Security of electronic cigarettes is uncertain. There is little data about their safety, and considerable variability among electric cigarettes and in their liquids and thus the content of aerosols is delivered to the user. Reviews on electrical cigarette safety have reached significantly different conclusions. The World Health Organization (WHO) 2014 report warns of potential risks of using e-cigarettes. US Food and Drug and Food Products (FDA) that are regulated such as nicotine inhalers may be safer than electric cigarettes. A systematic review shows that electronic cigarettes are less harmful than smoking and because they do not contain tobacco and do not involve burning, users can avoid some of the harmful elements normally found in tobacco smoke. However, e-cigarettes can not be considered harmless.
The e-liquid cytotoxicity varies, and contamination with various chemicals has been detected in the liquid. The metal part of the e-cigarette in contact with the e-liquid can contaminate the metal. Many chemicals including carbonyl compounds such as formaldehyde can be inadvertently generated when the nichrome wire (heating element) that touches the e-liquid is heated and chemically treated with the liquid. Normal use of e-cigarettes, and reduced voltage (3.0 V) devices produce very low formaldehyde levels. Next-generation cigarettes used with higher power can produce the same or higher levels of formaldehyde as smoking. A review of 2015 found that this level is the result of overheating under test conditions that bear little resemblance to common usage. The 2015 UK Public Health (PHE) report found that high levels of formaldehyde occur only in overheated "dry-hot". Users detect "dry puff" or "dry blow" and avoid it, and they conclude that "There is no indication that EC users are exposed to dangerous levels of aldehydes." However, e-cigarette users can "learn" to overcome the discomfort due to increased aldehyde formation, when nicotine demand is high enough. E-cigarette users using nicotine-containing devices are exposed to potentially harmful effects. Nicotine is associated with cardiovascular disease, potential birth defects, and poisoning. In vitro , studies of nicotine have linked it to cancer, but carcinogenicity has not been shown in vivo . There is insufficient research to show that nicotine is associated with cancer in humans. The risk may be low from inhalation of propylene glycol and glycerin. No information is available about the long-term effects of inhalation of taste.
E-cigarettes create aerosols composed of fine particle particles and ultrafine, with the majority of particles in the ultrafine range. Steam has been found to contain flavors, propylene glycol, glycerin, nicotine, small amounts of toxins, carcinogens, heavy metals, and metal nanoparticles, and other substances. Exactly what consists of steam varies in composition and concentration at and inside the manufacturer. E-cigarette steam potentially contains harmful substances that are not found in tobacco smoke. The majority of toxic chemicals found in tobacco smoke are absent in e-cigarette vapors. E-cigarette steam contains a lower concentration of potentially toxic chemicals compared to cigarette smoke. Those present, mostly below 1% the appropriate level are permitted by safety standards. But workplace safety standards do not recognize exposure to certain vulnerable groups such as people with medical illness, children, and babies who may be exposed to spent vapors. There is concern that some of the major steam exhaled by e-cigarette users may be inhaled by observers, especially indoors. The use of electronic cigarettes by parents can lead to unintentional health risks in offspring. The 2014 review recommends that e-cigarettes be regulated for consumer safety. There is limited information available on environmental issues surrounding the production, use and disposal of electric cigarettes using cartridges.
Video Safety of electronic cigarettes
Health effects
Worries
Reviews on the safety of electric cigarettes, evaluating roughly the same study, have reached very different conclusions. Due to a variety of methodological issues, severe conflicts of interest, and inconsistent research, no definite conclusions can be determined on the safety of electronic cigarettes. However, e-cigarettes can not be considered harmless. There is little data about their safety, and considerable variability between the vaporizer and in their liquid material and thus the aerosol content is delivered to the user. The health community, pharmaceutical industry, and other groups have raised concerns about the emerging phenomenon of electric cigarettes, including unknown health risks from long-term use of electric cigarettes. Concern is there that the majority of smokers who try to stop with vaping can quit smoking but maintain the intake of nicotine because its long-term effects are not clear. A policy statement by the American Association for Cancer Research and the American Society of Clinical Oncology has reported that "Benefits and dangers should be evaluated with respect to the population as a whole, taking into account the effects on youth, adults, non-smokers, and smokers." (WHO) July 2014 warns about potential risks in children and adolescents, pregnant women, and women of reproductive age regarding the use of e-cigarettes. E-cigarettes have also been found to reduce lung and myocardial function, increase inflammation, and have toxic contents including carcinogens, but to a much lower degree than flammable cigarettes in almost all cases.
It is suggested the precautionary principle is used for electric cigarettes because of the long history of the tobacco crisis, to assess their long-term benefits and effects and to avoid another nicotine crisis. The 2014 review recommends that e-cigarettes be adequately regulated for consumer safety by regulation on the design of electronic products. Production rules and promotion of e-cigarettes can help to reduce some of the adverse effects associated with tobacco use. The entrance of major US tobacco producers, Altria Group, Reynolds American, and Lorillard, to the electric cigarette sector poses many potential public health problems. Instead of pushing to stop, the tobacco industry can market electric cigarettes as a way to get around clean indoor air laws, which promote dual use. This industry can also cause vaper tobacco products, which will increase instead of reducing the overall addiction.
Unknown
The health effects associated with the use of electric cigarettes are largely unknown. The health effects on intensive e-cigarette users are unknown. The effect on the population health of e-cigarettes is unknown. Smokefree.gov, a website run by the Tobacco Control Research Branch of the National Cancer Institute to provide information to help quit smoking, states that "Since e-cigs have not been regulated, there is no way to know how much nicotine is in it. "Although the electric cigarette may be safer than a conventional cigarette, we do not yet know the long-term effects of vaping on the body." The British National Health Service has stated, "Although electric cigarettes may be safer than conventional cigarettes, we do not yet know the long-term effects of vaping on the body." The American Diabetes Association stated "There is no evidence that electric cigarettes are a healthy alternative to smoking." In August 2014, the International Respiratory Community Forum stated that electric cigarettes have not been proven safe. Health Canada has stated that, "their safety, quality, and efficacy remain unknown." The National Institute for Drug Abuse states that "At present no action is taken to confirm their purity or safety, and the long-term health consequences of using e-cigarettes remain unknown."
