open access

Vol 87, No 2 (2019)
REVIEWS
Published online: 2019-04-18
Submitted: 2019-02-07
Accepted: 2019-04-10
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E-cigarettes or heat-not-burn tobacco products — advantages or disadvantages for the lungs of smokers

Paweł Górski
DOI: 10.5603/ARM.2019.0020
·
Pubmed: 31038725
·
Adv Respir Med 2019;87(2):123-134.

open access

Vol 87, No 2 (2019)
REVIEWS
Published online: 2019-04-18
Submitted: 2019-02-07
Accepted: 2019-04-10

Abstract

This is a narrative review considering the use of e-cigarettes and heat-not-burn tobacco products. Advantages and disadvantages
of both devices, including biological and clinical consequences, were described. The role of these products in limiting tobacco
dependence was also discussed. Possible implications for clinical practice were addressed as well.

Abstract

This is a narrative review considering the use of e-cigarettes and heat-not-burn tobacco products. Advantages and disadvantages
of both devices, including biological and clinical consequences, were described. The role of these products in limiting tobacco
dependence was also discussed. Possible implications for clinical practice were addressed as well.

Get Citation

Keywords

e-cigarettes, heat-not-burn tobacco products, HNB

About this article
Title

E-cigarettes or heat-not-burn tobacco products — advantages or disadvantages for the lungs of smokers

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 2 (2019)

Pages

123-134

Published online

2019-04-18

DOI

10.5603/ARM.2019.0020

Pubmed

31038725

Bibliographic record

Adv Respir Med 2019;87(2):123-134.

