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5 degrees C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak. Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.
Article
We describe a case of acute propylene glycol toxicity following ingestion of ethanol and propylene glycol-containing antifreeze in which blood lactate, serum propylene glycol, ethanol, and CO2 concentrations were serially measured. A 61-year-old man was hospitalized after acute ingestion of ethanol and automotive antifreeze. His clinical presentation and course were essentially unremarkable. Initial lab tests revealed serum ethanol concentration, 167 mg/dL, normal serum electrolytes and osmol gap, 120 mOsm/kg. Intravenous 10% ethanol infusion was begun for suspected ethylene glycol toxicity and discontinued at approximately 17 hours post-ingestion. Toxicological analysis of urine was positive for ethanol and propylene glycol, and negative for ethylene glycol, methanol, and isopropanol. Blood lactate was mildly elevated and serum CO2 concentration was normal. Gas chromatographic analysis of serial serum specimens for propylene glycol concentration revealed a maximum value of 470 mg/dL at 7 hours and a nonlinear decline to below detection limit (3 mg/dL) at 57 hours after antifreeze ingestion. The patient was discharged on hospital day 2. The propylene glycol elimination pattern, absence of significant acid-base disturbance, and minimal lactate elevation in this case are consistent with ethanol-related inhibition of propylene glycol metabolism. The effect of ethanol on clinical outcome after acute propylene glycol intoxication remains uncertain.
Contact dermatitis from propylene glycol in ECG electrodes, complicated by medicament allergy Reference spirometric values using techniques and equipment that meet ATS recommenda-tions
  • Oh Cincinnati
  • Us
  • Department
  • Human Health
  • Niosh Services
  • M Connolly
  • Buckley
  • Da
Cincinnati OH: US Department of Health and Human Services, NIOSH. Connolly M, Buckley DA. 2004. Contact dermatitis from propylene glycol in ECG electrodes, complicated by medicament allergy. Contact Dermatitis 50:42. Crapo RO, Morris AH, Gardner RM. 1981. Reference spirometric values using techniques and equipment that meet ATS recommenda-tions. Am Rev Respir Dis 123:659–664.
Singer sues opera over fake fog machine triggered asthma diva claims. San Francisco Chronicle Sect
  • C Squatriglia
Squatriglia C. 2001. Singer sues opera over fake fog machine triggered asthma diva claims. San Francisco Chronicle Sect. A26. 5-12-2001.
Broadway's ?Beauty? leaves some performers feeling beastly
  • Willman
Willman D. 2003. Broadway's 'Beauty' leaves some performers feeling beastly. CNN Showbiz News.1-1-1998. 1-9-2003.
Singer sues opera over fake fog machine triggered asthma diva claims
  • Squatriglia
Voices fading in the fog: Performers say chemicals in synthetic mists on stage are health risk
  • Russell
Russell S. 2001. Voices fading in the fog: Performers say chemicals in synthetic mists on stage are health risk. San Francisco Chronicle Sect. A1. 1-2-2001.
  • American Thoracic Society
Lung function testing: Selection of reference values and interpretive strategies
American Thoracic Society. 1991. Lung function testing: Selection of reference values and interpretive strategies. Am J Res Crit Care Med 144:1202-1218.
  • G A Burr
  • T J Van Gilder
  • D B Trout
  • T G Wilcox
  • R Driscoll
Burr GA, van Gilder TJ, Trout DB, Wilcox TG, Driscoll R. 1994. NIOSH Health Hazard Evaluation Report HETA 90-355-2449.
US Department of Health and Human Services
  • O H Cincinnati
Cincinnati OH: US Department of Health and Human Services, NIOSH.
The Voice Handicap Index
  • B H Jacobsen
  • A Johnson
  • C Grywalski
  • A Silbergleit
  • G Jacobson
  • M S Benninger
Jacobsen BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. 1997. The Voice Handicap Index. Am J Speech Language-Path 6:66-70.
Opera halts use of controversial fog 7 chorus members cited health risks. San Francisco Chronical Sect. D2
  • J Kosman
Kosman J. 2001. Opera halts use of controversial fog 7 chorus members cited health risks. San Francisco Chronical Sect. D2. June 9, 2001.