What is the nicotine delivery profile of electronic cigarettes?

Introduction:
This text provides an in-depth analysis of the nicotine delivery profile of electronic cigarettes (e-cigarettes), including the factors that impact nicotine content, aerosolization, and delivery to users. The key points of the text highlight the variability in e-cigarette liquid nicotine content, aerosol nicotine yield, and nicotine delivery to users, with some devices incapable of delivering nicotine while others can deliver nicotine as effectively as combustible cigarettes. The text also discusses the potential public health impact of e-cigarettes, including their potential role in smoking cessation and the risk of adolescent nicotine dependence.

Key Points:

* E-cigarettes have evolved rapidly since their introduction in the early 2000s, with a heterogeneous and ever-changing product class marketed to a large population that is likely under-informed regarding their exposure to nicotine and other toxicants in e-cigarette aerosol.
* Some e-cigarettes are incapable of delivering nicotine to the user, while others can deliver nicotine as effectively as combustible cigarettes.
* Nicotine delivery from pod-based devices that contain nicotine salts is of particular concern due to their growing popularity and the potential for youth nicotine dependence.
* Nicotine flux is a potential regulatory target for e-cigarettes, accounting for all factors that influence nicotine delivery and conditions that produce a flux that is too low or too high.
* Population-level studies of the effects of e-cigarette use are challenging due to e-cigarette heterogeneity, which can obscure as well as reveal.
* Clinicians working with a smoker might consider strongly the value of urging behavioral support as a necessary element of any e-cigarette-assisted smoking cessation attempt.
* E-cigarette regulation, under the authority of the Food and Drug administration (FDa), has the potential to reduce heterogeneity in the marketplace but is challenged by the need to balance the public health promise of combustible cigarette cessation with the public health threat of adolescent nicotine dependence, the potential for transition from e-cigarettes to combustible cigarette smoking, and the unknown health risks of long-term e-cigarette use.

Main Message:
The text emphasizes the importance of understanding the nicotine delivery profile of e-cigarettes, as some products can deliver nicotine as effectively as combustible cigarettes while others cannot. The potential public health impact of e-cigarettes is significant, with the potential to help smokers quit while also posing a risk of adolescent nicotine dependence. Nicotine flux is a potential regulatory target for e-cigarettes, and population-level studies of the effects of e-cigarette use are challenging due to e-cigarette heterogeneity. Clinicians should consider behavioral support as a necessary element of any e-cigarette-assisted smoking cessation attempt. Overall, the text highlights the need for effective regulation and further research to fully understand the public health impact of e-cigarettes.

Voos N, Goniewicz ML, Eissenberg T. What is the nicotine delivery profile of electronic cigarettes? Expert opinion on drug delivery. 2019;16(11):1193-1203. doi:10.1080/17425247.2019.1665647