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Comment: 

Reflecting on  the blog feedback, I decided to submit this important paper to the FDA as a public comment.  (The tracking number is /sites/tobacco.ucsf.edu/files/u9/FDA-comment-eNO-1jy-8cms-8qbp.pdf" target="_blank";1jy-8cms-8qbp.)
 
<strong;Evidence that e-cigarette aerosol has the same effects on an important measure of lung function as cigarette smoke undermines the assumption that e-cigarettes are uniformly less risky than conventional cigarettes</strong;
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Evidence that e-cigarette aerosol has the same effects on an important measure of lung function as cigarette smoke undermines the assumption that e-cigarettes are uniformly less risky than conventional cigarettes
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The paper, "Short-term effects of electronic and tobacco cigarettes on exhaled nitric oxide," by Sara Marinia, et al, just published in <em;Toxicology and Applied Pharmacology</em; (Volume 278, Issue 1, 1 July 2014, Pages 9–15), reports important data showing that nicotine e-cigarettes, non-nicotine e-cigarettes, and conventional cigarettes all have similar effects of depression of exhaled nitric oxide (see figure from their paper /sites/tobacco.ucsf.edu/files/u9/FDA-comment-eNO-1jy-8cms-8qbp.pdf" target="_blank";[available in the PDF of the comment]).
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The authors compared three situations:
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1. Smoking a conventional cigarette
2. Smoking and nicotine e-cigarette
3. Smoking a nicotine-free e-cigarette
4. Inhaling through an ecigarette without a liquid cartridge (i.e., breathing normal room air)
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Conditions 1-3 all reduced exhaled nitric oxide by about the same amount.&nbsp; There was no effect of condition 4.
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What this means is that the ultrafine particles in the e-cigarette aerosol (not the nicotine or something special about cigarette smoke aerosol) is what is causing the decrement in lung function reflected by lower exhaled nitric oxide.
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This is an important finding because it shows, at least for this important biological measure of the effects of using e-cigarettes on lungs, they are no different than cigarettes and so, for this end point, do not pose less risk.&nbsp;
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This finding, which, as the authors point out in their paper, is consistent with earlier studies, demonstrates that <strong;the FDA must be extremely careful about assuming that e-cigarettes uniformly pose less risk than conventional cigarettes.&nbsp; The FDA should not make such an assumption until there is affirmative evidence to support such an assumption.</strong;
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Stanton A. Glantz, PhD
Professor and Director

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