Public Health Consequences of E-Cigarettes (2018) / Chapter Skim
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11 Respiratory Diseases
11 Respiratory Diseases
Pages 405-454
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From page 405... ...
. In addition to the adverse respiratory health effects caused by smoking combustible tobacco products, secondhand smoke exposure has been reported to be associated with significant respiratory morbidities in non‑users (Jayes et al., 2016)
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. Postnatal exposure to tobacco smoke also has been associated with an increased risk of wheeze and upper and lower respiratory tract illnesses in exposed children compared with unexposed children (Jayes et al., 2016)
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From page 407... ...
Therefore, understanding the health effects of e‑cigarettes is dependent on the context of age, current and prior use of combustible tobacco products, and whether the user has preexisting lung conditions such as asthma and COPD. In addition, there is a need to examine the short‑ and long‑term effects of secondhand and thirdhand e‑cigarette aerosols on the respiratory health of non‑users, who may inhale or come
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From page 408... ...
Finally, exposure of the dual user to both combustible tobacco products and e‑cigarette aerosols may cause unique health risks to the respiratory system. CHARACTERIZATION OF DISEASE ENDPOINTS AND INTERMEDIATE OUTCOMES In studying the effects of e‑cigarette use on respiratory disease endpoints, an important question is whether or not e‑cigarette use by itself can lead to the development of chronic respiratory conditions such as asthma and COPD or if e‑cigarette use can worsen preexisting lung conditions compared with people who do not smoke.
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Prospective cohort studies in adolescents and young adult e‑cigarette users without a history of combustible tobacco product use should be performed to determine the likelihood of e‑cigarette use leading to the development of chronic respiratory symptoms or decline in lung function. Furthermore, since asthma is a common respiratory disease of childhood, it is also important to determine if adolescents and young adults with asthma are at increased risk for asthma exacerbations and a more rapid decline in lung function when using e‑cigarettes.
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From page 410... ...
However, since e‑cigarettes, unlike combustible tobacco products, lack substantial sidestream emissions, it is unclear how detrimental exposure to secondhand e‑cigarette emissions is to the non‑user. Further investigations into the effects of e‑cigarette aerosols on the lung defense mechanisms such as cough, MCC, and the innate and adaptive immune system are needed.
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From page 411... ...
reported significant improvement in self‑reported respiratory symptoms of cough/ phlegm at 52 weeks in smokers who switched completely to e‑cigarettes (18 of 130 subjects) and a significant increase in FEF25–75 percent, but not in FEV1 or FVC.
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. E-cigarette receiving 10-second randomized, kit with either e-cigarettes exhalation; clinical trial; "original" (2.4% with 0% (2)
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with those in eCO at all time points; (3) High prevalence of respiratory symptoms was reported at baseline and virtually disappeared very quickly in both quitters and reducers.
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(4) E-cigarette smoking patterns.
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Substantial reduction in combustible tobacco cigarette use also observed in dual users; their mean cigarette/day consumption at baseline decreasing from 20.7 to 5.3 at follow-up 1, 3.7 at follow-up 2, and 3.5 at follow-up 3. Out of 16 asthmatics, 10 were still exclusively using e-cigarettes at 24 months and not smoking combustible tobacco cigarettes throughout the study (single users)
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Cravo et al., n = 419 Randomized, E-cigarette with Combustible Primary 2016 parallel group rechargeable tobacco outcomes: clinical study; battery, atomizer, cigarette AEs, vital combustible capsule with smokers signs, 12-lead tobacco e-liquid; 2% ECG, lung cigarette nicotine; subjects function tests, smokers in combustible hematology, switched to tobacco cigarette clinical e-cigarettes for arm smoked own biochemistry, 12 weeks usual brand urinalysis
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No clinically significant findings in vital signs, electrocardiogram, lung function tests and standard clinical laboratory parameters. AEs reported: more frequent during the first week and then reduced; 1,515 reported AEs, 495 related to nicotine withdrawal symptoms.
