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Original Research: TOBACCO CESSATION AND PREVENTION |

Short-term Pulmonary Effects of Using an Electronic CigaretteImmediate Respiratory Effects of e-Cigarette Use: Impact on Respiratory Flow Resistance, Impedance, and Exhaled Nitric Oxide

Constantine I. Vardavas, MD, MPH, PhD; Nektarios Anagnostopoulos, MD; Marios Kougias, MD; Vassiliki Evangelopoulou, MD; Gregory N. Connolly, DMD, MPH; Panagiotis K. Behrakis, MD, PhD, FCCP
Author and Funding Information

From the Center for Global Tobacco Control(Drs Vardavas, Connolly, and Behrakis), Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA; the Smoking and Lung Cancer Research Center (Drs Vardavas, Anagnostopoulos, Kougias, Evangelopoulou, and Behrakis), Hellenic Cancer Society, Athens, Greece; and the Laboratory of Respiratory Physiology (Drs Anagnostopoulos, Kougias, and Behrakis), Department of Medicine, University of Athens, Greece.

Correspondence to: Constantine I. Vardavas, MD, MPH, PhD, Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, Landmark, 3rd Floor E, Boston, MA 02115; e-mail: vardavas@hsph.harvard.edu


For editorial comment see page 1371

Funding: This project was partially supported by internal funds of the Hellenic Cancer Society, Greece.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1400-1406. doi:10.1378/chest.11-2443
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Background:  Debate exists over the scientific evidence for claims that electronic cigarettes (e-cigarettes) have no health-related ramifications. This study aimed to assess whether using an e-cigarette for 5 min has an impact on the pulmonary function tests and fraction of exhaled nitric oxide (Feno) of healthy adult smokers.

Methods:  Thirty healthy smokers (aged 19-56 years, 14 men) participated in this laboratory-based experimental vs control group study. Ab lib use of an e-cigarette for 5 min with the cartridge included (experimental group, n = 30) or removed from the device (control group, n = 10) was assessed.

Results:  Using an e-cigarette for 5 min led to an immediate decrease in Feno within the experimental group by 2.14 ppb (P = .005) but not in the control group (P = .859). Total respiratory impedance at 5 Hz in the experimental group was found to also increase by 0.033 kPa/(L/s) (P < .001), and flow respiratory resistance at 5 Hz, 10 Hz, and 20 Hz also statistically increased. Regression analyses controlling for baseline measurements indicated a statistically significant decrease in Feno and an increase in impedance by 0.04 kPa/(L/s) (P = .003), respiratory resistance at 5 Hz by 0.04 kPa/(L/s) (P = .003), at 10 Hz by 0.034 kPa/(L/s) (P = .008), at 20 Hz by 0.043 kPa/(L/s) (P = .007), and overall peripheral airway resistance (β, 0.042 kPa/[L/s]; P = .024), after using an e-cigarette.

Conclusions:  e-Cigarettes assessed in the context of this study were found to have immediate adverse physiologic effects after short-term use that are similar to some of the effects seen with tobacco smoking; however, the long-term health effects of e-cigarette use are unknown but potentially adverse and worthy of further investigation.


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