E-CIGARETTES „HEALTHIER“ SMOKING ??? .
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Transcript of E-CIGARETTES „HEALTHIER“ SMOKING ??? .
e-CIGARETTES
„HEALTHIER“ SMOKING ???
https://is.muni.cz/www/2422/um
DEFINITION
E-CIGARETTES = PRODUCTS USED FOR CONSUMPTION OF NICOTINE-CONTAINING VAPOUR VIA A MOUTH PIECE,
OR ANY COMPONENT OF THAT PRODUCT (CARTRIDGE, TANK, DEVICE)
CAN BE: DISPOSABLE, REFILABLE, RECHARGEABLE
EU Tobacco Products Direction, 2014
David O´Reilly, BAT
Thanks to mass manufacturing, globalization, two world wars and population growth, the 20th century was the CIGARETTE CENTURY
Thanks to technology, the 21st century could be the e-CIGARETTE CENTURY
Nicotine is an important, useful, cultural drug. It gets mothers, fathers, professionals stimulations and relax through their stresses in their daily lives.
The world would be a poorer place without it. The possitive roles that nicotine plays in our society has been lost in the smoke of the TOBACCO WARS.
The past is past, this is a new era!
Gregory N. Connolly:
THE 20th CENTURY WAS THE CIGARETTE CENTURY.
NOW, THE 21st CENTURY IS ABOUT MULTIPLE TOBACCO PRODUCTS.
THEY ARE CHEAP, FLAWORED. AND SOME OF THEM YOU CAN USE
ANYWHERE
E-CIGARETY
Electronic Nicotine Delivery Systems 1993 in China,
Currently 468 sorts, 7764 flavours Every month 10 new sorts and more than
240 new flavours (a) SMOKING CESSATION (b) SMOKING AT PUBLIC PLACES
PARAMETERS
TUBE – MICROPROCESOR – ATOMIZER – DIODA
FILLING: nicotine, propylenglykol/glycerin, menthol, chocolate, fruit, vanilla, alcohol, caramel aj.)
SELF- FILLING! (liquid) TEMPERATURE cca 60o C
PRODUCTION
SMALL MANUFACTURES, LOW STANDARD OF PRODUCTION
DIFFERENCES FROM DECLARED CONCENTRATIONS ( FDA)
„HOME MADE“ – INDIVIDUAL CREATION of MIXTURES
INTEREST of BIG TOBACCO
ALTRIA (PM) …………. ..MARK TEN REYNOLDS Am……….. ..VUSE BRITISH AM.TOBACCO…VYPE IMPERIAL TOBACCO ….. RUYAN LORILLARK …………….. BLU SWISHER ………………… E- SCHWISHER
SORTS of e-CIGARETTES
1st GENERATION – fixed form 2nd GENERATION - change of cartridge,
self-filling, new forms and tastes 3rd GENERATION - changed galvanic
tension => influence on taste and effects
e-cigarettes
„TANK SYSTEM“
Nikotine + additives are dropped on batery => increasing of volts (from 3,2 V to 4,8 V) => increased of temperatury => significant increasing of toxins levels
FORMALDEHYD : similar levels as for classic cigarettes
Dripper
ADVERTISING
„HARM REDUCTION“ = healthier, clean, cheaper alternative of smoking
BACK TO 50.-60. at 20.CENTURY: freedom, sofisticated, new subculture, MAX-imum style)
REDUCTION of CLASSIC CIGARETTES SMOKING CESSATION SMOKING on PUBLIC PLACES TV, internet, press,VIP persons, physicians
ALSO:
National Vaper´s Club Consumer Advocates for Smoke-free
Alternatives Association Web pages Altria (PM) a R.J.Reynolds:
Citizens for Tobacco Rights and Transform Tobacco
E-cigarettes on You Tube
196 videos: 94 % POSITIVE
4 % NEUTRAL
2 % ANTI
POSITIVE: 84,3 % with web buy contact
71,4 % with „healthier“declaration
DISPERSION
International Tobacco Control Four-Country Survey 2013:
KNOWLEDGE: 46.6% (US 73, UK 54, Ca 40, Au 20) HAVE TRIED: 7.6% (= 16% from informated) CURRENT USERS: 2.9% (= 39% from experimentators) UK prevalence of users has grown 3times between 2012-
2014
SOCIAL TRENDS: young, higher income
EUROBAROMETR 2012
26.566 persons > 15 years from 27 countries EU, representative samples
EVER USED 23.1 MILIONS of EUROPEANS: 20.3 % smokers 4.4 % ex-smokers 1.1 % no smokers• In CR (N= 1003 persons), tried 34,3%Vardavas C et al. Tobacco Control 2014,June 16; doi: 10.1136tobaccocontrol-2013-051394
POLAND STUDY
REPRESENT. Sample, age 15-19 y
2010/11 2013/14
Ever tried (%) 16.8 62.1
Current users 5.5 29.9
Dual smokers 3.6 21.8
Cassic cig. Smoke 23.9 38.0Goniewicz ML. Et al. Rise in electronic cigarette use among adolescents in Poland. J Adolesc.Health 2014;55:713-715
DETERMINANTS e.CIG. (OR)
SMOKER BIG CITY EAST EUROPE 15-24 years 25 – 39 years „SINGLES“
11,88 1,53 1,71 5,26 1,82 1,49
REASONS :
75.4% smoking reduction 85.1% smoking cessation 79.8% believe about safety „DUAL SMOKING“
RESEARCH PROBLEMS
NO STANDARD of TECHNOLOGY QUICK CHANGES IN LEVELS of NICOTINE GALVANIC VOLTS ADITIVES
NICOTINE
SOURCE: tobacco? Synthetic? DIFFERENCES IN
PHARMACODYNAMIC and PHARMACO KINETIC PROPERTIES?
