Abstract
Keywords
- •E-cigarettes have become a popular source of nicotine.
- •E-cigarettes have acute physiological effects, including increases in blood pressure, heart rate, and airway resistance.
- •The long-term effects of e-cigarettes are unknown.
- •There is insufficient evidence to recommend e-cigarettes for smoking cessation, although some reports of improved cessation exist. Dual use with regular cigarettes has been associated with decreased smoking cessation.
- •E-cigarettes should not be viewed as “safe” as they can cause acute lung disease, atrial fibrillation, and nicotine poisoning.
Grana R, Benowitz N, Glantz SA. Background paper on E-cigarettes (Electronic Nicotine Delivery Systems). 2013. Available at: http://escholarship.org/uc/item/13p2b72n. Accessed August 27, 2014.
Name | Definition | Other Names |
---|---|---|
Electronic cigarette | The device designed to produce aerosol by heating the solution in the cartridge. | E-cig, smokeless cigarette, cig-a-like, vaporette, technofogger, personal vaporizer, vaping device, vapor pen, e-hookah. |
Electronic cigarette use | The act of inhaling the heated aerosolized solution and subsequently exhaling is similar to smoking a regular cigarette. | Verbalized as “vaping.” An e-cigarette user may be described as a “vaper.” These terms are actually misnomers as the aerosol produced is technically not a vapor. The aerosol produced by e-cigarettes has a particulate phase, not just a gas phase like a vapor. 5 |
Electronic cigarette solution | The solution usually contains a mixture of propylene glycol or vegetable glycerin or both, with or without nicotine, and flavorings. | E-juice, e-liquid, juice, vapor juice, smoke juice |
Hot cigarette | A regular tobacco cigarette | |
Mods | Modifications made to an e-cigarette used to produce higher amounts of aerosol | Cloud chaser, cloud chasing |
Composition, Marketing, Sales Data, and Response From the Tobacco Industry
Construction

BBC News. Man killed as e-cigarette explodes. Available at: http://www.bbc.com/news/uk-england-merseyside-28701515. Accessed August 27, 2014.
Styles
Operation
Marketing and Sales
US Food and Drug Administration (FDA). FDA news release. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394667.htm. Accessed August 27, 2014.
Regulations.gov. Electronic cigarettes and public health workshop. Available at: http://www.regulations.gov/#!docketBrowser;rpp=25;po=0;D=FDA-2014-N-1936. Accessed December 5, 2014.
Stanford DD. E-cig sales slide as regular smokers return to the real thing. Available at: http://www.bloomberg.com/news/2014-07-16/e-cig-sales-slide-as-regular-smokers-return-to-real-thing.html. Accessed August 27, 2014.
Big Tobacco
McArdle M. E-cigarettes: a $1.5 billion industry braces FDA regulation. Available at: http://www.businessweek.com/articles/2014-02-06/e-cigarettes-fda-regulation-looms-for-1-dot-5-billion-industry#p1. Accessed August 27, 2014.
Use Patterns in the Public: Adults, Teenagers, Pregnancy
Centers for Disease Control and Prevention (CDC). Notes from the field: electronic cigarette use among middle and high school students—United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2013;62(35);729-730. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm?s_cid=mm6235a6_w. Accessed August 27, 2014.
- Suter M.A.
- Mastrobattista J.
- Sachs M.
- Aagaard K.
Regulation by the FDA or Other National/International Entities
US Food and Drug Administration (FDA). FDA news release. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394667.htm. Accessed August 27, 2014.
US Food and Drug Administration (FDA). Electronic cigarettes (E-cigarettes). Available at: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm. Accessed December 5, 2014.
European Commission. Public health: tobacco products directive memo. Available at: http://ec.europa.eu/health/tobacco/products/index_en.htm. Accessed August 27, 2014.