Positive relative to cigarettes
The 2015 UK Public Health (PHE) report states that electronic cigarettes are estimated to be 95% more dangerous than smoking, although these estimates have been disputed. In June 2014, the Royal College of Physicians stated that, "Based on existing evidence, the RCP believes that electric cigarettes can cause a significant reduction in the prevalence of smoking in the UK, prevent many deaths and episodes of serious illness, and help reduce social inequalities in health is currently exacerbated by tobacco smoking. "A systematic review in 2014 shows that electric cigarettes are less harmful than smoking because there is no tobacco, no burning, and users can avoid some of the harmful elements normally found in tobacco smoke. A review of 2014 found that e-cigarette aerosols contain far less carcinogens than tobacco smoke, and conclude that electric cigarettes "provide a lower disease potential" than traditional cigarettes. A 2015 study found serious adverse events associated with electrical cigarettes were hypotension, seizures, chest pain, rapid heartbeat, disorientation, and congestive heart failure but it was not clear to what extent they were the result of e-cigarettes. Less serious side effects may include abdominal pain, headache, blurred vision, throat and irritation of the mouth, vomiting, nausea, and cough. The WHO report 2014 says "END [electronic nicotine delivery system] poses a serious threat to teens and fetuses." Scientific studies advocate caution before appointing e-cigarettes as something useful but vapers continue to believe that they are beneficial.
Negative
The American Cancer Society has stated, "The makers of electric cigarettes say that the ingredients are" safe ", but this only means that the ingredients have been found safe to eat.Inhaling the substance is not the same as swallowing it is a question of how safe it is to inhale some substance in the vapor e-cigarette to the lungs. "The Canadian Cancer Society has stated that," Some studies have shown that there may be low levels of harmful substances in some e-cigarettes, even if they do not have nicotine. " Since 2009, the FDA has shown that electric cigarettes contain "levels of carcinogens and toxic chemicals that can be detected by which users can be exposed." In the UK, the National Institute for Health and Care Excellence (NICE) guidelines do not recommend e-cigarettes because of questions about the safety, efficacy, and quality of these products. The National Association of County and the US Municipal Health Service have stated, "Public health experts have expressed concern that electric cigarettes can increase nicotine addiction and tobacco use in young people." No long-term study evaluates the use of tobacco in the future as a result of the use of electric cigarettes. E-cigarette steam potentially contains harmful substances that are not found in tobacco smoke.
Maps Safety of electronic cigarettes
Adverse effects
In 2015, the short-term and long-term effects of e-cigarette use remain unclear. Side effects are mostly related to short-term use and the reported adverse effects decrease over time. Long-term studies of the effects of constant use of e-cigarettes are not available. The adverse effects of electric cigarettes on people with cancer are unknown. The 2014 Cochrane Review found no serious adverse effects reported in the trial, but serious events have been reported in the case study.
Evidence shows that they produce less harmful effects than burning tobacco. The most frequently reported effects of vaping versus smoking are to reduce breathlessness, reduce cough, reduce spit, and reduce sore throat. Many of the health benefits associated with switching from tobacco to electric cigarettes include weight loss after quitting and improving exercise tolerance. Vaping may be dangerous because it delays quitting smoking, serving as a gateway to tobacco use in smokers never smoking or leading to the return of smoking in former smokers. Smith, L; Brar, K; Srinivasan, K; Enja, M; Lippmann, S (June 2016). "E-cigarettes: How" safe "they are?". The Journal of Family Practice . 65 (6): 380-385. PMIDÃ, 27474819. Ã, & lt;/ref & gt; Quitting smoking will probably have a far greater beneficial effect on overall health than vaping to reduce the number of cigarettes smoked.
More serious side effects are often associated with quitting smoking including depression, insomnia, and rare anxiety with the use of electric cigarettes. A 2015 study found serious adverse events associated with electrical cigarettes were hypotension, seizures, chest pain, rapid heartbeat, disorientation, and congestive heart failure but it was not clear to what extent they were the result of e-cigarettes. Less serious side effects include abdominal pain, headache, blurred vision, throat and mouth irritation, vomiting, nausea, and cough. The most commonly reported short-term adverse effects are irritation of the mouth and throat, dry cough, and nausea. The majority of adverse events reported are nausea, vomiting, dizziness and oral irritation. Some case reports have found a health hazard posed by electric cigarettes in many countries, such as the US and Europe; the most common effects are dryness of the mouth and throat. Some e-cigarette users experience side effects such as throat irritation that could be due to nicotine exposure, nicotine solvents, or toxins in the aerosol.
The US Food and Drug Administration Center for Tobacco Products reported between 2008 and early 2012, 47 cases of side effects associated with e-cigarettes, of which eight were taken seriously. Two peer-reviewed reports of lipoid pneumonia are linked to the use of e-cigarettes, as well as two reports in Spanish and English media. Men from the United Kingdom reportedly died of severe lipoid pneumonia in 2011. Reports to the Food and Drug Administration (FDA) for mild side effects identified by using e-cigarettes include headache, chest pain, nausea, and cough. The main adverse events reported to the FDA include hospitalization for pneumonia, congestive heart failure, seizures, rapid heart rate, and burns. But there is no proven direct connection between these effects and the use of electric cigarettes, and some of them may be caused by health problems. Many of the negative effects observed from the use of e-cigarettes concerning the nervous system and the sensory system may be associated with an overdose or nicotine withdrawal. Because e-cigarettes are meant to be used repeatedly, they can be easily used for long periods of time, which can contribute to an increase in adverse effects. E-cigarettes are associated with fewer side effects than nicotine patches.
Poisoning
Nicotine intoxication associated with an electric cigarette includes ingestion, inhalation, or absorption through the skin or the eyes. Accidental intoxication can result from the use of undiluted nicotine when incorrectly used as prepared e-liquid. E-cigarettes involve nicotine exposure in children. Unintentional exposures to pediatric patients include ingestion of e-liquids and inhaling electrical cigarette vapors. Strangling the components of electric cigarettes is a potential risk. It is recommended that youth access to electric cigarettes is prohibited.
