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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cigarette smoke is estimated to contain more than 5000 chemical components&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> of which up to 98 inhaled toxic compounds have been associated with cancer&#44; cardiovascular and respiratory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Pollution by heavy metals&#44; including rare earth elements &#40;REEs&#41; and other minor elements&#44; has increased over the past decade&#44; partly due to the use of technological and electronic devices&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although some of these heavy metals are needed to sustain life&#44; most are not essential&#44; and indeed are known to produce adverse effects on human health even at very low concentrations due to their high degree of toxicity &#40;e&#46;g&#46; arsenic&#44; cadmium&#44; chromium&#44; lead&#44; and mercury&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other elements&#44; some of which are essential&#44; have also been classified by the Agency for Toxic Substances and Disease Registry &#40;ATSDR&#41; as toxic to living organisms at high concentrations&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The ATSDR lists 275 priority pollutants&#44; including 23 heavy metals<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> which are also found in smoke and tobacco products as a result of environmental pollution&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This new group of pollutants&#44; known as REEs&#44; have been acquiring a great deal of environmental importance&#44; and their systematic use in the development of smartphones&#44; tablets&#44; computers&#44; photocopiers&#44; telephones&#44; rechargeable batteries&#44; etc&#46; has already generated a new occupational and health safety risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#8211;10</span></a> REEs are metals that include scandium&#44; yttrium and the 15 elements of the lanthanide group &#40;lanthanum&#44; cerium&#44; praseodymium&#44; neodymium&#44; promethium&#44; samarium&#44; europium&#44; gadolinium&#44; terbium&#44; dysprosium&#44; holmium&#44; erbium&#44; thulium&#44; ytterbium&#44; and lutetium&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and are the source of e-waste&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7</span></a> Tobacco plants can accumulate REEs when these contaminants are present in the soil&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Tobacco growers use certain techniques that make tobacco more susceptible to the accumulation of toxins&#59; tobacco plants deplete the macro and micronutrients of the soil in which they are grown&#44; and this process is intensified by agricultural practices used to increase the amount of nicotine in the leaves of the plant&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As a result&#44; we can conclude that the use of cigarettes and even electronic cigarettes &#40;e-cigarettes&#41; is a source of exposure to these emerging pollutants known as REEs&#46; Large studies must be conducted to determine the effect of these elements on human health&#44; and we call on national governments and worldwide organizations to impose multiple mandatory strategies at all levels for the management of this e-waste&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evidence available to date on the accumulation of these metals in cigarettes and e-cigarettes is unequivocal&#46; Zumbado et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> analyzed the levels of 33 metals used in tech industries in manufactured cigarettes and roll-your-own &#40;RYO&#41; cigarettes&#44; studying both the tobacco and the paper and filters&#46; They looked not only at heavy metals conventionally listed as toxic but also at e-waste products&#44; and found that all elements that appear in the ATSDR list were present in both rolling paper and tobacco&#44; with the exception of mercury&#44; that was not isolated in blond tobacco&#44; black tobacco&#44; or &#8220;slim&#8221; cigarettes&#46; Most REE elements were found in almost all samples &#40;all of them were found&#44; but some only sporadically&#41;&#46; Cigarette paper contained higher levels of most elements than the tobacco itself &#40;or even much higher levels&#44; in the case of antimony&#44; selenium&#44; silver&#44; thallium&#44; uranium&#44; and vanadium&#41;&#46; When the authors measured the concentrations of elements in the paper of manufactured cigarettes&#44; they found significant differences depending on the type of tobacco&#58; in black tobacco cigarettes&#44; significantly high concentrations of 7 elements &#40;barium&#44; copper&#44; lead&#44; antimony&#44; selenium&#44; and vanadium&#41; were found&#46; Likewise&#44; the levels of REE elements were practically double those of &#8220;slim&#8221; cigarettes&#44; which in contrast contained high concentrations of silver&#46; The paper used to roll blond cigarettes had the lowest concentration of those elements&#46; The concentrations of these metals in tobacco were always higher in black tobacco&#44; and they were also found in different concentrations in the paper of RYO cigarettes&#44; with high levels being detected in flavored papers&#46; The authors conclude that black tobacco contains the highest levels of these toxic metals&#44; the paper used to wrap tobacco significantly modifies the levels of these elements&#44; and flavored and fast-burning papers contribute to higher levels of these heavy metals&#46; Badea