Biologic Effects
Acute Physiological Effects
Parameter | Effect | Source |
---|---|---|
Serum carbon monoxide levels | No definite effect with contradicting studies | 22 , 23 |
Diastolic blood pressure | Significant increase | 24 |
Systolic blood pressure | No significant increase | 24 |
Ventricular systolic and diastolic function | No effect | 24 |
Heart rate | Significant increase after 5 and 10 minutes of use | 22 , 23 |
Blood counts | No change in WBCs, lymphocytes and granulocytes | 25 , 26 |
Exhaled nitric oxide (FeNO) | Significant decrease shortly after use | 27 , 28 |
Respiratory impedances (a marker of peripheral airway flow resistance) | Significant (18%) increase | 28 |
Airway resistance | Significant increase, including nicotine free solutions | 29 , 30 |
Nicotine Levels
Exposure to Chemical Substances Other Than Nicotine
“Second-hand Vapor”
Role in Smoking Cessation
Dual Use
E-Cigarette Toxicity
Lung
Cardiovascular
Cancer Risk
US Food and Drug Administration (FDA). Evaluation of e-cigarettes. 2009(DPATR-FY-09-23). Available at: http://www.fda.gov/downloads/Drugs/SCienceResearch/UCM173250.pdf. Accessed August 27, 2014.
Statements Made by National Medical Societies
Statements Made by International Medical Societies
Grana R, Benowitz N, Glantz SA. Background paper on E-cigarettes (Electronic Nicotine Delivery Systems). 2013. Available at: http://escholarship.org/uc/item/13p2b72n. Accessed August 27, 2014.
Conclusions
References
- E-Cigarettes: a scientific review.Circulation. 2014; 129: 1972-1986
- Introduction to tobacco control supplement.Tob Control. 2014; 23: ii1-ii3
Grana R, Benowitz N, Glantz SA. Background paper on E-cigarettes (Electronic Nicotine Delivery Systems). 2013. Available at: http://escholarship.org/uc/item/13p2b72n. Accessed August 27, 2014.
- Electronic cigarettes: product characterisation and design considerations.Tob Control. 2014; 23: ii4-ii10
- Electronic cigarette aerosol particle size distribution measurements.Inhal Toxicol. 2012; 24: 976-984
BBC News. Man killed as e-cigarette explodes. Available at: http://www.bbc.com/news/uk-england-merseyside-28701515. Accessed August 27, 2014.
- Achieving appropriate regulations for electronic cigarettes.Ther Adv Chronic Dis. 2014; 5: 50-61
US Food and Drug Administration (FDA). FDA news release. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394667.htm. Accessed August 27, 2014.
Regulations.gov. Electronic cigarettes and public health workshop. Available at: http://www.regulations.gov/#!docketBrowser;rpp=25;po=0;D=FDA-2014-N-1936. Accessed December 5, 2014.
- Exposure to electronic cigarette television advertisements among youth and young adults.Pediatrics. 2014; 134: E29-E36
Stanford DD. E-cig sales slide as regular smokers return to the real thing. Available at: http://www.bloomberg.com/news/2014-07-16/e-cig-sales-slide-as-regular-smokers-return-to-real-thing.html. Accessed August 27, 2014.
McArdle M. E-cigarettes: a $1.5 billion industry braces FDA regulation. Available at: http://www.businessweek.com/articles/2014-02-06/e-cigarettes-fda-regulation-looms-for-1-dot-5-billion-industry#p1. Accessed August 27, 2014.
Centers for Disease Control and Prevention (CDC). Notes from the field: electronic cigarette use among middle and high school students—United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2013;62(35);729-730. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm?s_cid=mm6235a6_w. Accessed August 27, 2014.
- Intentions to smoke cigarettes among never-smoking U.S. middle and high school electronic cigarette users, National Youth Tobacco Survey, 2011-2013.Nicotine Tob Res. 2015; 17: 228-235
- Electronic cigarettes and conventional cigarette use among US adolescents: a cross-sectional study.JAMA Pediatr. 2014; 168: 610-617
- Electronic cigarette use by college students.Drug Alcohol Depend. 2013; 131: 214-221
- Smokers who try e-cigarettes to quit smoking: findings from a multiethnic study in Hawaii.Am J Public Health. 2013; 103: e57-e62
- Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study.Addiction. 2014; 109: 1531-1540
- Is there evidence for potential harm of electronic cigarette use in pregnancy?.Birth Defects Res A Clin Mol Teratol. 2014; ([Epub ahead of print])https://doi.org/10.1002/bdra.23333
US Food and Drug Administration (FDA). Electronic cigarettes (E-cigarettes). Available at: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm. Accessed December 5, 2014.
