Differences in vaping topography in relation to adherence to exclusive electronic cigarette use in veterans

Abstract

BackgroundUnderstanding vaping patterns of electronic cigarette (EC) use is important to understand the real-life exposure to EC vapor. Long term information on vaping topography in relation to tobacco cigarette (TC) smoking cessation success has not been explored.MethodsObservational non-blinded study where active TC smokers were asked to replace TC with EC over 4 weeks (replacement phase, RP) followed by exclusive EC use for an additional 12 weeks (maintenance phase, MP). TC use and EC compliance was monitored weekly. Subjects were classified as success or failure whether or not they completed the protocol. Vaping information was stored and downloaded directly from the EC device and averaged per calendar day for analysis.ResultsFrom 25 subjects that followed the protocol, sixteen succeeded in completing the RP and 8 the MP (32%). No significant differences in baseline characteristics were noted between subjects in the success and failure groups including markers of nicotine addiction, plasma cotinine levels or smoking history. Success subjects showed significantly longer puff duration (seconds per vape) and total overall vapor exposure (number of vapes x average vape duration or vape-seconds) in both study phases. Furthermore, subjects in the success group continued to increase the number of vapes, device voltage and wattage significantly as they transitioned into the MP. After an initial drop, subjects in the success group were able to regain plasma cotinine levels comparable to their TC use while subjects in the failure group could not. Cotinine levels significantly correlated with the average number of daily vapes and vapes-seconds, but not with other vaping parameters.ConclusionThe topography of smokers who adhere to exclusive EC use reflects a progressive and dynamic device adaptation over weeks to maintain baseline cotinine levels. The higher inhaled volume over time should be considered when addressing the potential toxic effects of EC and the variable EC adherence when addressing public health policies regarding their use.

What factors reliably predict electronic cigarette nicotine delivery?

“…These same smokers also were able to achieve cotinine levels similar to their baseline level once they completely switched over to e-cigarette use. 39 These results, in combination with others, 920 demonstrate that e-cigarette-naïve cigarette smokers and ecigarette-experienced users likely alter puff duration to titrate their nicotine intake. In order for product regulation to account for user behaviour, e-cigarette designs would need to allow for puff durations that lead to sufficient nicotine delivery yet limit compensatory puffing behaviour and increases in temperatures known to produce volatile aldehydes and other toxicants.…”

“…619 This finding supports recent work in which cigarette smokers were asked to switch to e-cigarette use exclusively within a 4-week period. 39 In that study, those who were successful had significantly longer puff durations than those who were not, and participants had increased puff durations over time as they became more familiar with the e-cigarette product. These same smokers also were able to achieve cotinine levels similar to their baseline level once they completely switched over to e-cigarette use.…”

Comparative Studies of Environmentally Persistent Free Radicals on Total Particulate Matter Collected from Electronic and Tobacco Cigarettes

“…The smoking habits of e-cigarettes are typically different than tobacco cigarettes. This stems from the differences in delivery of active substance (nicotine) and compensatory mechanism by either increasing the puff time or frequency of puffing. , Studies have shown that the ultimate goal of changing puff habits are driven by achieving the desired nicotine/cotinine level in a biological system. , To accommodate for differences in smoking habits, all data are normalized to a common measure, i.e., mass of TPM produced and all data reflect content of subject chemical/species per unit mass of TPM. It is possible, thanks to the fact that emission profile of e-cigarettes does not vary much depending on the time of puffing as it is controlled electronically .…”

E-Cigarette Use: Device Market, Study Design, and Emerging Evidence of Biological Consequences

“…EC users can instinctively modulate their behavior, including puff frequency, puff duration, and intervals between EC sessions to achieve their desired nicotine exposure levels. Smokers transitioning to ECs modulate their usage patterns to recapitulate the nicotine delivery profile of cigarettes; this differs from EC users with no prior history of smoking [2,3]. Therefore, properly controlling for the variation present across all facets of EC use is challenging in clinical studies.…”