Keywords

e-cigarettes
heat-not-burn tobacco products
HNB

Authors

Paweł Górski

References (110)
  1. Simonavicius E, McNeill A, Shahab L, et al. Heat-not-burn tobacco products: a systematic literature review. Tob Control. 2018 [Epub ahead of print].
  2. Tabuchi T, Gallus S, Shinozaki T, et al. Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol. Tob Control. 2018; 27(e1): e25–e33.
  3. Brose L, Simonavicius E, Cheeseman H. Awareness and Use of 'Heat-not-burn' Tobacco Products in Great Britain. Tobacco Regulatory Science. 2018; 4(2): 44–50.
  4. Chun LF, Moazed F, Calfee CS, et al. Pulmonary toxicity of e-cigarettes. Am J Physiol Lung Cell Mol Physiol. 2017; 313(2): L193–L206.
  5. Dinakar C, O’Connor GT, Dinakar C, et al. The Health Effects of Electronic Cigarettes. N Engl J Med. 2016; 375(14): 1372–1381.
  6. Schick SF, Blount BC, Jacob P, et al. Biomarkers of exposure to new and emerging tobacco delivery products. Am J Physiol Lung Cell Mol Physiol. 2017; 313(3): L425–L452.
  7. National Cancer Institute. NCI Dictionary of Cancer Terms. 2017.
  8. Gasparyan H, Mariner D, Wright C, et al. Accurate measurement of main aerosol constituents from heated tobacco products (HTPs): Implications for a fundamentally different aerosol. Regul Toxicol Pharmacol. 2018; 99: 131–141.
  9. Forster M, Fiebelkorn S, Yurteri C, et al. Assessment of novel tobacco heating product THP1.0. Part 3: Comprehensive chemical characterisation of harmful and potentially harmful aerosol emissions. Regul Toxicol Pharmacol. 2018; 93: 14–33.
  10. Farsalinos KE, Yannovits N, Sarri T, et al. Nicotine Delivery to the Aerosol of a Heat-Not-Burn Tobacco Product: Comparison With a Tobacco Cigarette and E-Cigarettes. Nicotine Tob Res. 2018; 20(8): 1004–1009.
  11. Auer R, Concha-Lozano N, Jacot-Sadowski I, et al. JAMA Intern Med. 2017; 177: 1050–1052.
  12. Bekki K, Inaba Y, Uchiyama S, et al. Comparison of Chemicals in Mainstream Smoke in Heat-not-burn Tobacco and Combustion Cigarettes. J UOEH. 2017; 39(3): 201–207.
  13. Wilkinson GP, Burseg K, Stotesbury S, et al. Heated Tobacco Products Create Side-Stream Emissions: Implications for Regulation. Journal of Environmental Analytical Chemistry. 2015; 02(05).
  14. Protano C, Manigrasso M, Avino P, et al. Second-hand smoke exposure generated by new electronic devices (IQOS® and e-cigs) and traditional cigarettes: submicron particle behaviour in human respiratory system. Ann Ig. 2016; 28(2): 109–112.
  15. Ruprecht AA, Marco CDe, Saffari A, et al. Environmental pollution and emission factors of electronic cigarettes, heat-not-burn tobacco products, and conventional cigarettes. Aerosol Science and Technology. 2017; 51(6): 674–684.
  16. Protano C, Manigrasso M, Avino P, et al. Second-hand smoke generated by combustion and electronic smoking devices used in real scenarios: Ultrafine particle pollution and age-related dose assessment. Environ Int. 2017; 107: 190–195.
  17. Pratte P, Cosandey S, Goujon Ginglinger C. Investigation of solid particles in the mainstream aerosol of the Tobacco Heating System THS2.2 and mainstream smoke of a 3R4F reference cigarette. Hum Exp Toxicol. 2017; 36(11): 1115–1120.
  18. Mitova MI, Campelos PB, Goujon-Ginglinger CG, et al. Comparison of the impact of the Tobacco Heating System 2.2 and a cigarette on indoor air quality. Regul Toxicol Pharmacol. 2016; 80: 91–101.
  19. Forster M, McAughey J, Prasad K, et al. Assessment of tobacco heating product THP1.0. Part 4: Characterisation of indoor air quality and odour. Regul Toxicol Pharmacol. 2018; 93: 34–51.
  20. Lopez AA, Hiler M, Maloney S, et al. Expanding clinical laboratory tobacco product evaluation methods to loose-leaf tobacco vaporizers. Drug Alcohol Depend. 2016; 169: 33–40.
  21. Lüdicke F, Magnette J, Baker G, et al. A Japanese cross-sectional multicentre study of biomarkers associated with cardiovascular disease in smokers and non-smokers. Biomarkers. 2015; 20(6-7): 411–421.