European Commission. Public health: tobacco products directive memo. Available at: http://ec.europa.eu/health/tobacco/products/index_en.htm. Accessed August 27, 2014.
- A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects.Cancer Epidemiol Biomarkers Prev. 2010; 19: 1945-1953
- E-cigarette acute effect on symptoms and airway inflammation: comparison of nicotine with a non nicotine cigarette. 11th Annual Conference of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID).Tob Induc Dis. 2014; 12: A35
- Acute effects of using an electronic nicotine-delivery device (electronic cigarette) on myocardial function: comparison with the effects of regular cigarettes.BMC Cardiovasc Disord. 2014; 14: 78
- Chronic idiopathic neutrophilia in a smoker, relieved after smoking cessation with the use of electronic cigarette: a case report.Clin Med Insights Case Rep. 2013; 6: 15-21
- Acute effects of electronic and tobacco cigarette smoking on complete blood count.Food Chem Toxicol. 2012; 50: 3600-3603
- Short-term effects of electronic and tobacco cigarettes on exhaled nitric oxide.Toxicol Appl Pharmacol. 2014; 278: 9-15
- Short-term pulmonary effects of using an electronic cigarette impact on respiratory flow resistance, impedance, and exhaled nitric oxide.Chest. 2012; 141: 1400-1406
- Acute effect of e-cigarette on pulmonary function in healthy subjects and smokers.Eur Respir Soc. 2012; 40: P1053
- Acute effect on an e-cigarette with and without nicotine on lung function. 11th Annual Conference of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID).Tob Induc Dis. 2014; 12: A34
- Electronic cigarettes and nicotine clinical pharmacology.Tob Control. 2014; 23: ii30-ii35
- Saliva cotinine levels in users of electronic cigarettes.Eur Respir J. 2011; 38: 1219-1220
- Saliva cotinine levels in smokers and nonsmokers.Am J Epidemiol. 2000; 151: 251-258
- Variable and potentially fatal amounts of nicotine in e-cigarette nicotine solutions.Tob Control. 2014; 23: 77-78
- Three cases of attempted suicide by ingestion of nicotine liquid used in e-cigarettes.(Paper presented at) XXXIII International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT), Copenhagen, Denmark2013
- Bad news about an old poison. A case of nicotine poisoning due to both ingestion and injection of the content of an electronic cigarette refill.Emerg Care J. 2013; 9: 53-54
- Identification of amino-tadalafil and rimonabant in electronic cigarette products using high pressure liquid chromatography with diode array and tandem mass spectrometric detection.J Chromatogr A. 2010; 1217: 7547-7555
- Chemical evaluation of electronic cigarettes.Tob Control. 2014; 23: ii11-ii17
- Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol.PLos One. 2013; 8: e57987
- Carbonyl compounds in electronic cigarette vapors—effects of nicotine solvent and battery output voltage.Nicotine Tob Res. 2014; 16: 1319-1326
- Does e-cigarette consumption cause passive vaping?.Indoor Air. 2013; 23: 25-31
- Secondhand Exposure to Vapors From Electronic Cigarettes.Nicotine Tob Res. 2014; 16: 655-662
- Cigarettes vs. e-cigarettes: passive exposure at home measured by means of airborne marker and biomarkers.Environ Res. 2014; 135c: 76-80
- Electronic cigarettes are a source of thirdhand exposure to nicotine.Nicotine Tob Res. 2015; 17: 256-258
- Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial.Tob Control. 2010; 19: 98-103
- The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition.Addict Behav. 2012; 37: 970-973
- Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study.BMC Public Health. 2011; 11: 786
- Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers.Int J Environ Res Public Health. 2014; 11: 4356-4373
- A longitudinal study of electronic cigarette use in a population-based sample of adult smokers: association with smoking cessation and motivation to quit.Nicotine Tob Res. 2015; 17: 127-133
