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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

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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

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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