  22. Lüdicke F, Picavet P, Baker G, et al. Reduced Exposure to Harmful and Potentially Harmful Smoke Constituents With the Tobacco Heating System 2.1. Nicotine Tob Res. 2017; 19(2): 168–175.
  23. Lüdicke F, Haziza C, Weitkunat R, et al. Evaluation of Biomarkers of Exposure in Smokers Switching to a Carbon-Heated Tobacco Product: A Controlled, Randomized, Open-Label 5-Day Exposure Study. Nicotine Tob Res. 2016; 18(7): 1606–1613.
  24. Titz B S, Boue S, Philips B, et al. Effects of cigarrete smoke, cessation, switching to two heat-not-burn tobacco products on lung lipid metabolism in C57BL/6 and apoe-/-mice-an inegrative toxicology analysis. Toxicol Sci. 2016; 149(2): 441–457.
  25. Phillips BW, Schlage WK, Titz B, et al. A 90-day OECD TG 413 rat inhalation study with systems toxicology endpoints demonstrates reduced exposure effects of the aerosol from the carbon heated tobacco product version 1.2 (CHTP1.2) compared with cigarette smoke. I. Inhalation exposure, clinical pathology and histopathology. Food Chem Toxicol. 2018; 116(Pt B): 388–413.
  26. Haswell LE, Corke S, Verrastro I, et al. In vitro RNA-seq-based toxicogenomics assessment shows reduced biological effect of tobacco heating products when compared to cigarette smoke. Sci Rep. 2018; 8(1): 1145.
  27. Sewer A, Kogel U, Talikka M, et al. Evaluation of the Tobacco Heating System 2.2 (THS2.2). Part 5: microRNA expression from a 90-day rat inhalation study indicates that exposure to THS2.2 aerosol causes reduced effects on lung tissue compared with cigarette smoke. Regul Toxicol Pharmacol. 2016; 81 Suppl 2: S82–S92.
  28. Zanetti F, Sewer A, Scotti E, et al. Assessment of the impact of aerosol from a potential modified risk tobacco product compared with cigarette smoke on human organotypic oral epithelial cultures under different exposure regimens. Food Chem Toxicol. 2018; 115: 148–169.
  29. Haziza C, de La Bourdonnaye G, Merlet S, et al. Assessment of the reduction in levels of exposure to harmful and potentially harmful constituents in Japanese subjects using a novel tobacco heating system compared with conventional cigarettes and smoking abstinence: A randomized controlled study in confinement. Regul Toxicol Pharmacol. 2016; 81: 489–499.
  30. Haziza C, de La Bourdonnaye G, Skiada D, et al. Evaluation of the Tobacco Heating System 2.2. Part 8: 5-Day randomized reduced exposure clinical study in Poland. Regul Toxicol Pharmacol. 2016; 81 Suppl 2: S139–S150.
  31. Kamada T, Yamashita Y, Tomioka H. Acute eosinophilic pneumonia following heat-not-burn cigarette smoking. Respirology Case Reports. 2016; 4(6): e00190.
  32. The Goverment Response to Science and Technology Comitee’s Seventh Report of the Session 2017-19 on E-cigarettes. Dept Health&Social Care. 2018 Dec.
  33. Belluz J, Philip Morris wanted to market a new tobacco device as safer than cigarretes. Vox 2018. www.vox.com/science-and-health/2018.
  34. Bialous SA, Glantz SA. Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control. Tob Control. 2018; 27(Suppl 1): s111–s117.
  35. McMillen RC, Gottlieb MA, Shaefer RM, et al. Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine Tob Res. 2015; 17(10): 1195–1202.
  36. Ferkol TW, Farber HJ, La Grutta S, et al. Forum of International Respiratory Societies. Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies. Eur Respir J. 2018; 51(5).
  37. Jamal A, Gentzke A, Hu SS, et al. Tobacco Use Among Middle and High School Students - United States, 2011-2016. MMWR Morb Mortal Wkly Rep. 2017; 66(23): 597–603.
  38. Zarobkiewicz MK, Wawryk-Gawda E, Woźniakowski MM, et al. Tobacco smokers and electronic cigarettes users among Polish universities students. Rocz Panstw Zakl Hig. 2016; 67(1): 75–80.
  39. Kasza KA, Ambrose BK, Conway KP, et al. Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014. N Engl J Med. 2017; 376(4): 342–353.
  40. Chaffee BW, Couch ET, Gansky SA. Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015. PLoS One. 2017; 12(5): e0177073.
