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Journal ArticleDOI

Electronic cigarettes and lung toxicity

TL;DR: The public and the medical profession need more information about the long-term complications associated with the use of e-cigarettes and their benefit in smoking cessation efforts.
Abstract: The use of electronic cigarettes (e-cigarettes) in the United States has steadily increased since their introduction into the market in 2007. These devices deliver nicotine through the vaporization of a liquid which contains a vehicle (propylene glycol or glycerin), artificial flavoring, and nicotine. The combustion of these liquids creates a vapor containing particulates, multiple chemicals, and nicotine. The long-term safety of these products is unknown. Studies in healthy, non-smoking volunteers and smokers with no clinical pulmonary disease have demonstrated that the inhalation of e-cigarette vapor has minimal short-term effects on pulmonary function. The exposure of cell cultures to e-cigarette liquid or aerosols has been shown to reduce cell viability, induce cytokine production, and cause oxidative stress. The exposure of animals (mice and rats) to e-cigarette aerosols induces inflammatory responses in the lungs and delays the clearance of bacterial and viral challenges. There are a small number of case reports of patients developing acute pulmonary toxicity following the use of e-cigarettes. Two patients have developed lipoid pneumonia following the use of e-cigarettes for 3 and 7 months. Finally, several studies suggest that patients with chronic lung disease who switch from tobacco cigarettes to e-cigarettes can have improvement in lung function (asthmatics) and a reduction in the number of exacerbations (chronic obstructive pulmonary disease). Clearly, the public and the medical profession need more information about the long-term complications associated with the use of e-cigarettes and their benefit in smoking cessation efforts. Keywords: electronic

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Journal ArticleDOI
TL;DR: A case of young male presenting with subacute respiratory failure and later found to have diffuse alveolar hemorrhage syndrome that is likely induced by aggressive vaping is reported, adding up to the rising concern on the possible serious complications of this innovative technology designed as a safer alternative to traditional cigarettes.
Abstract: There has been a significant increase in electronic cigarette (e-cigarette) use since its introduction in 2007. Ironically, there remains very few published literature on the respiratory complications of e-cigarettes. The use of personalized vaporizers or commonly known as “vaping” has started to overtake standard e-cigarette. Its dynamic vaporizer customization makes it challenging to assess long-term health effects. Case reports on the pulmonary complications of e-cigarettes are limited to bronchiectasis, eosinophilic pneumonia, pleural effusion, and suspected hypersensitivity pneumonitis. Diffuse alveolar hemorrhage (DAH) is bleeding into the alveolar spaces of the lung secondary to disruption of the alveolar-capillary basement membrane. We report a case of young male presenting with subacute respiratory failure. He was later found to have diffuse alveolar hemorrhage syndrome that is likely induced by aggressive vaping. This adds up to the rising concern on the possible serious complications of this innovative technology designed as a safer alternative to traditional cigarettes.

75 citations


Cites background from "Electronic cigarettes and lung toxi..."

  • ...These are limited to bronchiectasis, eosinophilic pneumonia, pleural effusion, and suspected hypersensitivity pneumonitis [7, 8]....

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  • ...There exists very few reported cases of pulmonary complications of e-cigarettes and these are limited to hypersensitivity inhalational injury, pneumonitis, and acute eosinophilic pneumonia [7]....

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References
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Journal ArticleDOI
06 Feb 2015-PLOS ONE
TL;DR: Exposure to e-cig aerosols/juices incurs measurable oxidative and inflammatory responses in lung cells and tissues that could lead to unrealized health consequences.
Abstract: Oxidative stress and inflammatory response are the key events in the pathogenesis of chronic airway diseases. The consumption of electronic cigarettes (e-cigs) with a variety of e-liquids/e-juices is alarmingly increasing without the unrealized potential harmful health effects. We hypothesized that electronic nicotine delivery systems (ENDS)/e-cigs pose health concerns due to oxidative toxicity and inflammatory response in lung cells exposed to their aerosols. The aerosols produced by vaporizing ENDS e-liquids exhibit oxidant reactivity suggesting oxidants or reactive oxygen species (OX/ROS) may be inhaled directly into the lung during a “vaping” session. These OX/ROS are generated through activation of the heating element which is affected by heating element status (new versus used), and occurs during the process of e-liquid vaporization. Unvaporized e-liquids were oxidative in a manner dependent on flavor additives, while flavors containing sweet or fruit flavors were stronger oxidizers than tobacco flavors. In light of OX/ROS generated in ENDS e-liquids and aerosols, the effects of ENDS aerosols on tissues and cells of the lung were measured. Exposure of human airway epithelial cells (H292) in an air-liquid interface to ENDS aerosols from a popular device resulted in increased secretion of inflammatory cytokines, such as IL-6 and IL-8. Furthermore, human lung fibroblasts exhibited stress and morphological change in response to treatment with ENDS/e-liquids. These cells also secrete increased IL-8 in response to a cinnamon flavored e-liquid and are susceptible to loss of cell viability by ENDS e-liquids. Finally, exposure of wild type C57BL/6J mice to aerosols produced from a popular e-cig increase pro-inflammatory cytokines and diminished lung glutathione levels which are critical in maintaining cellular redox balance. Thus, exposure to e-cig aerosols/juices incurs measurable oxidative and inflammatory responses in lung cells and tissues that could lead to unrealized health consequences.

