NETWORKS: Disaster preparedness. New acronyms. ECS in transplantation. Electronic cigarettes.

The ongoing use of ECS in transplantation has a ripple effect that may prompt its use in other clinical scenarios, such as a rescue therapy in acute exacerbations of COPD, an alternative to mechanical ventilation following complex thoracic pulmonary or esophageal resections, and in cases of unexpected intraoperative cardiopulmonary collapse. One thing remains likely, however, ECS is here to stay.

Jeremiah Hayanga, MD

Steering Committee Member

Norihisa Shigemura, MD

Steering Committee Member

Women’s Health

Exposure of adolescents to electronic cigarettes: still a cause for alarm despite recent FDA ruling

Developed in 2003, electronic cigarettes (e-cigarettes) have been available in the United States since 2007. Between 2010 and 2013, adult use doubled. By 2013, the major tobacco companies had entered the market, and e-cigarettes were marketed widely (television, Internet, and print) as healthier alternatives to tobacco, useful for quitting smoking, and a way to circumvent smoke-free laws by allowing smokers to “smoke anywhere” (Grana et al. Circulation. 2014;129[19]:1972).

For adolescents, e-cigarette use tripled between 2013 and 2014, from 4.5% (660,000) to 13.4% (2 million) for high school students and from 1.1% (120,000) to 3.9% (450,000) for middle school students (CDC Press Release. https://www.cdc.gov/media/releases/2015/p0416-e-cigarette-use.html). Teenage experimentation, in conjunction with susceptibility to brain-modifying effects of nicotine, places this population at risk for lifelong nicotine addiction. Teenagers who use e-cigarettes are more likely to become regular cigarette smokers than nonusers (Dutra et al. JAMA Pediatr. 2014;168[7]:610; Levanthal et al. JAMA. 2015;314[7]:700). Local and state municipalities have enacted legislation, adding e-cigarettes and other electronic nicotine delivery systems (ENDS) to existing tobacco regulations. On May 5, 2016, a long-anticipated ruling from the FDA extended oversight to include all tobacco products, including e-cigarettes and hookahs, allowing the agency to address public health concerns, such as youth access. However, a key provision of the new tobacco “deeming” rules was subsequently removed less than a month later – one that would have removed flavored e-cigarettes, cigars, hookahs, and other flavored tobacco products from the market in November pending review by the Food and Drug Administration (Boyles. MedPage Today. medpagetoday.com/pulmonology/smoking/58274).

ENDS as a smoking cessation tool, a “safer” alternative to combustible tobacco, is much debated (Green et al. N Engl J Med. 2016;374[14]:1301). There is accumulating evidence of its in vivo and in vitro toxicity (Bhatnagar et al. Circulation. 2014;130[16]:1418; Gibbs et al. Chest. 2016;149[2]:552). Studies have shown that the varied concentration and flavorings used are cytotoxic to human embryonic stem cells as well as mice neural stem cells (Bahl et al. Reprod Toxicol. 2012[4];34:529) and that exposure to propylene glycol and glycerin, main base ingredients in e-liquids, can result in eye and respiratory irritation (Grana et al. Circulation. 2014; 129[19]:1972). Additionally, current evidence does not support e-cigarettes for smoking cessation (Grana et al. Circulation. 2014;129[19]:1972). The accumulating evidence of adverse effects and the increased use in adolescents underscores the need for stricter regulations by the FDA in order to prevent renormalization of the smoking behavior and to protect public health. The rollout of the FDA’s ruling will warrant ongoing evaluation.

Linda S. Efferen, MD, MBA

Consultant

Amanpreet Kaur, MD

Steering Committee Member