  41. Sung HY, Wang Y, Yao T, et al. Polytobacco Use and Nicotine Dependence Symptoms Among US Adults, 2012-2014. Nicotine Tob Res. 2018; 20(suppl_1): S88–S98.
  42. Wilson FA, Wang Y. Recent Findings on the Prevalence of E-Cigarette Use Among Adults in the U.S. Am J Prev Med. 2017; 52(3): 385–390.
  43. Barrington-Trimis J, Leventhal A. Adolescents’ Use of “Pod Mod” E-Cigarettes — Urgent Concerns. New England Journal of Medicine. 2018; 379(12): 1099–1102.
  44. Breland A, Soule E, Lopez A, et al. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci. 2017; 1394(1): 5–30.
  45. Talih S, Balhas Z, Eissenberg T, et al. Effects of user puff topography, device voltage, and liquid nicotine concentration on electronic cigarette nicotine yield: measurements and model predictions. Nicotine Tob Res. 2015; 17(2): 150–157.
  46. Hess CA, Olmedo P, Navas-Acien A, et al. E-cigarettes as a source of toxic and potentially carcinogenic metals. Environ Res. 2017; 152: 221–225.
  47. Talih S, Balhas Z, Salman R, et al. "Direct Dripping": A High-Temperature, High-Formaldehyde Emission Electronic Cigarette Use Method. Nicotine Tob Res. 2016; 18(4): 453–459.
  48. Hutzler C, Paschke M, Kruschinski S, et al. Chemical hazards present in liquids and vapors of electronic cigarettes. Arch Toxicol. 2014; 88(7): 1295–1308.
  49. Carter T, Tucker D, Kilic A, et al. Life-threatening Vesicular Bronchial Injury Requiring Veno-venous Extracorporeal Membrane Oxygenation Rescue in an Electronic Nicotine Delivery System User. Clin Pract Cases Emerg Med. 2017; 1(3): 212–217.
  50. Dimensionless group in fires and explosions. Fire Safety Journal. 1997; 29(2-3): 232–233.
  51. Patterson SB, Beckett AR, Lintner A, et al. A Novel Classification System for Injuries After Electronic Cigarette Explosions. J Burn Care Res. 2017; 38(1): e95–e9e100.
  52. Lisko JG, Tran H, Stanfill SB, et al. Chemical Composition and Evaluation of Nicotine, Tobacco Alkaloids, pH, and Selected Flavors in E-Cigarette Cartridges and Refill Solutions. Nicotine Tob Res. 2015; 17(10): 1270–1278.
  53. Stepanov I, Fujioka N. Bringing attention to e-cigarette pH as an important element for research and regulation. Tob Control. 2015; 24(4): 413–414.
  54. Abramovitz A, McQueen A, Martinez RE, et al. Electronic cigarettes: The nicotyrine hypothesis. Med Hypotheses. 2015; 85(3): 305–310.
  55. Martinez RE, Dhawan S, Sumner W, et al. On-Line Chemical Composition Analysis of Refillable Electronic Cigarette Aerosol-Measurement of Nicotine and Nicotyrine. Nicotine Tob Res. 2015; 17(10): 1263–1269.
  56. Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol. 2014; 88(1): 5–7.
  57. Mowry JB, Spyker DA, Brooks DE, et al. 2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila). 2016; 54(10): 924–1109.
  58. Glasser AM, Collins L, Pearson JL, et al. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med. 2017; 52(2): e33–e66.
  59. Varlet V, Farsalinos K, Augsburger M, et al. Toxicity assessment of refill liquids for electronic cigarettes. Int J Environ Res Public Health. 2015; 12(5): 4796–4815.
  60. Behar RZ, Davis B, Bahl V, et al. Identification of toxicants in cinnamon-flavored electronic cigarette refill fluids. Toxicol In Vitro. 2014; 28(2): 198–208.
  61. Behar RZ, Luo W, McWhirter KJ, et al. Analytical and toxicological evaluation of flavor chemicals in electronic cigarette refill fluids. Sci Rep. 2018; 8(1): 8288.
  62. Tierney PA, Karpinski CD, Brown JE, et al. Flavour chemicals in electronic cigarette fluids. Tob Control. 2016; 25(e1): e10–e15.
  63. Flake GP, Morgan DL. Pathology of diacetyl and 2,3-pentanedione airway lesions in a rat model of obliterative bronchiolitis. Toxicology. 2017; 388: 40–47.
  64. DeVito EE, Krishnan-Sarin S. E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure. Curr Neuropharmacol. 2018; 16(4): 438–459.