Four adults died in the US and Europe, after deliberately ingesting fluids. Two children, one in the US in 2014 and one in Israel in 2013, died after ingesting liquid nicotine. Deaths due to accidental nicotine intoxication are extremely rare.
Calls to US toxic control centers associated with e-cigarette exposure involving inhalation, eye exposure, skin exposure, and consumption, both in adults and children. Side effects are mild, moderate, and serious involving adults and young children. The small effects correlated with e-cigarette liquid poisoning are tachycardia, tremor, chest pain and hypertension. The more serious effects are bradycardia, hypotension, nausea, respiratory paralysis, atrial fibrillation and dyspnea. Correct correlation is not fully known between this effect and e-cigarettes. 58% of e-cigarette calls to a US poison control center are related to children aged 5 years or younger. Electronic cigarette calls have a greater chance of reporting adverse impacts and greater opportunities to report moderate or large adverse effects than traditional cigarette calls. Most of the traditional cigarette and cigarette calls are small effects. Severe outcomes were more than 2.5 times more frequent in children exposed to e-cigarettes and nicotine e-liquid compared to traditional cigarettes. E-cigarette sales are roughly equivalent to just 3.5% of traditional cigarette sales, but from the total number of traditional electric and cigarette cigarette calls to US poison control centers by December 2014, reported e-cigarette calls are 44%.
From September 1, 2010 through December 31, 2014, the most common adverse effects on electrically and e-liquid cigarettes reported to US poison control centers are: Ingestion exposure causes vomiting, nausea, drowsiness, tachycardia, or agitation; Inhalation/Nasal exposure results in nausea, vomiting, dizziness, anxiety, or headache; eye exposure causes eye irritation or pain, red eyes or conjunctivitis, blurred vision, headache, or abrasion of the cornea; some exposure routes cause eye irritation or pain, vomiting, red eye or conjunctivitis, nausea, or cough; and skin exposure resulting in nausea, dizziness, vomiting, headache, or tachycardia. The 10 most common side effects of e-cigarettes and e-liquids reported to US poison control centers are vomiting (40.4%), eye irritation or pain (20.3%), nausea (16.8%), eye red or conjunctivitis (10.5%), dizziness (7.5%), tachycardia (7.1%), drowsiness (7.1%), agitation (6.3%), headache (4.8%) , and cough (4.5%). In nine calls reported, the affected person declares the device leaked. In the five reported calls, individuals use e-liquid for their eyes instead of using eye drops. In one call reported, the baby was given e-liquid by an adult who thought it was a baby medicine. There are also reports of components of choking electric cigarettes.
From January 1, 2016 and April 30, 2016, the American Association of Poison Control Centers (AAPCC) reported 623 exposures related to e-cigarettes. The AAPCC reports 3,067 exposures related to e-cigarettes and nicotine liquid by 2015 and 3,783 by 2014. From September 1, 2010 to December 31, 2014, there were at least 5,970 e-cigarette calls to the US poison control center. Calls to US toxic control centers related to electric cigarettes increased between September 2010 and February 2014, and from the total number of cigarette and e-cigarette calls, e-cigarette calls increased from 0.3% to 41.7%. Calls to US toxic control centers associated with e-cigarette liquid poisoning increased from 1 in September 2010 to 215 for February 2014. The electronic cigarette call was 401 for April 2014. California Poison Control System reported 35 cases of e-cigarette contacts from 2010 until 2012, 14 in children and 25 came from unintentional contact.
It is possible that inhalation, consumption, or skin contact can expose people to a high level of nicotine. Concerns with exposure to e-liquids include leaks or spills and contact with contaminants in e-liquids. It may be very risky for children, pregnant women, and nursing mothers. The liquid quickly absorbs into the skin. Nicotine in e-liquids can be harmful to the baby. Even some e-liquids may be deadly for a small child. Excessive amount of nicotine for children capable of fatal result is 0.1-0.2 mg/kg body weight. Less than 1 tablespoon of contact or swallowing e-liquid may cause nausea, vomiting, cardiac arrest, seizures, or coma. Accidents swallowing only 6 mg may be lethal for children.
Children are prone to consumption because of their curiosity and desire for oral exploration. E-cigarettes are packed in colorful containers and children can be attracted to the scented liquid. More youth-oriented flavors include "My Birthday Cake" or "Tutti Frutti Gumballs". Many nicotine cartridges and fluid bottles can not bear children to stop the contact or consumption of the nicotine by children accidentally. The "Open" e-cigarette device, with a refill tank for e-liquid, is believed to be the biggest risk to children. It is recommended that e-cigarettes be kept in a safe place, where children and pets do not have access to them.
Nicotine toxicity is of concern when e-cigarette solutions are swallowed intentionally by adults as a suicidal overdose. Six people tried to commit suicide by injecting e-liquid. One teenager tried to commit suicide by swallowing e-liquid. Three deaths were reported to be caused by swallowing or injecting nicotine-containing e-liquids. Excessive amounts of nicotine for adults capable of fatal consequences are 0.5-1 mg/kg body weight. The oral lethal dose for an adult is about 30-60 mg. However, the widely used LD 50 estimate of around 0.8 mg/kg is questioned in the 2013 review, as some documented human cases survive at much higher doses; The 2013 review shows that the lower limit that produces fatal events is 500-1000 mg of digested nicotine, which is equivalent to 6.5-13 mg/kg orally. Reports of serious adverse events associated with acute nicotine toxicity resulting in hospitalization are extremely rare. Deaths from intentional toxicity of nicotine are not uncommon. Remove device labels and e-liquid may reduce unintentional exposures. Child-resistant packaging and clues for safe e-liquid handling can minimize some risks. In January 2016, the Children's Poisoning Prevention Act of the Year 2015 was passed into law in the US, which requires packing of children.
