title: Are metals emitted from electronic cigarettes a reason for health concern? A risk-assessment analysis of currently available literature.
abstract: BACKGROUND
  Studies have found that metals are emitted to the electronic cigarette (EC) aerosol. However, the potential health impact of exposure to such metals has not been adequately defined. The purpose of this study was to perform a risk assessment analysis, evaluating the exposure of electronic cigarette (EC) users to metal emissions based on findings from the published literature.
  
  
  METHODS
  Two studies were found in the literature, measuring metals emitted to the aerosol from 13 EC products. We estimated that users take on average 600 EC puffs per day, but we evaluated the daily exposure from 1200 puffs. Estimates of exposure were compared with the chronic Permissible Daily Exposure (PDE) from inhalational medications defined by the U.S. Pharmacopeia (cadmium, chromium, copper, lead and nickel), the Minimal Risk Level (MRL) defined by the Agency for Toxic Substances and Disease Registry (manganese) and the Recommended Exposure Limit (REL) defined by the National Institute of Occupational Safety and Health (aluminum, barium, iron, tin, titanium, zinc and zirconium).
  
  
  RESULTS
  The average daily exposure from 13 EC products was 2.6 to 387 times lower than the safety cut-off point of PDEs, 325 times lower than the safety limit of MRL and 665 to 77,514 times lower than the safety cut-off point of RELs. Only one of the 13 products was found to result in exposure 10% higher than PDE for one metal (cadmium) at the extreme daily use of 1200 puffs. Significant differences in emissions between products were observed.
  
  
  CONCLUSIONS
  Based on currently available data, overall exposure to metals from EC use is not expected to be of significant health concern for smokers switching to EC use, but is an unnecessary source of exposure for never-smokers. Metal analysis should be expanded to more products and exposure can be further reduced through improvements in product quality and appropriate choice of materials.
authors.affiliation: Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece. kfarsalinos@gmail.com.|Department of Pharmacy, University of Patras, Rio 26500, Greece. kfarsalinos@gmail.com.
authors.forename: Konstantinos E
authors.initials: KE
authors.lastname: Farsalinos
authors.affiliation: Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece. vvoudris@otenet.gr.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
authors.affiliation: Department of Pharmacy, University of Patras, Rio 26500, Greece. kpoulas@upatras.gr.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Poulas
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols / Q000737:chemistry*; D002104:Cadmium; D066300:Electronic Nicotine Delivery Systems; D006801:Humans; D008670:Metals / Q000032:analysis*; D018570:Risk Assessment; D012906:Smoke
chemical_list: D000336:Aerosols; D008670:Metals; D012906:Smoke; D002104:Cadmium
keywords: aerosol; electronic cigarettes; inhalation; metals; risk assessment; smoking