  65. Farsalinos K, Spyrou A, Stefopoulos C, et al. Nicotine absorption from electronic cigarette use: comparison between experienced consumers (vapers) and naïve users (smokers). Scientific Reports. 2015; 5(1).
  66. Volesky KD, Maki A, Scherf C, et al. The influence of three e-cigarette models on indoor fine and ultrafine particulate matter concentrations under real-world conditions. Environ Pollut. 2018; 243(Pt B): 882–889.
  67. van Drooge BL, Marco E, Perez N, et al. Influence of electronic cigarette vaping on the composition of indoor organic pollutants, particles, and exhaled breath of bystanders. Environ Sci Pollut Res Int. 2019; 26(5): 4654–4666.
  68. Gerloff J, Sundar IK, Freter R, et al. Inflammatory Response and Barrier Dysfunction by Different e-Cigarette Flavoring Chemicals Identified by Gas Chromatography-Mass Spectrometry in e-Liquids and e-Vapors on Human Lung Epithelial Cells and Fibroblasts. Appl In Vitro Toxicol. 2017; 3(1): 28–40.
  69. Scheffler S, Dieken H, Krischenowski O, et al. Evaluation of E-cigarette liquid vapor and mainstream cigarette smoke after direct exposure of primary human bronchial epithelial cells. Int J Environ Res Public Health. 2015; 12(4): 3915–3925.
  70. Aug A, Altraja S, Kilk K, et al. E-Cigarette Affects the Metabolome of Primary Normal Human Bronchial Epithelial Cells. PLoS One. 2015; 10(11): e0142053.
  71. Husari A, Shihadeh A, Talih S, et al. Acute Exposure to Electronic and Combustible Cigarette Aerosols: Effects in an Animal Model and in Human Alveolar Cells. Nicotine & Tobacco Research. 2015; 18(5): 613–619.
  72. Boas Z, Gupta P, Moheimani RS, et al. Activation of the "Splenocardiac Axis" by electronic and tobacco cigarettes in otherwise healthy young adults. Physiol Rep. 2017; 5(17).
  73. Wu Q, Jiang Di, Minor M, et al. Electronic cigarette liquid increases inflammation and virus infection in primary human airway epithelial cells. PLoS One. 2014; 9(9): e108342.
  74. Kim KJ, Borok Z, Crandall ED. A useful in vitro model for transport studies of alveolar epithelial barrier. Pharm Res. 2001; 18(3): 253–255.
  75. Hwang JH, Lyes M, Sladewski K, et al. Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria. J Mol Med (Berl). 2016; 94(6): 667–679.
  76. Palpant NJ, Hofsteen P, Pabon L, et al. Cardiac development in zebrafish and human embryonic stem cells is inhibited by exposure to tobacco cigarettes and e-cigarettes. PLoS One. 2015; 10(5): e0126259.
  77. Lerner CA, Sundar IK, Yao H, et al. Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung. PLoS One. 2015; 10(2): e0116732.
  78. Schweitzer KS, Chen SX, Law S, et al. Endothelial disruptive proinflammatory effects of nicotine and e-cigarette vapor exposures. Am J Physiol Lung Cell Mol Physiol. 2015; 309(2): L175–L187.
  79. Garcia-Arcos I, Geraghty P, Baumlin N, et al. Chronic electronic cigarette exposure in mice induces features of COPD in a nicotine-dependent manner. Thorax. 2016; 71(12): 1119–1129.
  80. Sussan TE, Gajghate S, Thimmulappa RK, et al. Exposure to electronic cigarettes impairs pulmonary anti-bacterial and anti-viral defenses in a mouse model. PLoS One. 2015; 10(2): e0116861.
  81. McGrath-Morrow SA, Hayashi M, Aherrera A, et al. The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice. PLoS One. 2015; 10(2): e0118344.
  82. Spindel E, McEvoy C. The Role of Nicotine in the Effects of Maternal Smoking during Pregnancy on Lung Development and Childhood Respiratory Disease. Implications for Dangers of E-Cigarettes. American Journal of Respiratory and Critical Care Medicine. 2016; 193(5): 486–494.
  83. Wang MP, Ho SY, Leung LT, et al. Electronic Cigarette Use and Respiratory Symptoms in Chinese Adolescents in Hong Kong. JAMA Pediatr. 2016; 170(1): 89–91.
  84. Cho JHo, Paik SY. Association between Electronic Cigarette Use and Asthma among High School Students in South Korea. PLoS One. 2016; 11(3): e0151022.
  85. Vardavas CI, Anagnostopoulos N, Kougias M, et al. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012; 141(6): 1400–1406.
