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The dangers of passive exposure to aerosols from electronic cigarettes is one of the factors considered in connection with electronic cigarettes, WHO believes pr. date, that passive exposure to aerosols from electronic cigarettes involves health risks. They recommend on this basis that electronic cigarettes should not be allowed to be used indoors, and that they are more or less regulated as regular cigarettes. The potential health effects of passive smoking of electronic cigarettes can be linked to various substances in the aerosol and are typical associated with hazards related to exposure to Propylene Glycol, Glycerin, aroma and other additives, heavy metals and carcinogens - not to mention nicotine. Research on electronic cigarettes are not extensive, and there are few studies that address electronic cigarettes adequately, or in a scientific useable manner. Several overviews of the present research is conducted all over the world. The Norwegian Institute of Public Health (FHI) and the Cochrane Collaboration for example have both performed review-reports, albeit slightly different - with virtually the same conclusions. Another institution that also has presented their own surveys and research are the National Institute for Alcohol and Drug Research (SIRUS). The question about nicotine from passive exposure to aerosols from electronic cigarettes have been actualized by FHI presenting their overview of research on electronic cigarettes, where nicotine from passive exposure to aerosols from electronic cigarettes could be seen as a weighty factor in relation to the regulation of electronic cigarettes. WHO recommends as mentioned, that accoeding to current research or knowledge-status, the use of electronic cigarettes indoors should be prohibited . It must be mentioned that the WHO emphasizes that the recommendations can change very quickly. Regarding nicotine from passive exposure to aerosols from electronic cigarettes to two fairly new surveys are ofte cited, Flouris et al (2013) and ballbar et al (2014). A "readers digest" presentation of what these two surveys find might be in place. Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function (Flouris et al, 2013) is unfortunately an article that must be purchased, and we relate here only to the publicly available summary. It seems as though the research maintains a high academic standard when it comes to selection and method, but as mentioned this assessment is based on the summary. The survey seems to be a controlled randomized study. The survey will assess the acute or immediate effect of electronic cigarettes on serum cotinine (serum cotinine is a measure of how much nicotine a person has been exposed to) and lung function. They look at both passive and active use. The researchers found virtually identical results for serum cotinine for both users of electronic cigarettes and regular cigarettes, which suggests that one gets roughly the same amount of nicotine from both types of cigarette. This applies to both active and passive exposure and to tobacco smoke and aerosol from electronic cigarettes. Regarding pulmonary function, the picture are totally different, here the electronic cigarettes did not affect lung function in any noticable degree - in heavy contrast to the ordinary cigarettes. The survey therefore seems unambiguously positive in relation to electronic cigarettes and nicotine, the user receives nicotine equivalent to a regular cigarette, while avoiding reduction of lung function. The survey has received some criticism for not being a proper examination of passive exposure to aerosols from electronic cigarettes, without having read the survey methodology chapter, it seems anyway from various comments, that this criticism may be correct. This do not affect the results and measures. Cigarettes vs. E-cigarettes: Passive exposure at home Measured by Means of airborne marker and biomarkers (Ballbar et al, 2014) is an openly accessible article that discusses passive exposure to aerosols from electronic cigarettes in the home. Also this study seems to be of high quality, although this survey use a convenience-sample. The authors present the survey results in a table. The table shows the measure of nicotine in the air, cotinine in saliva and cotinine in urine. Variables are typical number of cigarettes smoked and the number of hours of exposure to tobacco smoke, or exposure to aerosols from electronic cigarettes. There is also a control group neither exposed to tobacco smoke nor aerosol from electronic cigarettes. Regarding the number of cigarettes smoked in relation to the number of electronic cigarettes used (antall elektroniske sigaretter