There is an inconsistent labeling of the actual nicotine content in the e-liquid cartridges of some brands, and some nicotine have been found in the 'no nicotine' liquid. The 2015 PHE report notes overall labeling accuracy has increased. Most of the labeled inaccurate samples contain less nicotine than otherwise stated. Due to the inappropriateness of nicotine content, it is recommended that electric cigarette companies develop quality standards with respect to nicotine content.
Due to the lack of standard and production control, e-liquid purity is generally unreliable, and testing of some products has shown the presence of harmful substances. The German Cancer Research Center in Germany released a report stating that electric cigarettes can not be considered safe, in part because of technical errors that have been found. This includes cartridge leakage, accidental contact with nicotine when replacing cartridges, and potential undesirable overdose. The Australian Therapeutic Goods Administration (TGA) has stated that, "Some studies abroad indicate that nicotine-containing electronic cigarettes can be harmful, provide unreliable doses of nicotine (above or below the quantity mentioned), or contain chemicals toxic or carcinogenic, or leaking, nicotine, the leaking nicotine is a toxic hazard to electronic cigarette users, as well as others around them, especially children. "
Cannabinoid-containing e-liquides require long and complex processing, some available online without toxicological and clinical evaluation. It is estimated that the crushed cannabinoids at lower temperatures are safer because it creates toxins in smaller amounts than burning hot marijuana. The health effects of vaping marijuana formulations are largely unknown.
Most e-cigarettes use lithium batteries, improper usage that can cause accidents. It has been recommended that manufacturing quality standards be put in place to prevent such accidents. Better product design and standards may reduce some of the risks. Concern exists from the risks associated with e-cigarette outbursts for children and adults.
Some batteries are not designed properly, made with poor quality components, or have defects. Major injuries were caused by battery explosions and fires. A man experiences a unilateral corneoscleral laceration with a tissue of prolapsed iris and hyphemato to the eye area when an e-cigarette explodes in his mouth. A young man suffered bilateral corneal burns to the eye area when an e-cigarette exploded near his chest. The E-cigarette explosion has resulted in burns, missing teeth, broken neck bones, and acid battery contacts to the face, mouth and eyes. A man died when an electric cigarette filling exploded and caught fire next to the oxygen equipment. Home and car fires and skin burns have resulted from several explosions. The explosion is the result of extended charging, use of unsuitable chargers, or design flaws. There is a potential risk for observers from e-cigarette explosions. There is also the risk of property damage as a result of combustible burning materials from e-cigarette explosions. The US Fire Administration said that 25 fires and explosions were caused by electric cigarettes between 2009 and August 2014. In the UK, fire service calls increased from 43 in 2013 to 62 in 2014. The 2015 PHE report concluded that the fire risks of electric cigarettes "seem comparable with similar electrical goods ". The battery explosion is caused by an increase in internal battery temperature and some have resulted in severe skin burns. There is a small risk of battery explosion on the device being modified to increase battery power. Since e-cigarettes are not subject to product safety testing, they may not have safety designs to avoid overheating, thermal runaway, and battery failures including fires and explosions. There is insufficient product labeling to inform users of potential serious hazards. The risk of serious side effects is low, but the consequences can be disastrous with regard to e-cigarette outbursts. The victim has filed a lawsuit to restitution from the e-cigarette explosion. Adverse effects may be under-reported because reports to the FDA are voluntary.
In January 2015, the US Federal Aviation Administration issued a safety alert to the airline that e-cigarettes should not be allowed in the checked baggage after a review of fire safety issues, including two fires caused by e-cigarettes in the checked baggage. The International Civil Aviation Organization, a United Nations agency, also recommends banning e-cigarettes in checked luggage. A spokeswoman for the Tobacco Electronic Tobacco Electronic Association said that e-cigarettes do not cause problems if they are packaged properly in static-free packaging, but the irresponsible person can occasionally pack them carelessly or damage them. Use of in-flight e-cigarettes is prohibited in the US.
Users can change many devices, such as using it to manage other drugs like marijuana. Mixing E-liquid is another way users tamper with e-cigarettes. Mixing liquids in unclean areas leads to the risk of contamination. Users can add various flavors and thinners. Vodka or other alcohol forms may also be added. The addition of alcohol or nicotine can expose users to more toxins, especially when added in combination. Some ingredients in e-liquids can be flammable; this risk is more apprehensive for inexperienced users or do not use protective equipment. Users can adjust the voltage of some e-cigarettes. The amount of steam generated is controlled by battery power, which has caused some users to adjust their electric cigarettes to increase battery power to get a stronger "nicotine" blow, but there is a small risk of battery explosion. Some users add more or more batteries to non-adjustable electric cigarettes, which can cause battery leaks or explosions. The extent to which teens change e-cigarettes, such as dripping liquids into a sprayer to get more nicotine intake, is unknown.
Toxicology
The long-term health effects of using electric cigarettes are unknown. The long-term health effects of the main nicotine and propylene glycol chemicals in aerosols have not been fully understood. There is limited peer-reviewed data on e-cigarette toxicity for complete toxicological evaluation, and their cytotoxicity is unknown. The chemicals and toxins included in the e-cigarette have not been fully disclosed and their safety is not guaranteed. They are similar in toxicity to other nicotine replacement products, but the standard e-cigarette production is a variable standard, and many of the results may be more toxic than nicotine replacement products. The UK National Health Service notes that the toxic chemicals found by the FDA are at the rate of one thousandth of cigarette smoke, and that while there is no certainty that these small footprints are harmless, preliminary test results are convincing. While there is variability in materials and concentrations of ingredients in e-cigarette liquids, tobacco smoke contains thousands of chemicals, most of which are not understood and many are known to be harmful.
Carcinogenicity
Concerns about the carcinogenicity of electric cigarettes arise from both nicotine and from other chemicals that may be in the vapor. Regarding nicotine, there is evidence from in vitro and animal studies that nicotine may have a role as a tumor promoter, but carcinogenicity has not been shown in vivo. A Surgeon General report of the United States 2014 states that a single randomized, single trial "does not show a strong role for nicotine in promoting carcinogenesis in humans". They conclude that "There is not enough data to conclude that the cause of nicotine or contribute to cancer in humans, but there is evidence to suggest a possible risk of oral, esophageal or pancreatic cancer." Nicotine in the form of nicotine replacement products is less risky than smoking, and they have not been shown to be linked to cancer in the real world.
