Acute effects of electronic and tobacco cigarette smoking on complete blood count
Highlights
► We evaluated acute active and passive e-cigarette and tobacco cigarette smoking. ► We assessed effects on complete blood count in 15 smokers and 15 never-smokers. ► Control and active/passive tobacco and electronic cigarette sessions were used. ► We observed no effects of e-cigarettes on complete blood count. ► Tobacco cigarettes increased white blood cell, lymphocyte, and granulocyte counts.
Introduction
Evidence collected during the past four decades have unanimously demonstrated that both active and passive tobacco cigarette smoking increase morbidity and the risk for premature death and generate adverse acute and long-term health effects in nearly all systems of the human organism (Flouris et al., 2010b, World Health Organisation, 2004, World Health Organisation, 2006). Despite the global initiatives and the implementation of smoke-free measures, smoking still kills nearly 6 million people every year (Flouris, 2009, World Health Organisation, 2011). In this light, alternative smoking strategies may contribute towards reducing the threat to public health caused by the tobacco epidemic (Flouris and Oikonomou, 2010). One such strategy is the electronic cigarette (e-cigarette), an electronic nicotine delivery system that was introduced in the global market during the past five years (Polosa et al., 2011). These devices have become popular in spite the dearth of research on their safety and efficacy (Etter et al., 2011, Flouris and Oikonomou, 2010). The most recent World Health Organisation regulatory consultation on the safety of electronic nicotine delivery devices called for intensified research efforts assessing the health effects of their use (World Health Organisation, 2010).
Currently, there is a severe lack of published data regarding the potential toxic effects of the natural and/or synthetic chemicals incorporated in e-cigarettes. Researchers have primarily been focused on e-cigarette efficacy towards reducing nicotine withdrawal symptoms, but they have neglected chemical safety issues and other areas of consumer product safety. Indeed, very few studies have examined parameters related to the health effects of e-cigarette use. One study reported that e-cigarettes yield only 10% of the nicotine concentration in blood plasma compared to tobacco cigarettes (Bullen et al., 2010).This was in line with another study demonstrating that e-cigarettes do not affect plasma nicotine, exhaled CO, or resting heart rate (Vansickel et al., 2010). However, more recent studies by the same group reported that e-cigarettes can increase heart rate, deliver clinically significant amounts of nicotine, and reduce cigarette abstinence symptoms (Vansickel and Eissenberg, 2012, Vansickel et al., 2012). However, there is no information on more routinely-performed haematology laboratory tests such as the complete blood count (CBC) which is one of the most commonly ordered blood tests in medicine providing an overview of an individual’s general health status as well as information for infection, inflammation and inflammatory disease, deficiencies in the immune system, bone marrow disease and other health-related conditions (Michota and Frost, 2004). Acute and chronic active tobacco cigarette smoking has been known to increase white blood cell count (Bridges et al., 1993). Moreover, previous epidemiological studies reported that chronic passive tobacco cigarette smoking can increase white blood cell count (Panagiotakos et al., 2004, Ronchetti et al., 1990). Therefore, the purpose of this randomized crossover study was to evaluate the acute effect of active and passive e-cigarette and tobacco cigarette smoking on CBC markers.
Section snippets
Subjects and procedures
The experimental protocol was approved by the Ethics Committee at the University of Thessaly. Two groups of adults volunteered and provided written consent: 15 smokers (⩾15 cigarettes/day; 8 males; 7 females; 36.8 ± 9.9 years; body mass index 25.6 ± 4.1 kg/m2) and 15 never-smokers (8 males; 7 females; 28.87 ± 1.5 years; body mass index 23.6 ± 3.0 kg/m2). Exclusion criteria included pregnancy, signs of acute illness, abnormal spirometry and/or other evidence of pulmonary disease, other chronic conditions or
Results
In smokers, no changes were observed during the control session (Fig. 1). Active tobacco smoking increased white blood cell count, lymphocyte count, and granulocyte count for at least one hour (P < 0.05; Fig. 1), while the remaining CBC variables were not influenced. Specifically, Friedman tests revealed that white blood cell count (χ2 = 20.81; P < 0.001), lymphocyte count (χ2 = 7.65; P = 0.022), and granulocyte count (χ2 = 14.16; P = 0.001) increased significantly over time. Post hoc Wilcoxon signed-rank
Discussion
In this study we present the first comprehensive data regarding the acute effect of active and passive e-cigarette and tobacco cigarette smoking on CBC markers. Our results suggest that active e-cigarette smoking in smokers and passive e-cigarette smoking in never smokers do not affect markers of CBC. In contrast, active tobacco cigarette smoking in smokers and passive tobacco cigarette smoking in never smokers increase white blood cell count, lymphocyte count, and granulocyte count for at
Conflict of Interest
Andreas Flouris’ salary is paid by the Centre for Research and Technology Thessaly. He has served as an expert consultant for the World Health Organization regarding electronic nicotine delivery systems. All authors report no financial or personal relationships with other people or organisations that could inappropriately influence (bias) their actions.
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