Pathophysiology and Pathomorphology of the Lungs in Users of Electronic Nicotine Delivery Devices: Clinical and Experimental Data

Relevance. Currently, the use of tobacco and tobacco products has acquired the character of a global epidemic, and the number of diseases associated with this harmful habit is steadily growing. In the last 20 years, a trend has emerged worldwide to replace traditional cigarettes with electronic ones, positioned by marketers as less harmful. These devices, being fashionable and modern, have become especially popular among teenagers and young people. However, cases of severe lung pathology, including fatal ones, have been reported in users of electronic nicotine delivery systems. Aim. To analyze and structure data on methods of electronic delivery of nicotine to the body, as well as on the pathogenesis of lung damage from various liquids for "vaping". Results. Reusable devices have the most pathogenic effect on the body of users, especially when using liquids containing tetrahydrocannabinol, but even nicotine-free liquids are not harmless to health. More than 30 different substances with a potentially harmful effect on the body have been found in the aerosols of electronic liquids. In most cases, the picture of lung damage in "vapers" is represented by the development of diffuse alveolar damage, the pathogenesis of which involves both direct tissue damage by chemicals and a violation of the immune response and inflammatory mechanisms. E-cigarette users demonstrate a predominance of the pro-inflammatory phenotype of macrophages, an excess of pro-inflammatory cytokines and a lack of anti-inflammatory ones. Vapers using liquids based on tetrahydrocannabinol have foamy macrophages in the lung tissue and bronchoalveolar lavage that accumulate vitamin E acetate. Also, users of electronic nicotine delivery systems have been found to have multiple disturbances in gene expression by macrophages, as well as various damages to deoxyribonucleic acid in the epithelial cells of the oral mucosa, which may be an initiating factor in the development of malignant neoplasms and other types of pathology. In experiments on mice, it was shown that replacing conventional tobacco smoke with electronic aerosol does not improve the condition of the lung tissue in mice, and inhalation of aerosols containing nicotine is accompanied by an increase in platelet function. Conclusion. Electronic nicotine delivery systems are not a safe replacement for regular cigarettes. Moreover, even nicotine-free fluids have a damaging effect.