There is no long-term study of cancer risk associated with a possible level of exposure to the carcinogens identified in the vapors. In May 2014, Cancer Research UK stated that there were "unpublished early results showing that electric cigarettes promote tumor growth in human cells." Electrically charged cigarettes trigger the breaking of DNA strands and decrease the viability of in vitro cells . A 2013 study found some samples of e-cigarette vapor have cytotoxic effects on heart muscle cells, although the effect is less than that of cigarette smoke. In October 2012, the World Medical Association stated, "Manufacturers and marketers of electric cigarettes often claim that the use of their products is a safe alternative to smoking, especially since they do not produce carcinogenic fumes, but no research has been done to determine that the steam is not carcinogenic, and there are other potential risks associated with this device. "
Because nicotine-containing e-liquids are made from tobacco they can contain impurities such as cotinine, anabasine, anatabine, myosmine and beta-nicotyrine. The majority of evaluated e-cigarettes include tobacco-specific carcinogenic nitrosamines (TSNAs); heavy metals such as cadmium, nickel, and lead; and toluene carcinogens. However, compared to traditional cigarette smoke, the levels of toxic substances identified in steam e-cigarettes are 9- to 450-fold. E-liquid with tin is cytotoxic. E-cigarettes can not be considered absolutely safe because there is no safe level for carcinogens.
A 2014 review found higher levels of carcinogens and toxins compared with FDA-approved nicotine inhalers, suggesting that FDA-approved devices may deliver nicotine safer. In 2014, The World Lung Foundation stated that "The researchers found that many e-cigarettes contain toxins, contaminants and carcinogens that contradict the industry's image of its products as a purer and healthier alternative They also found a variation in the amount of nicotine delivered by different brands.None of this information is available to consumers so they really do not know what they swallow, or how much. "
A review of 2014 found "Various chemicals and ultrafine particles that are known to be toxic, carcinogenic and/or causing respiratory and cardiac disturbances have been identified in e-cigarette aerosols, cartridges, refill liquids and environmental emissions." Some of the methods used to analyze e-cigarette chemistry in review studies are evaluated validated.
Propylene glycol and other content
The main basic ingredients of the liquid solution are propylene glycol and glycerin. Approximately 20% to 27% of propylene glycol and glycerin-based particles are inhaled. The long-term effects of inhaled propylene glycol have not been studied, and are unknown. The effect of inhaled glycerin is unknown. Exposure to propylene glycol may cause irritation of the eyes and respiratory tract. The risks of inhalation of propylene glycol and glycerin may be low. Propylene glycol and glycerin have not been proven to be safe. Some studies suggest that propylene glycol emissions may cause respiratory irritation and increase the likelihood of developing asthma. Long-term inhalation of propylene glycol in the room may increase the risk for children to develop asthma. To reduce the risk, most electric cigarette companies start using water and glycerin instead of propylene glycol. Inhaled glycerine may cause lipoid pneumonia.
Some e-cigarette products have acrolein identified in aerosols. This can be produced when the glycerin is heated to a higher temperature. Akrolein may cause irritation of the upper respiratory tract. Acrolein levels are reduced by up to 60% in dual users and 80% for those who are completely switching to electric cigarettes when compared to traditional cigarettes. E-cigarette steam has been found to create oxidants and reactive oxygen species (OX/ROS). OX/ROS can react with other substances in steam because they are highly reactive. Although e-cigarettes have been found to contain OX/ROS about 100 times less than in cigarette smoke, they may induce significant biological effects.
The toxicity of e-cigarettes and e-liquids can vary greatly, as there are differences in construction and materials in shipping devices, the types and origin of materials in e-liquid, and the use or not of using good manufacturing practices and quality control approaches. If the exposure of aerosols to propylene glycol and glycerol rises to levels that would be considered exposure in relation to workplace settings, it would make sense to investigate the health of the exposed person. The short-term toxicity of e-cigarette use appears to be low, with the exception of some people with reactive airways.
Flavoring
The propylene glycol and/or glycerin essential mixtures may comprise natural or artificial ingredients to provide flavor. The e-liquid cytotoxicity varies, and contamination with various chemicals has been detected in the liquid. Some liquids are highly toxic and others have little or no cytotoxicity. Cytotoxicity is mostly due to the amount and amount of flavor added. Because nicotine has a bitter taste, nicotine fluids contain chemicals to mask nicotine flavor. Liquids contain aromatic substances such as tobacco, fruit, vanilla, caramel and coffee. Generally, these additives are described inappropriately, using terms such as "vegetable flavoring". Although they are approved for human consumption, there is no study of the short-term or long-term effects of inhaling. Security inhaling flavors is largely unknown, and their safety has not been determined by the Food Producers Association and Extracts. In some cases, the e-liquid contains excessive flavoring, which can cause irritation and inflammation of the respiratory and cardiovascular systems. Some flavors are considered toxic and some of them resemble carcinogens. Some artificial flavors are known to be cytotoxic. Steam without taste is less cytotoxic than flavored vapors. A 2012 study showed that in embryonic and adult cellular models, some vapor-like substances are not found in cytotoxic tobacco smoke.
Cinnamaldehyde has been described as highly in vitro cytotoxic ingredients in cinnamon refill liquids. Cinnamaldehyde has been identified as cytotoxic with an amount about 400 times less than that allowed by the US Environmental Protection Agency. A study in 2018 in vitro found that exposing lung cells to liquids or vapors containing cinnamaldehyde caused significant and rapid damage to their cilia and mitochondria. This led the study authors to conclude that "cinnamaldehyde inhalation exposure may increase the risk of respiratory infections in e-cigarette users." Some e-liquids containing cinnamaldehyde stimulate TRPA1, which may cause lung effects. E-liquids contain toxic aldehydes and reactive oxygen species (ROS). Many flavors are known of aldehydes, such as anisaldehid, cinnamaldehyde, and isovaleraldehyde. A 2012 study found a very toxic taste of butterscotch with one liquid and two others having low toxicity. An in vitro 2014 study showed that the use of balsamic e-cigarettes without nicotine can activate the release of proinflammatory cytokines in pulmonary epithelial cells and keratinocytes. Some additives may be added to reduce irritation of the pharynx. Long-term toxicity is subject to additives and contaminants in e-liquids.
