Passive smoking from new nicotine devices
1/3/2101
Chairman of Board of Directors, Manabu Sakuta, MDIntroduction
Passive smoking also occurs from new nicotine devices (heated tobacco devices and electronic
nicotine vaporizers). Instead of being pollution free, there are some compounds in the vapor(aerosol) even if they are difficult to see. With combustible tobacco, the density of smoke (or soot)can be measured as particulate matter of 2.5 microns or smaller (PM2.5), but in the case of novel
nicotine devices, the density of vapor is measured as total volatile organic compounds (TVOC).

I Effects of passive smoking from new nicotine devices
1. Experience of a patient with allergies to various compounds who was exposed to passive smoking
on an overnight bus:
Initially, I wondered if smoking passengers had smoke infused into their clothes and luggage (“thirdhand” smoke), but after smelling the odor for a second time, I developed a severe headache andnausea, and I could not move to a cleaner seat.
I had a splitting headache, and felt like I was about to vomit due to the nausea. I could not report
this to the bus crew and had to endure the fumes during the night. It was not easy to breathe, and I
could have died from an asthma attack. I lost consciousness (I could say that I fell asleep, butinstead I felt faint with a severe headache and nausea) and became aware again near the destination
at dawn.
After that event, nausea and headaches continued. Although these afflictions had previously
occurred only from tobacco, they now also occur with strong fragrances like from fabric softeners,
hair styling products, diesel exhaust and coffee.
2. Asthma patients
Coughing
3. I feel my nasal passages burn.
(I often hear about stuffy and burning nasal passages.)
4. Complaints of passive smoking

In a new neighboring house, two family members use heated tobacco repeatedly every day andblow their smoke/exhaust towards my house with a ventilation fan. Inside of my house, there is anodor of various chemicals, and I went to the hospital for inflammation of sinuses/nasal cavities and aheadache. Once I even called an ambulance because of an unbearable headache, and the pain
dissipated after I was able to breathe clean air outside of the home. Even after diplomaticallybroaching the topic to my neighbor, the situation has not improved. Smokers say that heated
tobacco devices are odorless, but I can smell the vapor. After a year and a half of suffering
symptoms, I ended up developing sinusitis that now occurs from exposure to various chemicals
including those in tobacco and nicotine vapor.
Known symptoms of passive smoking from heated tobacco devices include headache, nasal
congestion, itchy or red eyes, sore or irritated throat, cough, phlegm, fatigue, forgetfulness,drowsiness, eczema and others.
In sum, vapor from heated tobacco exposes one to many chemicals.
5. Remarks of those who encountered passive smoking from heated tobacco devices
A few days ago, a woman was inhaling from a IQOS device 15 to 20 meters away, and I wasexposed to the vapor downwind. I immediately felt an uncomfortable sensation on the left side of
my nasal passages.
When exposed to combusted tobacco smoke, I hold my breath to prevent inhaling smoke. But theheated vapor/steam is difficult to smell and has little particulate matter. Nonetheless, when I inhaled
it, I felt like something was sticking to my mucous membranes.
I left the scene immediately, but this discomfort lasted for an hour or so.
6. Cases of allergies to multiple compounds
I live in Chiba prefecture and work in Tokyo. I am in my forties (male).
In the middle of this year, exhalation from heated tobacco smokers (exhaled air after vaping) was themain reason that I developed allergies. I also have a medical certificate.
Nowadays, passing by a user of heated tobacco causes symptoms such as dizziness, constriction of
the respiratory tract, difficulty breathing and numbness. (Common leaf tobacco does not cause suchsymptoms.)
I also now have a strong reaction to the odors from fabric softeners, detergents and new clothing
in stores.
Other people have become atopic (asthmatic) due to heated tobacco in their surroundings.
Philip Morris, JT and other tobacco companies advertise that their heated tobacco devices reduce
toxic substances by 90%, but the substances in heated tobacco are completely different from those
combustible tobacco and pose separate harms.
7. Passive smoking symptoms caused by heated tobacco

In my case, the symptoms change a little depending on the brand of heated tobacco. From IQOS:
my tongue becomes numb; I have stomatitis; and I have difficulty breathing. From Plume Tech andGlo: No numbness, but I feel sick. I can not breathe easily. I frequently hyperventilate.

