Exhalation of alternative tobacco product aerosols differs from cigarette smoke—and may lead to alternative health risks

Karey, Emma; Reed, T. A.; Katsigeorgis, Maria; Farrell, Kayla; Hess, Jade; Gibbon, Grace; Weitzman, Michael; Gordon, Terry

doi:10.1177/1179173x221078200

Cited by 3 publications

(3 citation statements)

References 60 publications

(72 reference statements)

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“…Additionally, tobacco heating systems can also impact the upper respiratory tract, such as the aerosol formed during heating, which enters the respiratory system. This can trigger various reactions and consequences for the upper respiratory tract, including inflammation and other pathological scenarios [8,9].…”

Section: Introductionmentioning

confidence: 99%

Health implications forecast for electronic cigarette users

Vysochyna,

Yashkina

2023

Lik. sprava

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Electronic cigarettes have rapidly gained popularity in the tobacco market, primarily among young adults. Marketers exploit the lack of evidence regarding their health effects and label them as a safe alternative to traditional cigarettes. Our study aims to expand the existing body of evidence on their impact on the human body. Objective: To identify the most significant characteristics of individuals using electronic cigarettes based on statistical analysis of clinical and laboratory examination data. Materials and Methods. The study included 102 participants (main group – 66 individuals using electronic cigarettes as an alternative form of smoking; control group – 36 individuals who did not use electronic or industrial cigarettes) aged 20 to 35 years. Each participant provided written informed consent to participate. Patient examinations included the following parameters: height, weight, body mass index (BMI) calculation; measurement of blood pressure, heart rate, pulse, and respiratory rate; throat swab collection. Results. According to our data, individuals in the main group had higher height, weight, and BMI values. A higher BMI may be associated with excessive stimulation of salivary glands and, consequently, increased gastric secretion and appetite stimulation. Electronic cigarette users had significantly higher blood pressure levels compared to the control group. Users of nicotine delivery systems in throat swabs had significantly higher levels of mucus, coccal flora, and neutrophil percentage, indicating the presence of bacterial agents in the oral cavity mucosa. This may be related to bacterial agents’ dissemination through nicotine delivery devices. We conducted multiple logistic regression analysis with potential patient characteristics. Conclusions. Electronic cigarette users are characterized by higher height, weight, BMI, blood pressure levels compared to non-smoking peers, as well as reduced adaptation potential and a prevalence of parasympathetic nervous system regulation. It was found that a typical electronic cigarette user is a male (OR = 15.9364) with reduced IFZ – adaptive potential of functional abilities (OR = 7.8128) and an abnormal amount of oral cavity flora (OR = 1.7748).

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Section: Introductionmentioning

confidence: 99%

Health implications forecast for electronic cigarette users

Vysochyna,

Yashkina

2023

Lik. sprava

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“…Additionally, e-cigarette users have been shown to practice exclusive nasal exhalation patterns at significantly higher rates than traditional cigarette users. 8 These behavioral differences predispose the nasal cavity to toxicological impacts of e-cigarette use. However, while there has been significant research over the past 10 years regarding the effects of e-cigarette use on the lower airways, including in the context of acute respiratory distress syndrome, diffuse alveolar hemorrhage, and lipid pneumonia, few studies have examined the effects on the upper airway.…”

mentioning

confidence: 99%

“…The large distribution in particle sizes, primarily due to user device power levels, creates differential harmful effects of e‐cigarette use at sites within the upper and lower airways. Additionally, e‐cigarette users have been shown to practice exclusive nasal exhalation patterns at significantly higher rates than traditional cigarette users 8 . These behavioral differences predispose the nasal cavity to toxicological impacts of e‐cigarette use.…”

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confidence: 99%

The Toxicological Effects of e‐Cigarette Use in the Upper Airway: A Scoping Review

