Research articleMain and side stream effects of electronic cigarettes
Introduction
Over the last decade, electronic cigarettes (e-cigarettes, also named electronic nicotine delivery systems), that emulate smoking with a smoke-free technique are increasingly prevalent on the market in Western countries. By 2025, the global e-cigarette market is expected to surpass $50 billion. E-cigarettes are a new trend in the modern world and the public's perception differs about their health effects. The tobacco-free nature and the fewer perceived health aspects of vaping are some of the reasons for the significant increasing trend of e-cigarette use, especially among young people. Today, there are more than 10 million e-cigarette users around the world, mainly in the United States, the United Kingdom, France and other European countries (Margham et al., 2016). The legitimacy of e-cigarettes varies, and many countries impose restrictions on or ban the sale and use of e-cigarettes, such as in Australia, Brazil and Canada (Global Tobacco Control,, Trager,). Recently, the US Food and Drug Administration (FDA) announced new regulations that bring e-cigarettes under the same regulations as tobacco (US Food and Drug Administration).
The first inventor of the e-cigarette designed a device through which it was possible to inhale a hot vapor with a smoke flavor. The suggested device was different from Hon Lik's modern e-cigarette (invented and commercialized in China in 2003), but the thought was in the same direction. Under the hypothesis that all the damage and negative consequences arise from burning tobacco, if this was prevented, then the problem would be solved. Thus, paper and tobacco smoke were replaced with warm “aromatic air” (“An Interview with the Inventor of the Electronic Cigarette”, Herbert A Gilbert).
So far, e-cigarettes aggressive marketing resulted in four generations of devices with distinct capabilities. There are several device models (e.g. disposable, rechargeable, pen-style, tank-style) and brands (around 500 (Klager et al., 2017)), but generally their main parts are the power unit (battery), the electric sprayer (producing hot vapor or otherwise “mist”) and the replaceable cartridge containing the e-liquid that is vented and inhaled, when aspirated into the mouthpiece (Etter, 2010). The main constituents of e-liquids are flavors (commercially available 7700 flavors) (Klager et al., 2017) and usually nicotine, which are dissolved in propylene glycol (PG) and/or vegetable glycerol (VG) (Etter, 2010, Schaller et al., 2013, Cheng, 2014). E-cigarettes can potentially emit harmful substances, including nicotine, and its related derivatives and impurities (e.g. nitrosamines, myosmine, cotinine, anatabine, anabasine, and β-nicotyrine), heavy metals (e.g. Cr), Volatile Organic Compounds (VOCs) such as acetaldehyde, acrolein, formaldehyde, polycyclic aromatic compounds (PAHs), and particles (Margham et al., 2016) (“E-Cigarette Use Among Youth and Young Adults: A report of the Surgeon General” 2016)). This was recently revealed in a human analysis study of 5105 participants; urine samples of e-cigarette users showed greater concentrations of nicotine, tobacco-specific nitrosamines, VOCs, and metals compared to non-users, but in lower concentrations compared to cigarette smokers or both users of e-cigarettes and tobacco smokers (Goniewicz et al., 2018).
Boosted by the increasing worldwide prevalence of e-cigarettes and the subsequent growth among youth, there is a societal demand for more knowledge and better understanding of e-cigarettes' effects. Since e-cigarettes are not totally emission free devices but deliver some of the toxicant profile of tobacco smoking to users, a holistic approach on vaping side effects is explored and discussed. The aim of the present study is to raise public awareness and interest towards e-cigarettes wide use and further contribute to more knowledge regarding their safety. So far, limited research has been conducted, conflicting results were published and therefore many unresolved safety and environmental concerns exist. Therefore, in this review, e-cigarette related documentation is presented, issues addressing health and safety threats are highlighted, and special emphasis is given to the neglected environmental aspects.
Section snippets
VOCs sampling and analysis
The aerosol from e-cigarettes consists of specific VOCs associated with the flavors of the e-liquids. The main analytical methods used for exhaled breath VOCs determination are gas chromatography-flame ionization detector (GC/FID) (Margham et al., 2016), gas chromatography-mass spectrometry (GC/MS) (Butler et al., 2015, Peace et al., 2017), thermal desorption (TD-GC/MS) (Schober et al., 2013, Herrington et al., 2015, Marco and Grimalt, 2015), ion mobility spectrometry, IMS (Ulanowska and Ligor,
Medical aspects
In general, there is a lack of long-term epidemiological data on e-cigarette health effects. Nevertheless, their short-term effects remain a popular research task among the medical community. In this content, their impact on the cardiovascular system was recently reviewed by Qasim (Qasim et al., 2017). A step ahead, are the serious concerns raised after the increased risk observed on thrombogenesis as a result of the short term exposure to e-cigarettes (Qasim et al., 2018). The latter is of
Environmental aspects of e-cigarettes
Last but not least, is the addition of new solid wastes (both electronic and plastic waste) to the environment and their unexplored environmental consequences. E-cigarettes producers claim that e-cigarettes are “eco-friendly”, but this is probably a marketing strategy (Chang, 2014). E-cigarettes are increasing and probably require specialized waste management.
Another issue of major concern is the appropriate disposing of “vape” cartridges and lithium ion batteries. Lithium-ion batteries
Conclusions
E-cigarettes are non-combustible tobacco products, where the e-liquid (a mixture of nicotine, various compositions of flavorings, PG and VG, and other ingredients) is heated, to create an aerosol that is inhaled by the user. They have emerged as a hot trend in modern society and present high variability in the composition of flavoring and on device configurations. Their growing popularity is mainly based on the easily inhalable nicotine amounts and the aerosolized e-liquids (e.g. particle
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