Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies

To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies.

Published: 9 August 2014

Positive: Yes

Link to publication: http://jpubhealth.oxfordjournals.org/content/early/2014/08/09/pubmed.fdu055.short

doi: 10.1093/pubmed/fdu055

Authors:

Maria Rosaria Gualano
Stefano Passi
Fabrizio Bert
Giuseppe La Torre
Giacomo Scaioli
Roberta Siliquini


Summary

Methods We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register.

Results Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P < 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the number of cigarette/day (from 50 to 80%) after the introduction of the EC. ‘Mouth and throat irritation’, ‘nausea’, ‘headache’ and ‘dry cough’ were the most frequently AEs reported.


Conclusions

The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.

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Biochemically verified smoking cessation and vaping beliefs among vape store customers

To evaluate biochemically verified smoking status, and electronic nicotine delivery systems (ENDS) use behaviors and beliefs among a sample of customers from vapor stores (stores specializing in ENDS).

Published: Not yet (as of 13 February 2015)

Positive: Yes

Publication link: http://onlinelibrary.wiley.com/doi/10.1111/add.12878/abstract

doi: 10.1111/add.12878

Authors:

Alayna P. Tackett
William V. Lechner
Ellen Meier
DeMond M. Grant
Leslie M. Driskill
Noor N. Tahirkheli2
Theodore L. Wagener


Summary

Design, Setting, Participants

A cross-sectional survey of 215 adult vapor store customers at four retail locations in the Midwestern United States; a subset of participants (n=181) also completed exhaled carbon monoxide (CO) testing to verify smoking status.

Measurements

Outcomes evaluated included ENDS preferences, harm beliefs, use behaviors, smoking history and current biochemically verified smoking status.

Findings

Most customers reported starting ENDS as a means of smoking cessation (86%), using newer generation devices (89%), vaping non-tobacco/non-menthol flavors (72%), and using e-liquid with nicotine strengths of ≤20 mg/ml (72%). There was a high rate of switching (91.4%) to newer generation ENDS among those who started with a first generation product. Exhaled CO readings confirmed that 66% of the tested sample had quit smoking. Among those who continued to smoke, mean cigarettes per day decreased from 22.1 to 7.5 (p <.001). People who reported vaping longer (OR=4.7, 95% CI = 2.0–10.8), using newer generation devices (OR=3.0, 95% CI = 1.0–8.4) and using non-tobacco and non-menthol flavors (OR=2.6, 95% CI = 1.1–6.1) were more likely to have quit smoking.


Conclusions

Among vapor store customers in the US who use electronic nicotine delivery devices to stop smoking, vaping longer, using newer generation devices, and using non-tobacco and non-menthol flavored e-liquid appear to be associated with higher rates of smoking cessation. Continuer la lecture de Biochemically verified smoking cessation and vaping beliefs among vape store customers

Comparison of select analytes in aerosol from e-cigarettes with smoke from conventional cigarettes and with ambient air

Highlights

• The e-cigarettes contained and delivered mostly glycerin and/or PG and water.
• Aerosol nicotine content was 85% lower than the cigarette smoke nicotine.
• The levels of HPHCs in aerosol were consistent with the air blanks (<2 μg/puff).
• Mainstream cigarette smoke HPHCs (∼3000 μg/puff) were 1500 times higher than e-cigarette HPHCs.
• No significant contribution of tested HPHC classes was found for the e-cigarettes.

Published: 24 October 2014

Positive: Yes

Link to publication: http://www.sciencedirect.com/science/article/pii/S0273230014002505

Authors:

Rana Tayyarah
Gerald A. Long

Remarks: From Lorillard tobacco company


Summary

Leading commercial electronic cigarettes were tested to determine  bulk composition. The e-cigarettes and conventional cigarettes were evaluated using machine-puffing to compare nicotine delivery and relative yields of chemical constituents. The e-liquids tested were found to contain humectants, glycerin and/or propylene glycol, (⩾75% content); water (<20%); nicotine (approximately 2%); and flavor (<10%). The aerosol collected mass (ACM) of the e-cigarette samples was similar in composition to the e-liquids. Aerosol nicotine for the e-cigarette samples was 85% lower than nicotine yield for the conventional cigarettes. Analysis of the smoke from conventional cigarettes showed that the mainstream cigarette smoke delivered approximately 1500 times more harmful and potentially harmful constituents (HPHCs) tested when compared to e-cigarette aerosol or to puffing room air. The deliveries of HPHCs tested for these e-cigarette products were similar to the study air blanks rather than to deliveries from conventional cigarettes; no significant contribution of cigarette smoke HPHCs from any of the compound classes tested was found for the e-cigarettes. Thus, the results of this study support previous researchers’ discussion of e-cigarette products’ potential for reduced exposure compared to cigarette smoke.


