Compensatory Puffing With Lower Nicotine Concentration E-liquids Increases Carbonyl Exposure in E-cigarette Aerosols.

Introduction: Article 20 of the European Tobacco Products Directive (EU-TPD) specifies that e-liquids should not contain nicotine in excess of 20 mg/mL, thus many vapers may be compelled to switch to lower concentrations and in so doing, may engage in more intensive puffing. This study aimed to establish whether more intensive puffing produces higher levels of carbonyl compounds in e-cigarette aerosols. Methods: Using the HPLC-UV diode array method, four carbonyl compounds (formaldehyde, acetaldehyde, acetone, and acrolein) were measured in liquids and aerosols from nicotine solutions of 24 and 6 mg/mL. Aerosols were generated using a smoking machine configured to replicate puffing topography data previously obtained from 12 experienced e-cigarette users. Results: Carbonyl levels in aerosols from the puffing regimen of 6 mg/mL were significantly higher (p < .05 using independent samples t tests) compared with those of 24 mg/mL nicotine. For the 6 and 24 mg/mL nicotine aerosols respectively, means ± SD for formaldehyde levels were 3.41 ± 0.94, and 1.49 ± 0.30 µg per hour (µg/h) of e-cigarette use. Means ± SD for acetaldehyde levels were 2.17 ± 0.36 and 1.04 ± 0.13 µg/h. Means ± SD for acetone levels were 0.73 ± 0.20 and 0.28 ± 0.14 µg/h. Acrolein was not detected. Conclusions: Higher levels of carbonyls associated with more intensive puffing suggest that vapers switching to lower nicotine concentrations (either due to the EU-TPD implementation or personal choice), may increase their exposure to these compounds. Based on real human puffing topography data, this study suggests that limiting nicotine concentrations to 20 mg/mL may not result in the desired harm minimalization effect. Implications: More intensive puffing regimens associated with the use of low nicotine concentration e-liquids can lead to higher levels of carbonyl generation in the aerosol. Although in need of replication in a larger sample outside a laboratory, this study provides pragmatic empirical data on the potential risks of compensatory puffing behaviors in vapers, and can help to inform future regulatory decisions on nicotine e-liquid concentrations. The cap on nicotine concentration at 20 mg/mL set by the EU-TPD may therefore have the unintended consequence of encouraging use of lower nicotine concentration e-liquid, in turn increasing exposure to carbonyl compounds through compensatory puffing.

Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects.

RATIONALE: Self-titration is well documented in the tobacco literature. The extent to which e-cigarette users (vapers) self-titrate is unknown. OBJECTIVE: This study explored the effects of high and low nicotine strength liquid on puffing topography, nicotine delivery and subjective effects in experienced vapers. METHODS: Eleven experienced male vapers completed 60 min of ad libitum vaping under low (6 mg/mL) and high (24 mg/mL) nicotine liquid conditions in two separate sessions. Measurements included puffing topography (puff number, puff duration, volume of liquid consumed) and changes in plasma nicotine levels, craving, withdrawal symptoms, self-reported hit, satisfaction and adverse effects. RESULTS: Liquid consumption and puff number were higher and puff duration longer, in the low nicotine strength condition (all ps < 0.01). The mean difference in nicotine boost from baseline in the low condition was 8.59 (7.52) ng/mL, 16.99 (11.72) ng/mL and 22.03 (16.19) ng/mL at 10, 30 and 60 min, respectively. Corresponding values for the high condition were 33.77 (34.88) ng/mL, 35.48 (28.31) ng/mL and 43.57 (34.78) ng/mL (ps < 0.05). There were no statistically significant differences between conditions in self-reported craving, withdrawal symptoms, satisfaction, hit or adverse effects. CONCLUSIONS: Vapers engaged in compensatory puffing with lower nicotine strength liquid, doubling their consumption. Whilst compensatory puffing was sufficient to reduce craving and withdrawal discomfort, self-titration was incomplete with significantly higher plasma nicotine levels in the high condition.