Electronic Cigarettes—A Narrative Review for Clinicians

Orellana-Barrios, Menfil; Payne, Drew; Mulkey, Zachary; Nugent, Kenneth

doi:10.1016/j.amjmed.2015.01.033

Cited by 90 publications

(94 citation statements)

References 56 publications

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“…Of interest to this study was the e-cigarette liquid refill solution (e-liquid; Pepper & Eisenberg, 2014). E-liquids can be purchased separately from the e-cigarette and typically contain nicotine, flavors, and solvent chemicals, including polyethylene glycol and vegetable glycerin, but may also contain contaminants, such as diethylene glycol, heavy metals, and potential carcinogens, such as nitrosamines (Cheng, 2014; Orellana-Barrios, Payne, Mulkey, & Nugent, 2015). This study did not assess substances, legal or illegal, added by consumers after purchase.…”

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confidence: 99%

“…The aerosol released from e-cigarettes contains particulate matter and is not considered as safe as clean air (California Department of Public Health & California Tobacco Control Program, 2015; CDC, 2015b). Additionally, federal regulation and oversight of e-cigarettes and e-liquids are lacking (Orellana-Barrios et al, 2015). A systematic literature search showed several studies in which the labeling of the nicotine content on e-liquid containers varied significantly from the measured actual content; of the six studies that analyzed “refillable solutions,” one reported a range of ±100% deviation from the label (Cheng, 2014).…”

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confidence: 99%

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Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors

Buettner-Schmidt

Miller

Balasubramanian

2016

Journal of Pediatric Nursing

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Purpose To determine the accuracy of the labeled quantity of the nicotine content of the e-liquids sold in unlicensed vape stores, whether the packaging of e-liquids sold within the vape stores was child-resistant, whether minors were present within vape stores, and whether sales to minors occurred. This study was conducted across North Dakota prior to implementation of a new e-cigarette state law and provided a baseline assessment before enactment of the new legal requirements. Design and Methods We tested samples of e-liquids and performed observations in 16 stores that were selling e-cigarettes but were not legally required to be licensed for tobacco retail. The e-liquids were analyzed for nicotine content using a validated high-performance liquid chromatography method for nicotine analysis. Results Of the 70 collected e-liquid samples that claimed to contain nicotine, 17% contained more than the labeled quantity and 34% contained less than the labeled quantity by 10% or more, with one sample containing 172% more than the labeled quantity. Of the 94 e-liquid containers sampled, only 35% were determined to be child-resistant. Minors were present in stores, although no sales to minors occurred. Conclusions Mislabeling of nicotine in e-liquids is common and exposes the user to the harmful effects of nicotine. The lack of child-resistant packaging for this potentially toxic substance is a serious public health problem. E-cigarettes should be included in the legal definition of tobacco products, child-resistant packaging and nicotine labeling laws should be enacted and strictly enforced, and vape stores should be licensed by states.

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confidence: 99%

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confidence: 99%

Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors

Buettner-Schmidt

Miller

Balasubramanian

2016

Journal of Pediatric Nursing

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“…E-Cig users are a fast-growing subset of nicotine users who are described as "vapers" rather than smokers, since E-Cigs heat and generate aerosols but do not burn e-liquids. There is considerable controversy regarding the disease risk and toxicity of E-Cigs (112,116,127). However, because E-Cigs do not currently fall under the auspices of the Food and Drug Administration (FDA), they have not undergone the typical toxicological evaluation, followed by human clinical trials that are required of other inhaled products (e.g., inhaled therapeutic agents), and, as such, no safety data exist from either humans or animals.…”

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confidence: 99%

Will chronic e-cigarette use cause lung disease?

Rowell

Tarran

2015

American Journal of Physiology-Lung Cellular and Molecular Phys

101

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Chronic tobacco smoking is a major cause of preventable morbidity and mortality worldwide. In the lung, tobacco smoking increases the risk of lung cancer, and also causes chronic obstructive pulmonary disease (COPD), which encompasses both emphysema and chronic bronchitis. E-cigarettes (E-Cigs), or electronic nicotine delivery systems, were developed over a decade ago and are designed to deliver nicotine without combusting tobacco. Although tobacco smoking has declined since the 1950s, E-Cig usage has increased, attracting both former tobacco smokers and never smokers. E-Cig liquids (e-liquids) contain nicotine in a glycerol/propylene glycol vehicle with flavorings, which are vaporized and inhaled. To date, neither E-Cig devices, nor e-liquids, are regulated by the Food and Drug Administration (FDA). The FDA has proposed a deeming rule, which aims to initiate legislation to regulate E-Cigs, but the timeline to take effect is uncertain. Proponents of E-Cigs say that they are safe and should not be regulated. Opposition is varied, with some opponents proposing that E-Cig usage will introduce a new generation to nicotine addiction, reversing the decline seen with tobacco smoking, or that E-Cigs generally may not be safe and will trigger diseases like tobacco. In this review, we shall discuss what is known about the effects of E-Cigs on the mammalian lung and isolated lung cells in vitro. We hope that collating this data will help illustrate gaps in the knowledge of this burgeoning field, directing researchers toward answering whether or not E-Cigs are capable of causing disease.

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“…E-sigaraların kullanımı sonrası akut olarak diyastolik kan basıncını yükselttiği; kalp atım hızını artırdığı; ekshale nitrik oksiti azalttığı; periferik havayolu rezistansını yansıtan solunumsal impedansı artırdığı ve havayolu rezistansını artırdığı gösterilmiştir (21) . (22,23) .…”

Section: Akut Fizyolojik Etkileriunclassified