Certain flavors contain diacetyl and acetyl propionyl which give a butter flavor. Diacetyl and acetyl propionyl are associated with bronchiolitis obliterans. Review 2015 is recommended for the specific regulation of diacetyl and acetyl propionyl in e-liquid, which are safe when ingested but have been associated with respiratory distress when inhaled. Both diacetyl and acetyl-propionyl have been found in the above concentrations recommended by the US National Institute for Occupational Safety and Health. Diacetyl is usually found at lower levels in e-cigarettes than in traditional cigarettes. Concerns arise that flavors and additives in electric cigarettes can cause illness, including popcorn lungs. Cardiovascular effects, including a variety of flavors and fragrances, are unknown. The irritation of butyl acetate, diethyl carbonate, benzoic acid, quinoline, bis (2-ethylhexyl) phthalate, and 2,6-dimethyl phenol present as the materials declared in e-liquid. The exact materials of electric cigarettes are unknown.
Formaldehyde
The IARC has categorized formaldehyde as a human carcinogen, and acetaldehyde is categorized as potentially carcinogenic to humans. Aldehydes may cause harmful health effects; although, in most cases, the amount inhaled is less than that of traditional cigarettes. Many chemical compounds are inadvertently generated from electric cigarettes, especially carbonyl compounds such as formaldehyde, acetaldehyde, acrolein, and glioksal by e-liquid chemical reaction when the hearth nickel (heating element) is heated, to a high temperature. These compounds are often identified in e-cigarette aerosols. The fluid containing propylene glycol produces the most carbonyl in the e-cigarette aerosol. The level of toxic chemicals in the vapor is found to be 1 to 2 orders smaller than that of cigarette smoke but greater than that of the nicotine inhaler. Almost all e-cigarettes are evaluated, the toxic carbonylation and the irritants are identified. Reports on the level of toxic chemicals are inconsistent. This includes research showing that toxic levels in electric cigarettes may be higher than cigarette smoke.
Battery output voltage affects the level of carbonyl substances in the vapor. Some new e-cigarettes allow users to increase the amount of steam and nicotine provided by modifying the battery's output voltage. Higher voltage (5.0 V) e-cigarettes can emit carcinogens including formaldehyde at levels comparable to cigarette smoke, while reduced voltage (3.0Ã V) produces aerosols with formaldehyde and acetaldehyde levels of about 13 and 807 times less in cigarette smoke. "Dripping", in which liquid is dripped directly onto the atomizer, can create carbonyls including formaldehyde.
The 2015 PHE report found that normal use of e-cigarettes resulted in very low aldehyde levels. The normal use of electric cigarettes produces very low levels of formaldehyde, and in their normal settings produce very low formaldehyde levels. Next-generation cigarettes used with higher power can produce the same or higher levels of formaldehyde as smoking. A review of 2015 found that this level is the result of overheating under test conditions that bear little resemblance to common usage. The 2015 PHE report found that by applying maximum power and increasing the time the device is used in the puffer engine, thermal e-fluid can degrade and produce high levels of formaldehyde. Users detect "dry puffs" and avoid them, and they conclude that "There is no indication that EC users are exposed to dangerous levels of aldehydes." However, e-cigarette users can "learn" to overcome the discomfort due to increased aldehyde formation, when nicotine demand is high enough.
Nicotine
Pregnant women, nursing mothers, and parents are more sensitive to nicotine than others. There are security issues with nicotine exposure from e-cigarettes, which can lead to addiction and other side effects. Nicotine is considered a potentially lethal poison. Concerns arise that vaping can be harmful by exposing users to the toxic levels of nicotine. At low numbers, it has a mild analgesic effect. At fairly high doses, nicotine can cause nausea, vomiting, diarrhea, saliva, bradyarrhythmias, and possible seizures and hypoventilation. However, at the low amount of nicotine provided by e-cigarettes, a fatal overdose of use is unlikely; Conversely, a strong amount of nicotine in e-cigarette liquids may be toxic if accidentally ingested or absorbed through the skin. The effects of nicotine health on infants and children are unclear.
E-cigarettes give nicotine to the blood faster than nicotine inhalers. Levels are above users of nicotine replacement products. E-cigarettes appear to have a nicotine nicotine profile closer to nicotine replacement products than with traditional cigarettes. How efficient different electronic cigarettes give nicotine is unclear. Serum cotinine levels are comparable to traditional cigarettes, but they are not harmonious and depend on users and devices. The level of nicotine in blood increases gradually and takes more time to reach peak concentrations with e-cigarettes than with traditional cigarettes.
First generation device
When compared with traditional cigarettes, older devices typically transmit nicotine in low amounts. The use of e-cigarettes can be attributed to substantial nicotine spreading, resulting in plasma nicotine concentrations comparable to traditional cigarettes. This is caused by minute particles of nicotine in the vapor, which allows rapid delivery into the bloodstream. Nicotine shipped from an electric cigarette enters the body more slowly than a traditional cigarette. Studies show that inexperienced users get a moderate amount of nicotine from electric cigarettes. Concerns increase over the amount of inconsistent nicotine delivered when drawing on the device.
Next generation tools
Next-generation cigarettes give nicotine more effectively than first generation electric cigarettes. The next generation model with concentrated nicotine fluids can deliver nicotine at the same rate as traditional cigarettes. E-cigarette with a powerful battery hot solution for higher temperatures, which can increase blood nicotine levels to traditional cigarettes. Research shows that experienced e-cigarette users can obtain nicotine from electric cigarettes as traditional cigarettes. Then a nicotine-containing e-cigarette that increases heart rate is comparable to traditional cigarettes.