et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> analyzed 42 heavy metals including REEs in the blood of non-smokers&#44; smokers&#44; and e-cigarette users and found the highest levels of copper&#44; molybdenum&#44; zinc&#44; antimony and strontium among smokers&#44; and selenium&#44; silver&#44; tin and vanadium among e-cigarette users&#46; Beryllium&#44; europium&#44; and lanthanides were detected more frequently in e-cigarette users than in smokers&#59; moreover&#44; more than 10 different REE elements were identified in 11&#46;8&#37; of e-cigarette users&#46; Serum levels of cerium and erbium in e-cigarette users increased as consumption increased&#46; The authors conclude that tobacco smoke is an important source of heavy metals&#44; while e-cigarettes are a potential source of REE&#46; An understanding of the toxic substances present in e-cigarettes is becoming increasingly important in public health due to events associated with e-cigarette use that are currently coming to light in the USA&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and death rates are showing that the uncontrolled use of a product that contains chemical substances is unacceptable&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Drago et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> found that smoking in enclosed spaces was associated with elevated levels of suspended particles measuring less than 2&#46;5&#8239;&#181;m &#40;PM <span class="elsevierStyleInf">2&#46;5</span> &#41; of cerium&#44; lanthanum&#44; cadmium&#44; and thallium which were associated with a higher probability of respiratory symptoms among adolescents and children&#46; REEs &#40;lanthanum&#44; cerium&#44; europium&#44; and gadolinium&#41; have also been found in the semen of tobacco and alcohol users&#44; but without affecting its quality&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">JIG-O has received c for speaking engagements&#44; scientific consultancy&#44; clinical trial participation&#44; and preparation of publications for &#40;in alphabetical order&#41;&#58; <span class="elsevierStyleGrantSponsor" id="gs0005">AstraZeneca</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0010">Chiesi</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0015">Esteve</span>&#44; 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Editorial
E-waste: Rare earth elements, new toxic substances in cigarettes and electronic cigarettes
La e-basura: rare earth elements, nuevos tóxicos presentes en los cigarrillos y cigarrillos electrónicos
José Ignacio de Granda-Orivea,
Corresponding author
igo01m@gmail.com

Corresponding author.
, Cristina García-Querob
a Servicio de Neumología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
b Servicio de Neumología, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cigarette smoke is estimated to contain more than 5000 chemical components&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> of which up to 98 inhaled toxic compounds have been associated with cancer&#44; cardiovascular and respiratory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Pollution by heavy metals&#44; including rare earth elements &#40;REEs&#41; and other minor elements&#44; has increased over the past decade&#44; partly due to the use of technological and electronic devices&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although some of these heavy metals are needed to sustain life&#44; most are not essential&#44; and indeed are known to produce adverse effects on human health even at very low concentrations due to their high degree of toxicity &#40;e&#46;g&#46; arsenic&#44; cadmium&#44; chromium&#44; lead&#44; and mercury&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Other elements&#44; some of which are essential&#44; have also been classified by the Agency for Toxic Substances and Disease Registry &#40;ATSDR&#41; as toxic to living organisms at high concentrations&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The ATSDR lists 275 priority pollutants&#44; including 23 heavy metals<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> which are also found in smoke and tobacco products as a result of environmental pollution&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This new group of pollutants&#44; known as REEs&#44; have been acquiring a great deal of environmental importance&#44; and their systematic use in the development of smartphones&#44; tablets&#44; computers&#44; photocopiers&#44; telephones&#44; rechargeable batteries&#44; etc&#46; has already generated a new occupational and health safety risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#8211;10</span></a> REEs are metals that include scandium&#44; yttrium and the 15 elements of the lanthanide group &#40;lanthanum&#44; cerium&#44; praseodymium&#44; neodymium&#44; promethium&#44; samarium&#44; europium&#44; gadolinium&#44; terbium&#44; dysprosium&#44; holmium&#44; erbium&#44; thulium&#44; ytterbium&#44; and lutetium&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and are the source of e-waste&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7</span></a> Tobacco plants can accumulate REEs when these contaminants are present in the soil&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Tobacco growers use certain techniques that make tobacco more susceptible to the accumulation of toxins&#59; tobacco plants deplete the macro and micronutrients of the soil in which they are grown&#44; and this process is intensified by agricultural practices used to increase the amount of nicotine in the leaves of the