E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure

DeVito, Elise E.; Krishnan‐Sarin, Suchitra

doi:10.2174/1570159x15666171016164430

Cited by 201 publications

(153 citation statements)

References 201 publications

(218 reference statements)

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“…The characteristics of e‐cigarettes influence their ability to delivery nicotine , but e‐cigarette users can make compensatory changes (e.g. puff frequency, duration or volume) to achieve desired levels of nicotine in the body …”

Section: Introductionmentioning

confidence: 99%

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

et al. 2020

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Background and Aims Relative pharmacological effects of e-cigarettes and cigarettes during 24 hours of ad-libitum use have not been described. In this study, 24-hour blood plasma nicotine concentrations and 48-hour subjective effects with use of cigarettes and e-cigarettes were measured among dual users. Design Two-arm within-subject cross-over design with preferred e-cigarette or cigarette ad-libitum use over 48 hours. Setting Hospital research ward in San Francisco, California, USA. Participants Thirty-six healthy dual users of e-cigarettes and cigarettes (n = 8, 25% females). Measurements Twenty-four-hour blood plasma nicotine and cotinine concentrations and 48-hour self-reported nicotine withdrawal symptoms and rewarding effects. Findings Analyses used analysis of variance (ANOVA)-based mixed models with order of product (e-cigarette or cigarette) and product type (combustible cigarette or type of e-cigarette) as fixed effects, and subject as a repeated effect. During a 24-hour period, e-cigarettes produced lower nicotine exposure than cigarettes for the majority of users, although 25% received more nicotine from e-cigarettes, which was predicted by more frequent e-cigarette use or greater dependence. Compared to cigarette smoking, nicotine exposure for variable-power tank users was similar, while cig-a-like (t (30) = 2.71, P = 0.011, d = 0.745) and fixed-power tank users (t (30) = 3.37, P = 0.002, d = 0.993) were exposed to less nicotine. Cigarettes were rated higher than e-cigarettes on some desirable subjective effects (e.g. psychological reward, t (322) = 7.24 P < 0.001, d = 0.432), but withdrawal symptom reduction was comparable. No differences were found between e-cigarette types, but Bayes factors indicate that these measures were insensitive.Conclusions During a 24-hour period in a hospital setting in the United States, nicotine exposure for dual users of ecigarettes and cigarettes was similar when using cigarettes or variable-power tank devices only but was lower for those using cig-a-like or fixed-power devices only. Despite lower nicotine levels, all types of e-cigarette were effective in preventing withdrawal symptoms. E-cigarettes were rated less rewarding than cigarettes.

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Section: Introductionmentioning

confidence: 99%

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

et al. 2020

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“…However, e-cigarettes do not burn tobacco. Instead they vaporise e-liquid, a solution that is typically composed of nicotine, propylene glycol (PG) and vegetable glycerine (VG) often supplemented with various flavouring compounds and/or ethanol [1][2][3]. The main benefit of ecigarettes is that they enable nicotine intake without exposure to many other, often hazardous, chemicals which are normally present in tobacco cigarettes [4].…”

Section: Introductionmentioning

confidence: 99%

Nicotine intoxication by e-cigarette liquids: a study of case reports and pathophysiology

Maessen

Wijnhoven

Neijzen

et al. 2019

Clinical Toxicology

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Background: Electronic cigarettes (e-cigarettes), the smokeless alternative to conventional tobacco cigarettes, have become increasingly popular. E-cigarettes vaporise e-liquid, a solution of highly concentrated nicotine, propylene glycol (PG) and vegetable glycerine (VG). With the popularity of e-cigarettes, e-liquid refills have become easily accessible and several cases of intoxication due to the ingestion of e-liquid have been reported. We provide an overview of these cases, their pathophysiology and patients' characteristics. Methods: We carried out a retrospective evaluation of the scientific literature reporting on cases of liquid nicotine intoxication, using the following inclusion criteria: (1) the article is or contains a case report, (2) describes an intoxication with e-liquid, (3) the substance contains nicotine, and (4) intake is oral, intravenous or subcutaneous. Results: We found 26 case reports describing a total of 31 patients who suffered from e-liquid intoxication. All intoxications up to the age of six were reported as unintentional, whereas nearly all cases from ages 13 to 53 were due to suicide attempts. The three most prevalent symptoms of e-liquid intoxication were tachycardia, altered mental status and vomiting. Eleven cases resulted in the death of the patient. In the survivors, the highest plasma concentration of nicotine was 800 mg L À1 , while the lowest concentration in the non-survivors was 1600 mg L À1 . Conclusions: There is a mismatch between the generally accepted lethal oral nicotine dose of 60 mg, resulting in approximately 180 mg L À1 plasma concentration, and the 4.4-to 8.9-fold higher lethal plasma concentrations we found in cases of e-liquid intoxication. In these severe intoxications, plasma cotinine concentration does not act as a more reliable indicator of nicotine intoxication than nicotine itself. The ages of the patients display a bimodal distribution. In patients above the age of 10, intoxication results mainly from suicide attempts rather than accidental ingestion. The role of PG and VG in e-liquid intoxications is remarkably unclear. However, the similarity across nicotine and PG toxicity symptoms leads us to believe a cumulative effect cannot be excluded. ARTICLE HISTORY

