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    Evaluation of electronic cigarette liquids and vapour for thepresence of selected inhalation toxins.

    Journal: Nicotine & Tobacco Research

    Manuscript ID: NTR-2014-374.R2

    Manuscript Type: Original Investigation

    Date Submitted by the Author: 18-Aug-2014

    Complete List of Authors: Farsalinos, Konstantinos; Onassis Cardiac Surgery Center, Cardiology

    Kistler, Kurt; The Pennsylvania State University, ChemistryGillman, Gene; Enthalpy Analytical,Voudris, Vassilis; Onassis Cardiac Surgey Center, Cardiology

    Keywords: Public health, Biochemistry, Health consequences, Prevention

    Manuscripts submitted to Nicotine & Tobacco Research

    Nicotine & Tobacco Research Advance Access published September 1, 2014

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    Title: Evaluation of electronic cigarette liquids and aerosol for the presence of selected

    inhalation toxins.

    Authors: Konstantinos E. Farsalinos, MD1, Kurt A. Kistler, PhD

    2, Gene Gillman, PhD

    3, Vassilis

    Voudris, PhD

    1

    1 Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674,

    Greece.

    2Department of Chemistry, The Pennsylvania State University Brandywine, 25 Yearsley Mill

    Road, Media, Pennsylvania 19063, USA.

    3Enthalpy Analytical, Inc., 800 Capitola Drive, Suite 1, Durham, NC 27713.

    Corresponding author

    Page 1 of 27 Manuscripts submitted to Nicotine & Tobacco Research

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    Abstract

    Introduction. The purpose of this study was to evaluate sweet-flavoured electronic cigarette

    (EC) liquids for the presence of diacetyl (DA) and acetyl propionyl (AP), which are chemicals

    approved for food use but are associated with respiratory disease when inhaled.

    Methods. In total, 159 samples were purchased from 36 manufacturers and retailers from 7

    countries. Additionally, three liquids were prepared by dissolving a concentrated flavour sample

    of known DA and AP levels at 5%, 10% and 20% concentration in a mixture of propylene glycol

    and glycerol. Aerosol produced by an EC was analyzed to determine the concentration of DA

    and AP.

    Results.DA and AP were found in 74.2% of the samples, with more samples containing DA.

    Similar concentrations were found in liquid and aerosol for both chemicals. The median daily

    exposure levels were 56g/day (IQR: 26-278g/day) for DA and 91g/day (IQR: 20-432g/day)

    for AP. They were slightly lower than the strict NIOSH-defined safety limits for occupational

    Page 2 of 27Manuscripts submitted to Nicotine & Tobacco Research

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    INTRODUCTION

    Electronic cigarettes (ECs) are novel nicotine-delivery products which have gained

    popularity among smokers in recent years (Regan et al., 2013). They deliver nicotine in aerosol

    form through heating a nicotine-containing solution resulting in the production of visible

    vapour. Besides nicotine delivery, they address the whole smoking ritual and psycho-

    behavioural dependence through sensory stimulation and motor simulation (Farsalinos &

    Stimson, 2014).

    Sensory stimulation is perceived from EC use both by the throat hit induced during

    aerosol inhalation (Farsalinos et al., 2014a) as well as by the use of flavoured liquids. The use of

    flavourings has resulted in a large debate among public health professionals and regulators,

    suggesting that they can be attractive to youth. A recent survey of dedicated users (vapers)

    concluded that flavours variability contributes to both perceived pleasure and the effort to reduce

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    to specific flavours (Farsalinos et al., 2013b; Romagna et al., 2013; Bahl et al., 2012), indicating

    that further research is certainly needed in this area.

    Besides the lack of studies for the effects of flavouring substances when inhaled, there

    are some chemicals which, although approved for ingestion, have already established adverse

    health effects when inhaled. A characteristic example of this is diacetyl (DA, Figure 1). This

    substance, also known as 2,3-butanedione, is a member of a general class of organic compounds

    referred to as diketones, -diketones or -dicarbonyls. It is responsible