- Electronic cigarette use among patients with cancer: characteristics of electronic cigarette users and their smoking cessation outcomes.Cancer. 2014; 120: 3527-3535
- Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking.J Adolesc Health. 2014; 54: 684-690
- Electronic cigarettes for smoking cessation: a randomised controlled trial.Lancet. 2013; 382: 1629-1637
- EffiCiency and safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study.PLos One. 2013; 8: e66317
- Smoking Cessation and Reduction in Schizophrenia (SCARIS) with e-cigarette: study protocol for a randomized control trial.Trials. 2014; 15: 88
- Multicentric cohort study on the long-term efficacy and safety of electronic cigarettes: study design and methodology.BMC Public Health. 2013; 13: 883
- Study protocol for a randomised controlled trial of electronic cigarettes versus nicotine patch for smoking cessation.BMC Public Health. 2013; 13: 210
- Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study.Int J Environ Res Public Health. 2013; 10: 446-461
- Electronic cigarette exposures reported to Texas poison centers.Nicotine Tob Res. 2015; 17: 209-211
- Adverse effects of e-cigarette exposures.J Community Health. 2014; 39: 614-616
- Case report of electronic cigarettes possibly associated with eosinophilic pneumonitis in a previously healthy active-duty sailor.J Emerg Med. 2014; 47: 15-17
- An unexpected consequence of electronic cigarette use.Chest. 2012; 141: 1110-1113
- A case report of subacute bronchial toxicity induced by an electronic cigarette.Thorax. 2014; 69: 596-597
- E-cigarettes and cardiovascular risk: beyond science and mysticism.Semin Thromb Hemost. 2014; 40: 60-65
- Paroxysmal atrial fibrillation following electronic cigarette use in an elderly woman.Clin Geriatr. 2012; 20: 28-32
- Toxicology of smokeless tobacco: implications for immune, reproductive, and cardiovascular systems.J Toxicol Environ Health B Crit Rev. 2012; 15: 317-331
- Levels of selected carcinogens and toxicants in vapour from electronic cigarettes.Tob Control. 2014; 23: 133-139
- Determination of carbonyl compounds generated from the E-cigarette using coupled silica cartridges impregnated with hydroquinone and 2,4-dinitrophenylhydrazine, followed by high-performance liquid chromatography.Anal Sci. 2013; 29: 1219-1222
US Food and Drug Administration (FDA). Evaluation of e-cigarettes. 2009(DPATR-FY-09-23). Available at: http://www.fda.gov/downloads/Drugs/SCienceResearch/UCM173250.pdf. Accessed August 27, 2014.
- Electronic cigarettes: a position statement of the Forum of International Respiratory Societies.Am J Respir Crit Care Med. 2014; 190: 611-618
- Electronic cigarettes: a policy statement from the American Heart Association.Circulation. 2014; 130: 1418-1436
- El cigarrillo electrónico. Declaración oficial de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) sobre la eficacia, seguridad y regulación de los cigarrillos electrónicos [Spanish].Arch Bronconeumol. 2014; 50: 362-367
- JAMA patient page. e-Cigarettes.JAMA. 2014; 311: 212
- Electronic cigarettes. Cardiology patient page.Circulation. 2014; 129: e490-e492
Article Info
Publication History
Footnotes
Funding: None.
Conflict of Interest: None of the authors have conflicts of interest.
Authorship: All authors have seen and approve the submitted study manuscript.
Identification
Copyright
ScienceDirect
Access this article on ScienceDirectLinked Article
- Nicotine Lethal Dose: Ignorance or Counterfeit?The American Journal of MedicineVol. 128Issue 10
- PreviewOrellana-Barrios et al1 must be commended for the clear information they provide us on e-cigarettes to educate our patients. However, they stated “Nicotine…lethal dose ranges from 10-60 mg”1 without reference. Indeed, none exists, and searches can only retrieve circular and misleading references from dubious textbooks.2 More than 500 mg of oral nicotine is required to kill an adult.2 Moreover, ingestion cannot be massive because of incoercible vomiting.
- Full-Text
- Preview