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FEF25– 2014a longitudinal 75%, BHR, medical records and ACQ scores; (2) Combustible tobacco cigarette use; (3)
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. Similar reduction in combustible tobacco cigarette smoking was observed in dual users as well (22.4 at baseline to 3.9 at follow-up visit 2; p < 0.001)
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420 PUBLIC HEALTH CONSEQUENCES OF E-CIGARETTES TABLE 11-1 Continued Operationally Sample E-Cigarette Control Defined Reference Size Study Design Product Conditions Outcomes Polosa et al., n = 40 Observational Categoria None (1) >50% 2014b prospective e-cigarette, reduction study following "original" flavor, in number a cohort of 7.4-mg nicotine of cigarettes smokers in a cartridges (no from naturalistic more than 4 baseline and setting after cartridges per day)
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(2) Of these 11 combustible tobacco cigarette reducers, 6 could be classified as sustained heavy reducers at 24 months.
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422 PUBLIC HEALTH CONSEQUENCES OF E-CIGARETTES TABLE 11-1 Continued Operationally Sample E-Cigarette Control Defined Reference Size Study Design Product Conditions Outcomes Polosa et al., n = 48 Reviewed Not stated; varied Age- and (1) Changes 2016b clinical notes of sex- in smoking COPD patients matched behavior and attending COPD e-cigarette clinics; 2 follow- patients use.
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groups. Significant reduction in combustible tobacco cigarette consumption in dual users.
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. tobacco The commercial cigarette combustible ad lib for 5 tobacco cigarette minutes in (Marlboro® Red)
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(5) The combustible tobacco cigarette significantly decreased FEF25, FEF50, and FEF75 in the overall population, particularly due to the significant reductions of FEF25 in smokers and FEF75 in non-smokers while the reduction of FEF50 did not reach the significant levels in either smokers or non-smokers.
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; and (2) comparing pre- versus post-respiratory function among experimental group participants (intergroup comparison)
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and (2) Pulmonary function assessed via spirometry did not change in the relative baseline either group.
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(2) Secondary analysis with non-nicotine e-cigarette in 8 subjects who demonstrated large degrees of inhibition of cough reflex sensitivity.
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No correlation was found between the number of coughs induced by e-cigarette inhalation and subsequent change in cough reflex sensitivity.
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who quit nasal MCC smoking function. without the aid of medical therapy or a device, although they were provided cognitive behavioral treatment.
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(1) SNOT-22 scores were insignificant between groups before the cessation of cigarette smoking; there was a significant difference between the groups at the third-month measurements.
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no: "former user." Cigarette smoking assessed by question "Have you ever smoked, even one puff in your life?
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The combustible tobacco cigarette smoking history, allergic rhinitis was the highest factor that affected the effect of e-cigarettes on history. A variable for asthma.
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(3) Susceptibility to combustible tobacco cigarette smoking (asked about number of days smoked in past 30 days; if said never tried, assessed for susceptibility to combustible tobacco cigarette smoking)
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. Among students with current asthma who had never smoked combustible tobacco cigarettes, ever e-cigarette use was associated with higher odds of being susceptible to combustible tobacco cigarette smoking (AOR = 3.96)
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Lifetime number of cigarettes smoked was categorized as 0 (never smokers) , >0–10, 11–99, and >99 cigarettes.
