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Fourth generation e-cigarette vaping induces transient lung inflammation and gas exchanges disturbances: results from two randomized clinical trials

Martin Chaumont, Philippe van de Borne, Alfred Bernard, Alain Van Muylem, Guillaume Deprez, Julien Ullmo, Eliza Starczewska, Rachid Briki, Quentin de Hemptinne, Wael Zaher, Nadia Debbas
American Journal of Physiology. Lung Cellular and Molecular Physiology 2019 February 6
30724099

BACKGROUND: When heated by an electronic cigarette, propylene glycol and glycerol produce a nicotine-carrying-aerosol. This hygroscopic/hyperosmolar aerosol can deposit deep within the lung. Whether these deposits trigger local inflammation and disturb pulmonary gas exchanges is not known.

AIMS: To assess the acute effects of high-wattage electronic cigarette vaping with or without nicotine on lung inflammation biomarkers, transcutaneous gas tensions, and pulmonary function tests in young and healthy tobacco-smokers. Acute effects of vaping without nicotine on arterial blood gas tensions were also assessed in heavy-smokers suspected of coronary artery disease.

METHODS: Using a single-blind within-subjects study design, 25 young tobacco-smokers underwent three experimental sessions in random order: sham-vaping, vaping with and without nicotine at 60 Watts. Twenty heavy-smokers were also exposed to sham-vaping (n=10) or vaping without nicotine (n=10) in an open-label randomized-parallel study.

RESULTS: In the young tobacco-smokers, when compared to sham-vaping: 1) serum club-cell protein-16 increased after vaping without nicotine (mean±SEM, ‑0.5±0.2µg.L-1 vs. +1.1±0.3µg.L-1 ; P=0.013) and vaping with nicotine (+1.2±0.3µg.L-1 ; P=0.009); 2) transcutaneous oxygen tension decreased for 60-minutes after vaping without nicotine (nadir,‑0.3±1mmHg vs. ‑15.3±2.3mmHg; P<0.001) and for 80-minutes after vaping with nicotine (nadir, ‑19.6±2.8mmHg; P<0.001). Compared to sham-vaping, vaping without nicotine decreased arterial oxygen tension for 5-minutes in heavy-smokers patients (+5.4±3.3mmHg vs. ‑5.4±1.9mmHg; P=0.012).

CONCLUSIONS: Acute vaping of propylene glycol/glycerol aerosol at high wattage with or without nicotine induces airway epithelial injury and sustained decrement in transcutaneous oxygen tension in young tobacco-smokers. Intense vaping conditions also transiently impair arterial oxygen tension in heavy-smokers.

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