  86. Scott A, Lugg ST, Aldridge K, et al. Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages. Thorax. 2018; 73(12): 1161–1169.
  87. Yan XS, D'Ruiz C. Effects of using electronic cigarettes on nicotine delivery and cardiovascular function in comparison with regular cigarettes. Regul Toxicol Pharmacol. 2015; 71(1): 24–34.
  88. Szołtysek-Bołdys I, Sobczak A, Zielińska-Danch W, et al. Influence of inhaled nicotine source on arterial stiffness. Przegl Lek. 2014; 71(11): 572–575.
  89. Benowitz NL, Fraiman JB. Cardiovascular effects of electronic cigarettes. Nat Rev Cardiol. 2017; 14(8): 447–456.
  90. Pankow JF, Kim K, McWhirter KJ, et al. Benzene formation in electronic cigarettes. PLoS One. 2017; 12(3): e0173055.
  91. Shahab L, Goniewicz ML, Blount BC, et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Ann Intern Med. 2017; 166(6): 390–400.
  92. Leigh NJ, Palumbo MN, Marino AM, et al. Tobacco-specific nitrosamines (TSNA) in heated tobacco product IQOS. Tob Control. 2018; 27(Suppl 1): s37–s38.
  93. Shaito A, Saliba J, Husari A, et al. Electronic Cigarette Smoke Impairs Normal Mesenchymal Stem Cell Differentiation. Sci Rep. 2017; 7(1): 14281.
  94. Ramôa CP, Hiler MM, Spindle TR, et al. Electronic cigarette nicotine delivery can exceed that of combustible cigarettes: a preliminary report. Tob Control. 2016; 25(e1): e6–e9.
  95. Sung HY, Wang Y, Yao T, et al. Polytobacco Use and Nicotine Dependence Symptoms Among US Adults, 2012-2014. Nicotine Tob Res. 2018; 20(suppl_1): S88–S98.
  96. Chaffee BW, Couch ET, Gansky SA. Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015. PLoS One. 2017; 12(5): e0177073.
  97. Pauly JR, Slotkin TA. Maternal tobacco smoking, nicotine replacement and neurobehavioural development. Acta Paediatr. 2008; 97(10): 1331–1337.
  98. Chatham-Stephens K, Law R, Taylor E, et al. Centers for Disease Control and Prevention (CDC). Notes from the field: calls to poison centers for exposures to electronic cigarettes--United States, September 2010-February 2014. MMWR Morb Mortal Wkly Rep. 2014; 63(13): 292–293.
  99. Vannier S, Ronziere T, Ferre JC, et al. Reversible cerebral vasoconstriction syndrome triggered by an electronic cigarette: case report. Eur J Neurol. 2015; 22(5): e64–e65.
  100. Camus M, Gallois C, Gallois G, et al. Ulcerative colitis and electronic cigarette: what's the matter? Am J Gastroenterol. 2014; 109(4): 608–609.
  101. McCauley L, Markin C, Hosmer D. An unexpected consequence of electronic cigarette use. Chest. 2012; 141(4): 1110–1113.
  102. Hureaux J, Drouet M, Urban T. A case report of subacute bronchial toxicity induced by an electronic cigarette. Thorax. 2014; 69(6): 596–597.
  103. Morjaria JB, Mondati E, Polosa R. E-cigarettes in patients with COPD: current perspectives. Int J Chron Obstruct Pulmon Dis. 2017; 12: 3203–3210.
  104. Bowler RP, Hansel NN, Jacobson S, et al. for COPDGene and SPIROMICS Investigators. Electronic Cigarette Use in US Adults at Risk for or with COPD: Analysis from Two Observational Cohorts. J Gen Intern Med. 2017; 32(12): 1315–1322.
  105. Fairchild AL, Lee JuS, Bayer R, et al. E-Cigarettes and the Harm-Reduction Continuum. N Engl J Med. 2018; 378(3): 216–219.
  106. McKeganey N, Dickson T. Why Don't More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers. Int J Environ Res Public Health. 2017; 14(6).
  107. Van Schayck OCP, Williams S, Barchilon V, et al. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. NPJ Prim Care Respir Med. 2017; 27(1): 38.
  108. Konsumpcja nikotyny. Raport z badań ilościowych dla Biura do Spraw Substancji Chemicznych. CBOS Warszawa. 2018: 3–35.
  109. Hajek P, Phillips-Waller A, Przulj D, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 2019; 380(7): 629–637.
  110. Drazen JM, Morrissey S, Campion EW. The Dangerous Flavors of E-Cigarettes. N Engl J Med. 2019; 380(7): 679–680.

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