Cherry-Flavored e-Cigarettes Linked to Lung Irritant

Liam Davenport

February 01, 2016

Use of flavored e-cigarettes, particularly cherry-flavored, may expose users to a respiratory irritant at levels higher than occurs with conventional cigarettes, investigators warn.

In a laboratory study of more than 140 commonly used flavors of e-cigarettes, the team found that regular use of flavored e-cigarettes often results in exposure to benzaldehyde. Such exposure was significantly increased with cherry-flavored products.

Although many flavorings used in e-cigarettes are considered safe in food products, benzaldehyde, an aromatic aldehyde used in food and cosmetics, has been shown in previous animal and occupational exposure studies to cause respiratory airway irritation.

"As e-cigarette popularity increases, respiratory clinicians need to be aware of potential risks that may result from use," investigators, led by Maciej Goniewicz, PhD, PharmD, assistant professor of oncology, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, write.

"Given the uncertainty surrounding adverse health effects stemming from long-term inhalation of flavouring ingredients such as benzaldehyde, patients should be asked about use of flavoured products, particularly patients with respiratory diseases," they add.

The research was published online January 29 in Thorax.

Worst Culprit

The team measured benzaldehyde levels in aerosol generated by e-cigarettes containing the following flavored nicotine solutions: berry/tropical fruit (n = 40), tobacco (n = 37), alcohol related/drink (n = 15), chocolate/sweet flavor (n = 11), coffee/tea (n = 11), mint/menthol (n = 10), cherry (n = 10), and nonidentifiable flavors, such as Indian Summer and Cosmopolitan (n = 11).

A protocol was used to simulate smoking, at an inhalation time of 1.8 seconds and a puff volume of 70 ml, with a 17-second interval between puffs. For each flavor, 30 puffs were generated in two groups of 15, separated by 5 minutes.

On the assumption that a user puffs an e-cigarette 163 times a day, the daily inhaled dose was determined. This degree of exposure was compared with the typical exposure of a healthy worker over an 8-hour shift to the permissible exposure limit (PEL) of benzaldehyde, as defined by the US Workplace Environmental Exposure Level Guides.

In all, 108 products yielded detectable levels of benzaldehyde, defined as 0.025 μg/30 puffs. The highest levels were detected in cherry-flavored products, at 5.129 - 141.2 μg/30 puffs; these levels were significantly higher than those in other products (P < .0001), which were in the range of 0.025 - 10.27 μg/30 puffs.

It was calculated that the benzaldehyde dose from 30 puffs of flavored e-cigarette was often higher than that detected from conventional cigarettes. The median daily inhaled benzaldehyde dose from cherry-flavored e-cigarettes was estimated to be 70.3 μg, more than 1000 times higher than the PEL.

"Users of cherry-flavoured products may inhale significantly higher doses of benzaldehyde compared with users of other flavoured products," the authors write.

"Although e-cigarettes may be a promising harm reduction tool for smokers, findings indicate that using these products could result in repeated inhalation of benzaldehyde, with long-term users risking regular exposure to the substance," they add.

The study was supported by the Medical University of Silesia, the Institute of Occupational and Environmental Health, the NIDA/NIH, and the FDA Center for Tobacco Products. Several coauthors are employees of the Institute of Occupational Medicine and Environmental Health. One coauthor accepted personal fees from the eSmoking Institute, in Poznan, Poland, and nonfinancial support from Chic Group LTD, a manufacturer of e-cigarettes in Poland, outside of the submitted work.

Thorax. Published online January 29, 2016. Full text

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