503 citations


"Electronic cigarettes and lung toxi..." refers methods in this paper

  • ...Lerner et al exposed mice to either room air or e-cigarette aerosols for 5 hours per day for three consecutive days.(19) The mice then underwent bronchoalveolar lavage to measure cytokine production and lung homogenization to measure changes in glutathione levels....

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Journal ArticleDOI
01 Jun 2012-Chest
TL;DR: In this paper, the authors found that using an e-cigarette for 5 min led to an immediate decrease in F ENO within the experimental group by 2.14 ppb (P 5.005) but not in the control group (P5.859), total respiratory impedance at 5 Hz in the experimental groups was found to also increase by 0.033 kPa/(L/s) (P,.001), and fl ow respiratory resistance at 5, 10, and 20 Hz also statistically increased.

468 citations

Journal ArticleDOI
TL;DR: There has been rapid growth in ever and current electronic cigarette use over the past 4 years, with use highest among young adults and current cigarette smokers, suggesting that e-cigarettes contribute to primary nicotine addiction and to renormalization of tobacco use.
Abstract: Objectives: We assessed trends in use of electronic cigarettes among U.S. adults, demographic predictors of use, and smoking status of current electronic cigarette users. Methods: Mixed-mode surveys were used to obtain representative, cross-sectional samples of U.S. adults in each of 4 years. Results: Sample sizes for 2010, 2011, 2012, and 2013 were 3,240, 3,097, 3,101, and 3,245, respectively. Ever use of electronic cigarettes increased from 1.8% (2010) to 13.0% (2013), while current use increased from 0.3% to 6.8%, p < .001. Prevalence of use increased significantly across all demographic groups. In 2013, current use among young adults 18–24 (14.2%) was higher than adults 25–44 (8.6%), 45–64 (5.5%), and 65+ (1.2%). Daily smokers (30.3%) and nondaily smokers (34.1%) were the most likely to currently use e-cigarettes, compared to former smokers (5.4%) and never-smokers (1.4%), p < .001. However, 32.5% of current electronic cigarette users are never- or former smokers. Conclusions: There has been rapid growth in ever and current electronic cigarette use over the past 4 years. Use is highest among young adults and current cigarette smokers. Although smokers are most likely to use these products, almost a third of current users are nonsmokers, suggesting that e-cigarettes contribute to primary nicotine addiction and to renormalization of tobacco use. Regulatory action is needed at the federal, state, and local levels to ensure that these products do not contribute to preventable chronic disease.

458 citations


"Electronic cigarettes and lung toxi..." refers background in this paper

  • ...8% over the same time period.(3) Due to this increase in use, clinicians should be aware of the potential effects e-cigarettes have on the respiratory system....

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Journal ArticleDOI
TL;DR: Regarding short-term usage, the studied e-cigarettes generate smaller changes in lung function but similar nicotinergic impact to tobacco cigarettes, and future research should target the health effects of long-term e-cigarette usage, including the effects of nicotine dosage.
Abstract: Context: Electronic cigarettes (e-cigarettes) are becoming increasingly popular yet their effects on health remain unknown.Objective: To conduct the first comprehensive and standardized assessment ...

374 citations


"Electronic cigarettes and lung toxi..." refers methods in this paper

  • ...Flouris et al enrolled 30 subjects in two cohorts; one cohort included fifteen smokers who smoked greater than fifteen cigarettes a day and the other cohort included fifteen never smokers.(4) Smokers were exposed to e-cigarette vapor consistent with the level of nicotine found in two traditional cigarettes, while never smokers were exposed to passive levels of e-cigarette vapor consistent with that of a bar/restaurant with e-cigarette use....

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Journal ArticleDOI
TL;DR: Because of the associations between diacetyl and bronchiolitis obliterans and other severe respiratory diseases observed in workers, urgent action is recommended to further evaluate this potentially widespread exposure via flavored e-cigarettes.
Abstract: Background:There are > 7,000 e-cigarette flavors currently marketed. Flavoring chemicals gained notoriety in the early 2000s when inhalation exposure of the flavoring chemical diacetyl was found to...

366 citations


"Electronic cigarettes and lung toxi..." refers background in this paper

  • ...In addition, the flavoring chemicals in e-cigarettes, especially sweet or cinnamon e-liquid, can contain diacetyl, a compound linked to respiratory injury.(9) The long term effects of exposure are unknown, and documented acute adverse effects on the lungs from e-liquid exposure have been limited to infrequent case reports and abstracts (Table)....

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