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“…A large cross-sectional study of e-cigarette users reported that the transition from vape pens to mods was far more common than the reverse and that a majority of later-generation-device users reported use of a latergeneration device to "obtain a more satisfying hit." 32,33 For the same e-liquid nicotine concentration, there are higher levels of nicotine delivery by mods, which typically include a larger battery, greater power, and higher temperature (all of which can be programmed even higher by the user); therefore, our findings that mods are associated with greater frequency of cigarette smoking at follow-up could be explained by higher levels of nicotine delivery and consumption and nicotine dependence in these individuals. Exposure to greater levels of nicotine may increase dependence on nicotine and thereby result in increases in smoking behavior to attain sufficient nicotine levels.…”

Section: Discussionmentioning

confidence: 79%

“…Alternatively, adolescents and young adults may enjoy the sensations that accompany nicotine use and seek out other forms of nicotine. Findings of several smoke-machine studies [33][34][35] and laboratory studies 33,36,37 have revealed that later-generation devices (eg, mods) produce a greater volume of aerosol and higher nicotine yield than earlier-generation devices (eg, cigalikes or penlike devices) even when nicotine in the e-cigarette solution is held constant. Thus, nicotine dependence may explain part of this association, but in this population, a device that efficiently delivers nicotine did not protect against initiation or maintenance of combustible cigarettes.…”

Section: Discussionmentioning

confidence: 99%

E-cigarette Product Characteristics and Subsequent Frequency of Cigarette Smoking

et al. 2020

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BACKGROUND: There is a dearth of evidence regarding the association of use of electronic cigarettes (e-cigarettes) with certain product characteristics and adolescent and young adult risk of unhealthy tobacco use patterns (eg, frequency of combustible cigarette smoking), which is needed to inform the regulation of e-cigarettes.METHODS: Data were collected via an online survey of participants in the Southern California Children's Health Study from 2015 to 2016 (baseline) and 2016 to 2017 (follow-up) (N = 1312). We evaluated the association of binary categories of 3 nonmutually exclusive characteristics of the e-cigarette used most frequently with the number of cigarettes smoked in the past 30 days at 1-year follow-up. Product characteristics included device (vape pen and/or modifiable electronic cigarette [mod]), use of nicotine in electronic liquid (e-liquid; yes or no), and use for dripping (directly dripping e-liquid onto the device; yes or no).RESULTS: Relative to never e-cigarette users, past-30-day e-cigarette use was associated with greater frequency of past-30-day cigarette smoking at follow-up. Among baseline past-30-day e-cigarette users, participants who used mods (versus vape pens) smoked .6 times as many cigarettes at follow-up (mean: 20.8 vs 1.3 cigarettes; rate ratio = 6.33; 95% confidence interval: 1.64-24.5) after adjustment for sociodemographic characteristics, baseline frequency of cigarette smoking, and number of days of e-cigarette use. After adjustment for device, neither nicotine e-liquid nor dripping were associated with frequency of cigarette smoking. CONCLUSIONS: Baseline mod users (versus vape pen users) smoked more cigarettes in the past 30 days at follow-up. Regulation of e-cigarette device type warrants consideration as a strategy to reduce cigarette smoking among adolescents and young adults who vape.WHAT'S KNOWN ON THIS SUBJECT: Electronic cigarette (e-cigarette) use has been associated with cigarette initiation and greater frequency of smoking among adolescents. It is not yet known whether there are certain product characteristics of e-cigarettes that may increase the frequency of cigarette smoking at follow-up.WHAT THIS STUDY ADDS: Young adults using modifiable (versus penlike) e-cigarette devices at baseline smoked .6 times as many cigarettes in the past 30 days at follow-up. Regulation of e-cigarette product characteristics might reduce the transition from e-cigarettes to heavier cigarette-smoking patterns.

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E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure

Cited by 201 publications

References 201 publications

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

Twenty‐four‐hour subjective and pharmacological effects of ad‐libitum electronic and combustible cigarette use among dual users

Nicotine intoxication by e-cigarette liquids: a study of case reports and pathophysiology

E-cigarette Product Characteristics and Subsequent Frequency of Cigarette Smoking

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