Conclusion

The purpose of this study was to determine content and delivery of e-cigarette ingredients and to compare e-cigarette aerosol to conventional cigarettes with respect to select HPHCs for which conventional cigarette smoke is routinely tested. Routine analytical methods were adapted and verified for e-cigarette testing. Aerosol collection was conducted using conventional smoking machines and an intense puffing regime. As machine puffing cannot, and is not intended to, mimic human puffing, results of this study are limited to the scope of the comparisons made between the e-cigarette and conventional cigarette products tested.

The main ingredients for the e-cigarettes tested were consistent with disclosed ingredients: glycerin and/or propylene glycol (⩾75%), water (⩽18%), and nicotine (∼2%). Machine-puffing of these products under a standardized intense regime indicated a direct transfer of these ingredients to the aerosol while maintaining an aerosol composition similar to the e-liquid. Nicotine yields to the aerosol were approximately 30 μg/puff or less for the e-cigarette samples and were 85% lower than the approximately 200 μg/puff from the conventional cigarettes tested.

Testing of the e-cigarette aerosol indicates little or no detectable levels of the HPHC constituents tested. Overall the cigarettes yielded approximately 3000 μg/puff of the HPHCs tested while the e-cigarettes and the air blanks yielded <2 μg. Small but measurable quantities of 5 of the 55 HPHCs tested were found in three of the e-cigarette aerosol samples at 50–900 times lower levels than measurable in the cigarette smoke samples. Overall, the deliveries of HPHCs tested for the e-cigarette products tested were more like the study air blanks than the deliveries for the conventional cigarettes tested. Though products tested, collection parameters, and analytical methods are not in common between this study and others, the results are very consistent. Researchers have reported that most or all of the HPHCs tested were not detected or were at trace levels. Burstyn (2014) used data from approximately 50 studies to estimate e-cigarette exposures compared to workplace threshold limit values (TLV) based on 150 puffs taken over 8 h. The vast majority of the analytes were estimated as ≪1% of TLV and select carbonyls were estimated as <5% of TLV. Cheng (2014) reviewed 29 publications reporting no to very low levels of select HPHCs relative to combustible cigarettes, while noting that some of the tested products exhibited considerable variability in their composition and yield. Goniewicz et al. (2014) tested a range of commercial products and reported quantifiable levels for select HPHCs in e-cigarette aerosols at 9- to 450-fold lower levels than those in cigarette smoke that in some instances were on the order of levels determined for the study reference (a medicinal nicotine inhaler). Laugesen, 2009 and Theophilus et al., 2014 have presented results for commercial e-cigarette product liquids and aerosols having no quantifiable levels of tested HPHCs, or extremely low levels of measurable constituents relative to cigarette smoke. Additionally, findings from several recent studies indicate that short-term use of e-cigarettes by adult smokers is generally well-tolerated, with significant adverse events reported relatively rarely (Etter, 2010, Polosa et al., 2011, Polosa et al., 2014, Caponnetto et al., 2013, Dawkins and Corcoran, 2014 and Hajek et al., 2014). Thus, the results obtained in the aforementioned studies and in the present work broadly support the potential for e-cigarette products to provide markedly reduced exposures to hazardous and potentially hazardous smoke constituents in smokers who use such products as an alternative to cigarettes.

Additional research related to e-cigarette aerosol characterization is warranted. For example, continued characterization of major components and flavors is needed. Establishment of standardized puffing regimes and reference products would greatly aid sharing of knowledge between researchers. Continued methods’ refinement may be necessary for improved accuracy for quantitation of analytes at the low levels determined in this study. To that end, it is critical that negative controls and steps to avoid sample contamination be included when characterizing e-cigarette aerosol since analytes are on the order of what has been measured in the background levels of a laboratory setting. Though researchers have reported quantification of select analytes, great care must be taken when interpreting results at such trace levels.

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