Concerns
The health effects of long-term nicotine use are unknown. It may be several decades before the long-term health effects of inhaled nicotine vapor are known. This is not recommended for non-smokers. Nicotine affects almost every cell in the body. Nicotine can cause high blood pressure and abnormal heart rhythms. Vapers that get higher amounts of nicotine in blood may be correlated with increased heart rate. Nicotine can have adverse effects on lipids, leading to insulin resistance. and may decrease coronary blood flow. Nicotine lowers estrogen levels and has been associated with early menopause in women. Nicotine can have properties that promote cancer, therefore long-term use may be harmless. Nicotine can cause variations in neuroplasticity in the brain. Nicotine can make cancer therapy less effective.
Youth
Children are more sensitive to nicotine than adults. In youth, nicotine can affect the ability to connect with higher cognitive functional processes, later achievements, and the possibility of nicotine addiction to life. Teens who develop the brain are very sensitive to the harmful effects of nicotine. Short periods of exposure to regular or occasional nicotine exposure in adolescence are given long-term neurobehavioral damage. In August 2014, the American Heart Association noted that "e-cigarettes can encourage and promote nicotine addiction, especially in children." A policy statement by the UK School of Public Health has stated, "The main concern for everyone in public health is that children and young people are subjected to bulk commercials of electric cigarettes.There is a danger that electric cigarettes will lead to young and non-smokers becoming nicotine addiction and smoking.The evidence from the US supports these concerns. "
Metal
There is limited evidence of long-term exposure to metals. Exposure to levels and types of metals found in aerosols depends on the material and other manufacturing design of the heating element. E-cigarettes contain some contamination with small amounts of metals in the emissions but it is unlikely that this amount will cause a serious risk to the health of the users. The device itself can contribute to the toxicity of small amounts of silicates and heavy metals found in liquids and vapors, as they have metal parts in contact with e-liquids. Low levels of chromium, lead, and potentially harmful nickel metal have been found in emissions. Chromium and nickel nanoparticles have also been found.
Metals can affect the nervous system. Overview 2013 discovers metals and nanoparticles associated with respiratory and disease disorders. A review of 2014 found a large number of tin, metal, and silicate particles derived from various components of electrically released cigarettes to aerosols, resulting in exposure that could be higher than with cigarette smoke. A 2013 study found metal particles in aerosols were at levels 10-50 times less than those permitted in inhalation drugs. The 2014 review suggests that there is no evidence of aerosol contamination with metals that justify health problems.
Comparison of toxic levels in e-cigarette aerosol
Abbreviations: ? G , micrograms; ng , nanogram; ND, undetected.
* Fifteen puffs were selected to estimate the delivery of nicotine from a traditional cigarette.
Effects on respiration and lung function
The risk to the lungs is not fully understood, and there are concerns about the negative effects on lung function. There is limited evidence of long-term health effects to the lungs. Many of the ingredients used in e-fluids have not been checked in the lungs. The effect of e-cigarette use on asthma and other respiratory diseases is unknown. A review of 2015 found that electric cigarettes can induce acute lung disease. A 2015 study found that an electric vapor can induce oxidative stress in pulmonary endothelial cells. Constant lung inflammation as a result of steam can lead to lung pathogenesis and cause serious illness, including chronic obstructive pulmonary disease and fibrosis. Limited evidence suggests that electric cigarettes produce fewer short-term effects on lung function than traditional cigarettes. A 2014 case report looked at the correlation between sub-acute bronchiolitis and vaping. After the vaping stops, the symptoms improve.
Long-term effects on respiratory flow resistance are unknown. E-cigarettes can harm the respiratory system. The direct effect of an electric cigarette after 5 minutes of use in lung function leads to increased resistance to pulmonary airflow. The 2013 review found an instant increase of airway resistance after using one e-cigarette. Any reported adverse effects on cardiovascular and respiratory function after short-term use of electric cigarettes are mild compared with cigarette smoke. When used in the short term, electric cigarettes produce increased respiratory resistance compared to traditional cigarettes. The use of electric cigarettes can cause respiratory illness among adolescents.
No data were available for long-term cardiovascular effects. No published research is available on vaping and thrombosis, platelet reactivity, atherosclerosis, or vascular function. Nicotine particles in the vapor may increase the risk of cardiac arrhythmias and hypertension that may place some users, especially those with atherosclerosis or other cardiovascular risk factors, at significant risk of acute coronary syndromes. Several case reports documented possible cardiovascular side effects of e-cigarette use, the majority associated with improper use. Although e-cigarettes are anticipated to produce fewer harmful substances than traditional cigarettes, limited evidence supporting those relative has a reduced cardiovascular risk. The use of e-cigarettes leads to sympathomimetic effects due to nicotine intake. It is said that there may be risks for harmful effects, including cardiomyopathy induced tachycardia. E-nicotine-containing cigarettes may have a lower cardiovascular effect than nicotine-containing nicotine. Short-term physiological effects include increased blood pressure and heart rate. A 2012 case report found a correlation between atrial paroxysmal and vaping fibrillation.
Comparable to traditional cigarettes, electric cigarette particles are small enough to enter the alveoli, allowing the absorption of nicotine. These particles are also small enough to enter the lungs and enter the systemic circulation. Local pulmonary toxicity can occur because metal nanoparticles can settle in the alveolar sac of the lung. Electric cigarette companies claim that particulates produced by electric cigarettes are too small to store in the alveoli. Different devices produce different particle sizes and cause different deposition in the respiratory tract, even from the same nicotine fluid. Aerosol production from electric cigarettes during vaping decreases, requiring stronger suction to produce the same aerosol volume. Stronger suckers can affect the deposition of substances into the lungs. Reports in the literature have shown respiratory and cardiovascular effects by these smaller size particles, suggesting potential health problems.
Other effects
Concern is about the immunological effects of e-liquid, and animal analysis shows that e-liquid vapors appear to have adverse effects on the immune system. There are reports of electric cigarettes that cause an immune system reaction involving inflammation of the gastrointestinal system. Long-term use may increase the risk of tuberculosis. It is possible that electric cigarettes can harm the periodontium due to the effects of nicotine on gum tissue and the immune system. Some of the health effects associated with the use of electric cigarettes may include recurrent ulcerative colitis, lipoid pneumonia, acute eosinophilic pneumonitis, sub acute bronchial toxicity, reversible cerebral vasoconstriction syndrome, and chronic idiopathic neutrophilia reversal.
