Abstract
BackgroundElectronic cigarettes (e-cigarettes) are popular alternatives to conventional cigarettes among adult smokers wishing to reduce their exposure to harmful smoke constituents. However, little information exists on the relative internal exposures resulting from the exclusive or dual use of e-cigarettes.MethodsMeasurements of product use; adverse events; changes in smoking urge; and blood, urine and exhaled breath biomarkers of exposure (BoE) representing toxicants believed to contribute to smoking related diseases were made at baseline and after five days of product use in 105 clinically-confined smokers randomized into groups that partially or completely substituted their usual brand combustible cigarette with commercial e-cigarettes, or discontinued all nicotine and tobacco products.ResultsSubjects switching to e-cigarettes had significantly lower levels (29 %–95 %) of urinary BoEs after 5 days. Nicotine equivalents declined by 25 %–40 %. Dual users who substituted half of their self-reported daily cigarette consumption with e-cigarettes experienced 7 %–38 % reductions, but had increases (1 %–20 %) in nicotine equivalents. Blood nicotine biomarker levels were lower in the cessation (75 %–96 %) and e-cigarette use groups (11 %–83 %); dual users had no significant reductions. All groups experienced significant decreases in exhaled CO (27 %–89 %). Exhaled NO increases (46 %–63 %) were observed in the cessation and e-cigarette use groups; dual users had minimal changes. By Day 5, all groups had greater reductions in smoking urge compared to cessation. However, reductions were larger in the dual use group. No serious adverse events were observed.ConclusionsExposures to harmful smoke toxicants were observed to be lower in smokers who completely or partially replaced their cigarettes with e-cigarettes over five days.
Highlights
Electronic cigarettes (e-cigarettes) are popular alternatives to conventional cigarettes among adult smokers wishing to reduce their exposure to harmful smoke constituents
By eliminating the tobacco combustion processes that lead to the formation of many of the known harmful chemical constituents that are abundantly present in cigarette smoke, e-cigarette aerosols have a much simpler chemical composition which may result in less exposure to combustion cigarette smoke toxicants [3,4,5,6,7,8]
The mean reported cigarette consumption at Screening ranged from approximately 15 cigarettes per day (CPD) to 21 CPD, with subjects to be randomized to exclusive use of the electronic cigarette products reporting fewer CPD than those randomized to the dual use and cessation groups
Summary
Electronic cigarettes (e-cigarettes) are popular alternatives to conventional cigarettes among adult smokers wishing to reduce their exposure to harmful smoke constituents. The combined efforts of governmental, educational and public health interests have reduced smoking to the lowest levels in recent decades, over 40 million Americans continue to smoke [2]. This reality suggests that novel approaches to reduce the burden of smoking-associated morbidity and mortality are needed. Exposures to cigarette smoke constituents that result from dual use may be anticipated to depend on both the extent of daily uses of the respective products, as well as any conscious or subconscious changes in puffing topography consequent to any nicotine or sensory deficits that may derive from the partial substitution of cigarettes by e-cigarettes. A more recent study of adult smokers who switched to using only e-cigarettes and to dual use of e-cigarettes and conventional cigarettes showed significant reductions in exposure to carbon monoxide and the toxicant acrolein over a four-week period [14]
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