Worden,

Hicks,

Hackman

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveWhile evidence continues to emerge on the negative health effects of electronic cigarettes (e‐cigarettes) on the lungs, little is known regarding their deleterious effects on the upper airway. The purpose of this review is to summarize the toxicological effects of e‐cigarettes, and their components, on the upper airway.Data SourcesPubMed, SCOPUS, EMBASE databases.Review MethodsSystematic searches were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines from 2003 to 2023. Studies were included if they investigated the toxicological effects of e‐cigarette exposure on human or animal upper airway tissue. Two authors independently screened, reviewed, and appraised all included articles.ResultsA total of 822 unique articles were identified, of which 53 met inclusion criteria and spanned subsites including the oral cavity (22/53 studies), nasal cavity/nasopharynx (13/53), multiple sites (10/53), larynx (5/53), trachea (2/53), and oropharynx (1/53). The most commonly observed consequences of e‐cigarette use on the upper airway included: proinflammatory (15/53 studies), histological (13/53), cytotoxicity (11/53), genotoxicity (11/53), and procarcinogenic (6/53). E‐cigarette humectants independently induced toxicity at multiple upper airway subsites, however, effects were generally amplified when flavoring(s) and/or nicotine were added. Across almost all studies, exposure to cigarette smoke exhibited increased toxicity in the upper airway compared with exposure to e‐cigarette vapor.ConclusionCurrent data suggest that while e‐cigarettes are generally less harmful than traditional cigarettes, they possess a distinct toxicological profile that is enhanced upon the addition of flavoring(s) and/or nicotine. Future investigations into underexamined subsites, such as the oropharynx and hypopharynx, are needed to comprehensively understand the effects of e‐cigarettes on the upper airway.

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E-Cigarette Use, Cigarette Smoking, and Sex Are Associated With Nasal Microbiome Dysbiosis

Hickman,

Roca,

Zorn

et al. 2024

Nicotine and Tobacco Research

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Introduction Previous research suggests that e-cigarettes can alter immune function, including in the nasal mucosa, in unique ways. The respiratory microbiome plays a key role in respiratory host defense, but the effects of e-cigarettes on the respiratory or nasal microbiome, are not well understood. Methods Using 16S rRNA gene sequencing on nasal samples from adult e-cigarette users, smokers, and nonsmokers, we determined that e-cigarette use and cigarette smoking are associated with differential respiratory microbiome dysbiosis and substantial sex-dependent differences in the nasal microbiome, particularly in e-cigarette users. Results Staphylococcus aureus, a common respiratory pathogen, was more abundant in both e-cigarette users and smokers in comparison with nonsmokers, while Lactobacillus iners, often consider a protective species, was more abundant in smokers but less abundant in e-cigarette users in comparison with nonsmokers. In addition, we identified significant dysbiosis of the nasal microbiome between e-cigarette users and smokers with high versus low serum cotinine levels, an indicator of tobacco product use and toxicant exposure. We also analyzed nasal lavage fluid for immune mediators associated with host-microbiota interactions. Conclusions Our analysis identified disruption of immune mediators in the nose of e-cigarette users and smokers, which is indicative of disrupted respiratory mucosal immune responses. Taken together, our data identified unique, sex-dependent host immune dysfunction associated with e-cigarette use in the nasal mucosa. More broadly, our data highlight the need for continued inclusion and careful consideration of sex as an important variable in the context of toxicant exposures. Implications This is the first study investigating the effects of e-cigarette use and sex on the nasal microbiome, which is considered an important gatekeeper for protecting the lower respiratory tract from pathogens. We found significant sex, exposure group, and serum cotinine level associated differences in the composition of the nasal microbiome, demonstrating the importance of considering sex in future nasal microbiome studies and warranting further investigation of the mechanisms by which e-cigarette use dysregulates nasal immune homeostasis.

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Exhalation of alternative tobacco product aerosols differs from cigarette smoke—and may lead to alternative health risks

Cited by 3 publications

References 60 publications

Health implications forecast for electronic cigarette users

Health implications forecast for electronic cigarette users

The Toxicological Effects of e‐Cigarette Use in the Upper Airway: A Scoping Review

E-Cigarette Use, Cigarette Smoking, and Sex Are Associated With Nasal Microbiome Dysbiosis

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