Aerosol and e-liquid
Aerosol electrical cigarettes are generated when the e-liquid reaches a temperature of about 100-250 ° C in a room. Users inhale aerosols, commonly called steam, not cigarette smoke. In physics, the vapor is a substance in the gas phase while the aerosol is a suspension of small particles of liquid, solid or both in the gas. Aerosols are composed of liquid sub-micron particles of viscous vapor, most of which comprise propylene glycol, glycerol, water, flavorings, nicotine, and other chemicals. After sucking, inhale aerosols move from the device to the mouth and lungs. The particle size distribution and the number of particles emitted by electrical cigarettes such as traditional cigarettes, with the majority of particles in the ultrafine range.
After the aerosol is inhaled, it is exhaled. Emissions from electronic cigarettes are not comparable to environmental pollution or cigarette smoke because their chemical properties and composition are completely different. The particles are larger, with an average size of 600 nm in the inhaled aerosol and 300 nm in the exhaled vapor. Bystanders are exposed to these particles from exhaled e-cigarette vapors. There is concern that some of the major steam exhaled by e-cigarette users can be inhaled by observers, especially indoors, and has significant adverse effects. Since e-cigarettes involve the aerosolization process, it is recommended that no significant amount of carbon monoxide be present. Thus, cardiocirculatory effects caused by carbon monoxide are not possible. The use of electronic cigarettes by parents can lead to unintentional health risks in offspring. E-cigarettes pose many safety problems for children. For example, indoor surfaces can accumulate nicotine where e-cigarettes are used, which may be inhaled by children, especially children, long after they are used.
E-liquid is a mixture used in steam products such as electronic cigarettes. The main ingredients in e-liquids are usually propylene glycol, glycerin, nicotine, and flavorings. However, there are e-liquids that are sold without propylene glycol, nicotine, or flavor. The fluid usually contains 95% propylene glycol and glycerin. The flavor may be natural or artificial. About 8,000 flavors exist in 2014. There are many e-liquid manufacturers in the US and around the world. Although there is currently no US Food and Drug manufacturing standard (FDA) for e-liquid, the FDA has proposed a regulation that is expected to be completed by the end of 2015. Industry standards have been created and published by the American E-Liquid Manufacturing Standards Association (AEMSA).
Effects during pregnancy
There is concern about exposure of pregnant women to e-cigarette steam through direct use or through exhaled vapors. There is no evidence to suggest that electrically safe cigarettes are used for pregnant women. No amount of nicotine is safe for pregnant women. By 2014, there is no conclusion about the possible dangers of pregnant women using e-cigarettes, and there is growing research about the negative effects of nicotine on prenatal brain development. E-cigarettes are considered harmful to the fetus during pregnancy if e-cigarettes are used by the mother. Nicotine is harmful to the growing fetus. Nicotine accumulates in the fetus because it passes through the placenta.
In 2015, the long-term issues of electric cigarettes in both the mother and the unborn baby are unknown. Prenatal nicotine exposure is associated with adverse effects on developing fetuses, including effects for the normal growth of endocrine, reproductive, respiratory, cardiovascular, and neurologic systems. Prenatal nicotine exposure is associated with lower birth weight than other infants, stillbirths, sudden infant death syndromes, and changes in normal brain development. Exposure to prenatal nicotine is associated with asthma and wheezing that can continue into adulthood. Exposure to nicotine gestational age is associated with many neurological deficits. Prenatal exposure has been linked to obesity, diabetes, high cholesterol and high blood pressure in minors. Exposure to prenatal nicotine in women can lead to early menarche. Babies are born with necrosis enterocolitis due to the use of e-cigarettes during pregnancy.
In what ways e-liquid ingredients can affect the unknown fetus. The toxicity of e-liquid flavor is higher in embryonic stem cells compared to differentiated lung fibroblasts, which causes concerns about pregnant women who are exposed to second-hand steam. There are concerns about the health impact of pediatric exposure to secondhand e-cigarette vapors and third-hand. The Surgeon General 2014 report found "that nicotine adversely affects maternal and fetal health during pregnancy, and nicotine exposure during fetal development has adverse consequences for the development of the brain." The belief that electric cigarettes are safer than traditional cigarettes can increase their use in pregnant women. The toxic effects identified with e-cigarette refills on stem cells can be defined as embryonic death or birth defects. Because e-cigarettes are not validated as a cessation device, it may contain nicotine at an inconsistent rate and potentially harmful additives, allowing e-cigarettes to be used among pregnant women to reduce smoking puts this group at substantial risk. There are concerns for lactating women using e-cigarettes, because of lack of data on propylene glycol transfer to breast milk.
Environmental impact
There is limited available information about environmental issues related to the production, use and disposal of the cartoon e-cigarette models. In 2014, no formal research has been done to evaluate the environmental impact of the manufacture or disposal of any electric cigarette parts including battery or nicotine production. By 2014, it is uncertain whether nicotine in e-liquids is nicotine in the United States Pharmacopoeia level, tobacco extract, or synthetic nicotine when questioning the environmental impact of how it is made. It is unclear what method of making is used to make nicotine used in electric cigarettes. Emissions from making nicotine can be great from manufacturing if not properly controlled. Some brands of electric cigarettes using cartridges claim that their products are 'environmentally friendly' or 'green', although there are no supporting studies. Some authors argue that such marketing can increase sales and increase interest in e-cigarettes, especially among minors.
It is unclear how many traditional cigarettes can be compared with using an e-cigarette that uses cartridges for the average user. Information is limited to the energy and materials used for the production of electric cigarettes versus traditional cigarettes, for comparable use. E-cigarettes can be made manually put together in small factories, or they can be made in automatic lines on a much larger scale. Larger plants will produce greater emissions into the surrounding environment, and thus will have greater environmental impact. Although some brands have begun to recycle services for their cartridges and e-cigarette batteries, prevalence
Source of the article : Wikipedia
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