Electronic cigarettes: a task force report from the European Respiratory Society

Abstract

There is a marked increase in the development and use of electronic nicotine delivery systems or electronic cigarettes (ECIGs). This statement covers electronic cigarettes (ECIGs), defined as “electrical devices that generate an aerosol from a liquid” and thus excludes devices that contain tobacco. Database searches identified published articles that were used to summarise the current knowledge on the epidemiology of ECIG use; their ingredients and accompanied health effects; second-hand exposure; use of ECIGs for smoking cessation; behavioural aspects of ECIGs and social impact;in vitroand animal studies; and user perspectives.ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support ECIGs as an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licenced stop-smoking treatments. So far, there are conflicting data that use of ECIGs results in a renormalisation of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out.

Association of Electronic Cigarette Regulations With Electronic Cigarette Use Among Adults in the United States

“…[46][47][48][49] Widespread use of e-cigarettes can also lead to secondhand exposure to nicotine and other toxic substances from e-cigarettes. [50][51][52] Therefore, careful consideration of the potential benefits and harms of e-cigarettes is needed in determining the net public health consequences associated with use of e-cigarettes.…”

Application of a multi-layer systems toxicology framework for in vitro assessment of the biological effects of Classic Tobacco e-liquid and its corresponding aerosol using an e-cigarette device with MESH™ technology

“…Nonetheless, the safety of EC use is highly debated. ECs "are electrical devices that generate an aerosol from a liquid" (Bals et al 2019). The liquid, generally referred to as e-liquid, is typically composed of humectants (e.g., propylene glycol [PG] and vegetable glycerin [VG]) and flavors, with or without nicotine (Grana et al 2014;NAS 2018).…”

“…The liquid, generally referred to as e-liquid, is typically composed of humectants (e.g., propylene glycol [PG] and vegetable glycerin [VG]) and flavors, with or without nicotine (Grana et al 2014;NAS 2018). With more than 8000 flavors now available on the market (Bals et al 2019) and around 242 new flavors added every month (Tierney et al 2016), the selection of e-liquids adequate for use with ECs should be driven by relevant toxicological analysis.…”

E-cigarettes: Effects in phagocytosis and cytokines response against Mycobacterium tuberculosis

“…In the last years, Electronic Nicotine Delivery Systems (ENDS) and especially electronic cigarettes (e-cigs) have appeared as a cooler, cheaper and healthier alternative to conventional tobacco, proving more attractive to the younger population. However, in the medical community there is a growing concern due to: i) the health effects from ENDS, ii) the inexact labelling of the electronic cigarette liquid (e-liquid) components, iii) the lack of international laws for quality production, iv) non-smokers being converted by e-cigs into dual users [14][15][16].…”