brukt), this is somewhat difficult to estimate - few people Smoker electronic cigarette pr. day. In the table there is therefore only one row for "electronic cigarette variable", this variable is called "All overexposed = 2 hours / day". For ordinary cigarettes there are varaibles for both the number of cigarettes smoked, and time exposed to tobacco smoke. The only row among these variables that seem suited to compare electronic cigarettes to, is the row labeled "No. of hours / day exposed at home "and the value" = 2 hours / day. " These seem comparable, although it is not clear that it is in the home exposure happens when it comes to electronic cigarettes. The numbers seems clear. When it comes to nicotine in the air, regular cigarettes delivers about 20 times as much nicotine to the air as an electronic cigarette does - 1,90mg nicotine / m3 against 0,11mg nicotine / m3. Moreover, the lowest measurement for regular cigarettes was 0,69mg nicotine/ m3 nicone compared to 0,06mg nicotine / m3,the lowest measurement for electronic cigarettes. The highest reading for regular cigarettes was 4,54mg nicotine / m3 compared to 0,32mg nicotine/m3 as the highest reding for the electronic cigarette. As seen is the lowest measurement for regular cigarettes here twice as high as the highest reading for electronic cigarettes. Not equally big is the difference when it comes to cotinine in saliva, it seems that one gets in a little over twice as much nicotine from passive exposure to tobacco smoke as by exposure to aerosol from electronic cigarettes. The figures are 0.58 ng cotinine / ml (normal tobacco smoke) against 0,24ng cotinine / ml (aerosol from electronic cigarettes). When it comes to tobacco smoke, the lowest measurement is 0,27ng cotinine / ml and the highest is 0,97ng cotinine / ml. For aerosol from electronic cigarettes is the lowest measurement is 0,15ng cotinine / ml and the highest is 0,31ng cotinine / ml. We can see that the lowest measure for tobacco smoke is approximately equal to the highest reading from an electronic cigarette. Measurements of cotinine in urine is almost similar for both types of exposure. Passive smoke exposure gives a urinary cotinine level 2,88ng cotinine / ml, and passive exposure to aerosols from electronic cigarettes provide a urine cotinine level 2,64ng cotinine / ml. Nor are the differences between the highest and lowest measuring tobacco smoke exposure and exposure to aerosols from electronic cigarettes so big. Lowest urinary cotinine measurement to tobacco smoke exposure is 1,23ng cotinine / ml, and the highest reading is 8,67ng cotinine / ml. For exposure to aerosols from electronic cigarettes is the lowest measurement is 0,70ng cotinine / ml, and the highest reading is 4,04ng cotinine / ml. The researchers conclude in this report that there are higher levels of nicotine in the air in homes where there used electronic cigarettes compared to homes where there are no-smoking (approximately ten times more), that biomarkers related to nicotine intake have approximately the same values ??for aerosol from electronic cigarettes and tobacco smoke - and that passive exposure to aerosols from electronic cigarettes leads to uptake of nicotine. It seems a little strange at this study is that even if the electronic cigarette delivers approximately 20 times lesser amount of airborne nicotine from aerosol to air, the levels of urinary cotinine are approximately equal for both passive exposure to tobacco smoke and the aerosol from electronic cigarettes. This would mean that the nicotine found in electronic cigarettes should have a bio-availability approximately 20 times greater than nicotine from ordinary tobacco smoke. This needs to be investigated if it is correct. Both reports clearly show that passive exposure to aerosols from electronic cigarettes leads to uptake of nicotine to an extent similar to passive tobacco smoke exposure. To interpret the present results in any other way does not seem correct. It therefore seems that passive exposure to aerosols from electronic cigarettes causes uptake of nicotine in the organism, but there is reason to assume that this will be to a significantly smaller extent than to exposure to tobacco smoke - because of lesser nicotine levesls in the air from using an electronic cigarette rather than using a regular cigarette. These investigations also seem to confirm that electronic cigarettes may be a way to use nicotine, which do not harm the lungs or the respiratory system.
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electronic cigarettes, research, nicotine, SIRUS, FHI, Folkehelseinstituttet, e cigarettes, e juice, aerosol, passive smoking,
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