II. What is in the new type of nicotine vape aerosol?
Propylene glycol and glycerol are the main components of nicotine vaping solution used withheated tobacco devices and nicotine vaporizers. These are oxidized through ordinary use of thedevices1,2).
When propylene glycol is oxidized through the heating process; it becomes formaldehyde,acetaldehyde, and methylglyoxal. When glycerol is oxidized through the heating process; it becomes
formaldehyde, acrolein, glyoxal, and methylglyoxal.
Risk assessment of carbonyls containing e-cigarettes
Assessment of electronic cigarettes
Implementation procedure based on "Initial Risk Evaluation Report" Independent AdministrativeInstitution (Product Evaluation Technology Infrastructure Organization)
1. MOE (margin of exposure) calculation based on NOAEL (no observed adverse effect level)
2. Comparison of MOE and uncertainty coefficient product
It is calculated by (NOAEL) / (exposure amount (estimated intake amount)) with a coefficientindicating how far the MOE exposure amount is from the human NOAEL.
Although this value is large, the current exposure amount indicates that there is a large margin until
it develops harmfulness to humans.
Uncertainty coefficient product = difference between animals and humans Species difference (10) x
individual difference (10) x LOAEL use (10) x test period (1-10)
The amount of smoke absorbed per day for electronic cigarettes was set to 14500 ml based on thereport 1) by Matsumoto et al.
The average weight was 50 kg
Concentration Daily cigarette smoke Smoker's electronic cigarette NOAEL MOE Uncertainty
coefficient product
Grounds for NOAEL (from the initial risk assessment report for chemical substances)(mg / m3) 2) Smoke absorption (ml) Average body weight (kg) (= A * B / C) (mg / kg / day) (mg /kg / day) (= NOAEL / D)Formaldehyde 61. 0.0177 0.039 2.2 200 A 26-week inhalation exposure test using monkeys withNOAEL 0.2 ppm as an index, using the metaplasia of the nasal cavity mucosa and turbinate mucosa
as an index.
Acetaldehyde 48. 0.0139 36. 2586.2 1000
IPCS US EPA and Canada's Ministry of Environment and Health applied data from his Wistar rat's
tail mucosa using NOAEL 150 ppm as an indicator of degeneration.
Acrolein 36. 0.0104 0.15 14.4 5000 From the index of emphysema and non-specific inflammation inthe liver, lungs, kidneys and heart in a 90-day continuous exposure test of dogs.
Glyoxal 29. 0.0084 0.02 2.4 1000
Mucosal or submucosal in a 29-day inhalation exposure test in rats
Mild epiglottis epithelium with lymphocyte-like cell infiltration was used as an index.
CommentI calculated the MOE for e-cigarette use and found that formaldehyde, acrolein, and glyoxal werelower than the product of uncertainties. That is, it is suggested that he is (has) adversely affected
human health.
(From the slide of Dr. Tomiko Mochizuki: 2016 5th Expert Committee of Tobacco Health Impact
Assessment: electronic tobacco )III. Measurement of heated tobacco aerosol
Total volatile organic compounds (TVOC) can be used. Various compounds compose TVOC, but I
think that it is primarily propylene glycol. TVOC value of 400 μg/m3 or more is above normal.
Benzene, toluene, ethylbenzene, xylene, n-propylbenzene,
1,2,4 trimethylbenzene, 1,3,5, trimethylbenzene, 2-ethyltoluene
Styrene, naphthalene, 4-phenylcyclohexene
Aliphatic hydrocarbons (n-C6 to C16) n-hexane, n-heptane, n-octane, n-nonane, n-decane
n-Undecane, n-Dodecane, n-Tridecane, n-Tetradecane, n-Pentadecanen-hexadecane, n-methylpentane, 3-methylpentane, 1-octene, 1-decene
Cyclic alkane methylcyclopentane, cyclohexane, methylcyclohexane,
Terpen 3-carene, α-pinene, β-pinene, limonene
Alcohol 2-propanol, 1-ptanol, 2-ethyl-1-hexanol

Glycol / glycol ether 2-methoxyethanol, 2-ethoxyethanol
2-Putoxyethanol, 1-methoxy-2-propanol, 2-Putoxyethoxyethanol
Aldecht butanal, pentanal, hexanal, nonanal, benzaldehyde
Ketone Methyl ethyl ketone, methyl isoptyl ketone, cyclohexanone, acetophenone
Halogen katankaiso trichlorethylene, tetrachlorethylene, 1,1,1-trichloroethane 1,4-dichlorobenzene
Acid Caproic acid
Ethyl acetate, petit acetate, isopropyl acetate, 2-ethoxyethyl acetate
Texanol isoptilate
Among these, propylene glycol most likely.

IV. What are other things in it?
Philip Morris (PM) has reported some contents of IQOS to the FDA, but there are substances thatwere not intentionally reported. These omitted substances are listed below, including some toxic
and/or carcinogenic substances3).

V. Summary
Heated tobacco devices and electronic vaporizers generate vapors (aerosols). Glycerol or propylene
glycol is used as a base fluid, which are oxidized through the heating process and create various
carcinogenic and/or toxic substances. The most concentrated ones include formaldehyde, acrolein
and glyoxal, as well as less concentrated ones like ethylbenzene, furan, dimethylaniline, cycloalkene,
linalol oxide, cyclohexane, furanone and furanmethanol. In addition to their toxic effects for theprimary user, they can generate illness and toxicity for bystanders through passive vaping.

References
Japan Society for Tobacco Control, Smoking Cessation Studies 4th Edition, Nanzando, Tokyo, 2019
1) Takahiro Tabuchi: ibid., Heated tobacco p162) Michiyuki Matsuzaki: ibid., Heated tobacco toxicity p22
3) Masahiko Ishida: Why does Aikos' "Philip Morris" repeat "lie"?
https://news.yahoo.co.jp/byline/ishidamasahiko/20200626-00185035/