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. They were attenuated of e-cigarettes with by additional adjustment for lifetime number of cigarettes smoked bronchitic symptoms and secondhand smoke exposure in the home (OR = 1.71, for past and wheeze were and 1.41 for current use)
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use status, respiratory symptoms, demographic characteristics, secondhand smoke exposure) NOTES: 6-MWD = 6-minute walk distance; ACQ = asthma control questionnaire; AE = adverse event; AHR = airway hyperresponsiveness; ANCOVA = analysis of covariance; ANOVA = analysis of variance; AOR = adjusted odds ratios; BHR = bronchial hyperresponsiveness; BL = baseline; C5 = cough reflex sensitivity; CAT = COPD Assessment Test; CO = carbon monoxide; COPD = chronic obstructive pulmonary disease; Cu = urge to cough; eCO = exhaled carbon monoxide; ECG = echocardiogram; FeCO = fractional concentration smokers with respiratory conditions were excluded from the study and subjects in the e‑cigarette randomized arm, although encouraged not to use combustible tobacco cigarettes, did often report dual use (Cravo et al., 2016)
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of carbon monoxide; FeNO = fractional concentration of nitric oxide; FEF25–75% = forced expiratory flow at 25–75 percent of the pulmonary volume; FEV1 = forced expiratory volume; FVC = forced vital capacity; GOLD Stages 1–4 = Global Initiative for Chronic Obstructive Lung Disease Stages of COPD (1 = mild, 2 = moderate; 3 = severe; 4 = very severe) ; MCC = mucociliary clearance; NF = nicotine free; NO = nitric oxide; PEF = peak expiratory flow; SHS = secondhand smoke; SNOT-22 = Sino-Nasal Outcome Test; SoB = shortness of breath.
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Following cessation of combustible tobacco cigarette smoking, this centrally mediated cough reflex returned (Dicpinigaitis, 2017)
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or glycerol e‑cigarette solutions with and without nicotine. They found that mice exposed to tobacco smoke had increased pulmonary inflammation and changes in pulmonary function, including methacholine hyperresponsiveness.
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The authors found a significant increase in interleukin‑1β (IL‑1β) with exposure to e‑cigarette, while combustible tobacco cigarette smoke resulted in significant increases in IL‑1β, IL‑6, TNF‑α expression, and oxidative stress.
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From page 443... ...
, which also used mice and showed impaired bacterial clearance in the lungs of mice. Together, these studies provide evidence that exposure to e‑cigarette aerosols during adolescence and early adulthood is not harmless to the lungs and can result in significant impairments in lung function even in the absence of lung inflammation.
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Laube and colleagues (2017) examined MCC changes in C57BL/6 mice after 3 weeks of daily exposure and found that young adult male mice exposed to PG alone had significantly higher MCC than mice exposed to nicotine/PG aerosol.
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They include large groups of adolescents from three countries and reach similar results, thus providing moderate evidence of an association between respiratory symptoms in adolescents and e‑cigarette use. In non‑users who are exposed to secondhand smoke and in healthy adolescents and young adult users, common respiratory endpoints can include an increase in asthma symptoms and severity and a higher prevalence of upper and greater lower respiratory tract symptoms and infections (Liu et al., 2016; Shargorodsky, 2016; Shargorodsky et al., 2015; Wilson et al., 2013)
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. In addition, there is limited evidence to indicate that e‑cigarette substitution for tobacco product use in established smokers is associated with a decrease in cellular oxidative stress and improved respiratory symptoms and lung function.
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Harm may occur if e‑cigarette use prevents the smoker from quitting entirely and instead prolongs the use of combustible tobacco products through dual use. Harm may also occur in an individual with COPD if single use of an e‑cigarette as a substitute for combustible tobacco cigarettes causes additional airway inflammation in already damaged lungs.
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. Cystic Fibrosis Children and adolescents with other respiratory diseases who use e‑cigarettes may also be at increased risk for worsening of respiratory symptoms.
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2016. Lung function and respiratory symptoms in a random ized smoking cessation trial of electronic cigarettes.
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2011. Environmental tobacco smoke exposure and Chinese schoolchildren's respiratory health: A prospective cohort study.
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2015. Vapors produced by electronic cigarettes and e‑juices with flavor ings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung.
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2017. Electronic cigarette use and respiratory symptoms in adolescents.
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2017. The association between environmental tobacco smoke exposure and childhood respiratory disease: A review.
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2013. Secondhand tobacco smoke exposure and severity of influenza in hospitalized children.
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