plant&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As a result&#44; we can conclude that the use of cigarettes and even electronic cigarettes &#40;e-cigarettes&#41; is a source of exposure to these emerging pollutants known as REEs&#46; Large studies must be conducted to determine the effect of these elements on human health&#44; and we call on national governments and worldwide organizations to impose multiple mandatory strategies at all levels for the management of this e-waste&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The evidence available to date on the accumulation of these metals in cigarettes and e-cigarettes is unequivocal&#46; Zumbado et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> analyzed the levels of 33 metals used in tech industries in manufactured cigarettes and roll-your-own &#40;RYO&#41; cigarettes&#44; studying both the tobacco and the paper and filters&#46; They looked not only at heavy metals conventionally listed as toxic but also at e-waste products&#44; and found that all elements that appear in the ATSDR list were present in both rolling paper and tobacco&#44; with the exception of mercury&#44; that was not isolated in blond tobacco&#44; black tobacco&#44; or &#8220;slim&#8221; cigarettes&#46; Most REE elements were found in almost all samples &#40;all of them were found&#44; but some only sporadically&#41;&#46; Cigarette paper contained higher levels of most elements than the tobacco itself &#40;or even much higher levels&#44; in the case of antimony&#44; selenium&#44; silver&#44; thallium&#44; uranium&#44; and vanadium&#41;&#46; When the authors measured the concentrations of elements in the paper of manufactured cigarettes&#44; they found significant differences depending on the type of tobacco&#58; in black tobacco cigarettes&#44; significantly high concentrations of 7 elements &#40;barium&#44; copper&#44; lead&#44; antimony&#44; selenium&#44; and vanadium&#41; were found&#46; Likewise&#44; the levels of REE elements were practically double those of &#8220;slim&#8221; cigarettes&#44; which in contrast contained high concentrations of silver&#46; The paper used to roll blond cigarettes had the lowest concentration of those elements&#46; The concentrations of these metals in tobacco were always higher in black tobacco&#44; and they were also found in different concentrations in the paper of RYO cigarettes&#44; with high levels being detected in flavored papers&#46; The authors conclude that black tobacco contains the highest levels of these toxic metals&#44; the paper used to wrap tobacco significantly modifies the levels of these elements&#44; and flavored and fast-burning papers contribute to higher levels of these heavy metals&#46; Badea et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> analyzed 42 heavy metals including REEs in the blood of non-smokers&#44; smokers&#44; and e-cigarette users and found the highest levels of copper&#44; molybdenum&#44; zinc&#44; antimony and strontium among smokers&#44; and selenium&#44; silver&#44; tin and vanadium among e-cigarette users&#46; Beryllium&#44; europium&#44; and lanthanides were detected more frequently in e-cigarette users than in smokers&#59; moreover&#44; more than 10 different REE elements were identified in 11&#46;8&#37; of e-cigarette users&#46; Serum levels of cerium and erbium in e-cigarette users increased as consumption increased&#46; The authors conclude that tobacco smoke is an important source of heavy metals&#44; while e-cigarettes are a potential source of REE&#46; An understanding of the toxic substances present in e-cigarettes is becoming increasingly important in public health due to events associated with e-cigarette use that are currently coming to light in the USA&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and death rates are showing that the uncontrolled use of a product that contains chemical substances is unacceptable&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Drago et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> found that smoking in enclosed spaces was associated with elevated levels of suspended particles measuring less than 2&#46;5&#8239;&#181;m &#40;PM <span class="elsevierStyleInf">2&#46;5</span> &#41; of cerium&#44; lanthanum&#44; cadmium&#44; and thallium which were associated with a higher probability of respiratory symptoms among adolescents and children&#46; REEs &#40;lanthanum&#44; cerium&#44; europium&#44; and gadolinium&#41; have also been found in the semen of tobacco and alcohol users&#44; but without affecting its quality&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">JIG-O has received c for speaking engagements&#44; scientific consultancy&#44; clinical trial participation&#44; and preparation of publications for &#40;in alphabetical order&#41;&#58; <span class="elsevierStyleGrantSponsor" id="gs0005">AstraZeneca</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0010">Chiesi</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0015">Esteve</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0020">Faes</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0025">Gebro</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0030">Menarini</span> and <span class="elsevierStyleGrantSponsor" id="gs0035">Pfizer</span>&#46; CG-Q has received honoraria for participating in clinical trials from <span class="elsevierStyleGrantSponsor" id="gs0040">GSK</span>&#46;</p></span></span>"
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Article information
ISSN: 15792129
Original language: English
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