• Uncategorized

Pulmonary Effects of Smoking Electronic Cigarettes

Mahdi Rahat

Midwestern State University

Bachelor of Science in Respiratory Therapy Program

RESP 4423


Electronic cigarettes denoted as e-cigs are devices made to imitatethe working of conventional cigarettes by delivering nicotine throughinhalation without the combustion of tobacco. In the United States,the e-cigs sector is approximately $1.7 billion, and about 3.4% ofAmericans used electronic cigarettes in 2013 (Sussan et al., 2015).These devices are perceived as safer substitutes for cigarettesbecause it is believed that they produce nicotine that is not mixedwith other toxicants. This paper will explore the pulmonary effectsof consumption of e-cigarettes.

The major question that dominates the e-cigs’ usage debate is, arethese devices safer than the conventional cigarette? Sussan et al.,(2015) found that e-cigs vapor has surprisingly high levels of freeradicals that can have severe repercussions to the human body. Sussan et al., (2015) report that cigarette smoke emits1014free radicals per puff compared to 7×1011for the e-cigs vapor. Grana et al., (2014) report about a studyconducted by Goniewicz and colleagues that analyzed aerosols from 12major brands of electronic cigarettes and compared their toxin levelswith that of a conventional cigarette. The researchers found that“the levels of toxicants in the e-cigs aerosols were one to threeorders of magnitude lowers than smoke from the traditional cigarette”(Grana, 2014, 1978). However, the two articles by Sussan et al., andGrana et al., concluded that there is a need for further studies toassess whether or not the electronic cigarettes are healthysubstitutes for conventional cigarettes.

Several studies show that e-cigs cause the inflammation of theairways. For example, Sussan et al., (2015) found that &quote-cigsexposure resulted in a 58% increase in macrophage inflation thatcauses a modest inflammation response in the airways.&quotA studyconducted to access the pulmonary function of healthy smokerfollowing five minutes of puffing of e-cigarettes found a significantincrease in dynamic air resistance as well as a decrease in theexpired nitric oxide. This made the researchers to conclude that the“use of e-cigarettes constricts peripheral airways as a result ofthe irritant effects of propylene glycol” (Grana, Benowitz, &ampGlantz, 2014). On this note, according to Lerner et al., (2015),fibroblast treated with 1% glycerin or propylene glycol for 24 hoursexhibited a variety of morphological alterations.

Besides, e-cigs exposure has detrimental effects onpulmonary-antibacterial defenses. Exposure to e-cigarette vaporincreases the pulmonary bacterial load as measured in lunghomogenates or bronchoalveolar lavage fluid. A study conducted bySussan et al., (2015), found that mice exposed to e-cigs and treatedwith S. pneumonia bacteria experienced an increase in bacteria loadin culture media four hours after the infection. As such, exposure toelectronic cigarettes hinders bacterial elimination by alveolarmacrophage (Sussan et al., 2015). Additionally, Lerner et al.,(2015) found that exposure to e-cigs aerosols result in diminishedlung glutathione levels which affect the maintenance of cellularredox balance. In another study Beas-2b cells exposed to blue e-cigsaerosols for 15 minutes were collected and analyzed using twodifferent colored lasers. The researchers found that “e-cigsaerosol components attach themselves to cell surfaces submerged undera thin layer of cultural media and result in inflammatory andpro-oxidant” (Lerner et al., 2015).

In conclusion, the e-cigs sector is expanding at a rapid rate inAmerica. One of the major reasons for the rapid expansion of theindustry is the perception that these devices do not have harmfuleffects. Numerous studies have shown that e-cigs contain relativelylower levels of toxicants and free radicals compared to thetraditional cigarette. However, this does not mean that theelectronic cigarettes are safer than the conventional cigarettes.This paper has demonstrated that exposure to e-cigs can result in theinflammation of the airway and alteration of the pulmonaryanti-bacteria defense. However, more studies are needed to establishwhether or not electronic cigarettes are safer substitutes for thetraditional cigarettes.


Grana, R., Benowitz, N., &amp Glantz, S. A. (2014). E-cigarettes: Ascientific review. Circulation, 129(19), 1972-1986.doi:10.1161/circulationaha.114.007667

Lerner, C. A., Sundar, I. K., Yao, H., Gerloff, J., Ossip, D. J.,Mcintosh, S., . . . Rahman, I. (2015). Vapors produced by electroniccigarettes and e-juices with flavorings induce toxicity, oxidativestress, and inflammatory response in lung epithelial cells and inmouse lung. Plos One, 10(2). doi:10.1371/journal.pone.0116732

Sussan, T. E., Gajghate, S., Thimmulappa, R. K., Ma, J., Kim, J.,Sudini, K., . . . Biswal, S. (2015). Exposure to electroniccigarettes impairs pulmonary anti-bacterial and anti-viral defensesin a mouse model. Plos One, 10(2).doi:10.1371/journal.pone.0116861