VAPOUR (60o C) vs BURNING (600-900o C)
JUICE
Free available, sweet -smelling bottles with poison,
Increasing number of poisoning (ingestion, transdermal)
Children under 6 y.
TEXAS POISON CENTERS
225 events: 2 – 2009; 6 – 2010; 11 – 2011; 43 – 2012; 123 – 2013; 40 up to Feb.2014
53 % < 5 years; 41 % > 20 years; 6 % rest 73 % by ingestion; 95 % at home 20 % vomiting; 10 % nauzea; 5 % irritation,
headache; lethargy, dizzinessOrdonez JE et al. Nicotine Tob Res 2014; doi:10.1093/ntr/ntu223
SYMPTOMS
Cholinergic crisis:
- Secretion, vomiting
- Neuromuscular block
- Respiratory fail
- Death
- Bassett RA aj. Nicotine poisoning in an infant. NEJM 2014; 370: 2249-2250
PROPYLENGLYCOL/ GLYCERIN
Irritation (eyes, respiratory, nausea,vomiting); damages of CNS, spleen
Lipoid pneumonia Propylenglycol=>PROPYLEN OXID (2B
carcinogen – IARC) Glycerin => AKROLEIN (irritant, 2B lung
carcinogen) MERCAPTURIC ACIDE
EXPLOSION of e-CIGARETTES
D.Aspinall, 48 let, Manchester: hluboké poranění nohy, ztráty krve, požár – vrátil se ke kouření, protože „cigarety jsou bezpečnější“
D.Thomson, 62 let, Merseyside – zemřel při výměně (požár) J.Booth, 65 let, Manchester – vážná popálení L.Batty, 18 let, Londýn – popálení Žena, Londýn – požár, popálení
E-cig. – FORCE RISKS?
FIRES FROM LITHIUM BATTERIES :
- 2009 aeroport SanPaulo, Minneapolis
- 2013 Japon aerolinies
- 2014 aeroport Boston
OTHER CHEMICALS:
NITROSAMINES POLYCYKLIC CHLORINATED H. POLYCYKLIC AROMATIC H. METALS: Ni, Cr, Cu, Sn, Pb, Cd, Ag, Fe –
levels are higher than from classic cigarettes
DUST MATTERS PM2,5
CLASSIC CIG.
4 x 109 /cm 3
E-CIGARETTES:
4.39 x 109 /cm 3
CORELATION WITH NIKOTINE CONTENT,
CYTOTOXIC and MUTAGENIG EFFECTS IN VITRO
CYTOTOXICITY
Human pulmonal fibroblasts Human embryonal stem cells !
(pregnancy!) Neural stem cells (mice) Heart myoblasts (rats)
HEALTH EFFECTS
*AC. RESPONSE from HEART and LUNGS SIMILAR as by classic cigarettes
*DEPENDENCE (both physical and behavioral)
*SIDE EFFECTS: headache, nauzea, irritation,
BIOMARKERS:
URINARY NICOTINE, COTININE – SIMILAR LEVELS as in classic cigarettes smokers
URINARY 1-HYDROXYPROPYLENE, NNAL, MERCAPTURIC ACIDES – LOWER LEVELS
NO KNOWLEDGE ABOUT HEALTH EFFECTS FROM CHRONIC USE
„SECONDHAND VAPING“
ETS CONTENT (comparred with classic cigarettes emisions)
- NH4OH lower by 41 %
- CO as in no-smoking environment
- Nicotine 10x lower(3.32 vs. 31.6 um/m3)
…but IDENTIFICATION of
Formaldehyde, acetaldehyde, acetone, 2-butadiene, propylenglycol, glycerine, aluminium, 7 polycyclic aromatic h.
Serum Cotinine levels of exposed no-smokers similar (0.5 ug/ml –e.cig, 0.8 ug/ml-classic cig.)
ETS from e-CIGARETTES
IS NOT ONLY „SAFE“ WATER STEAM,
IT INCLUDE MANY DANGEROUS CHEMICALS ,
IN DETECABLE – EVEN LOWER - LEVELS
SMOKING CESSATION
THE EFFECTS of e-CIGARETTES ARE LOWER THAN THOSE of NNT
Meta analysis: OR 0.61 (95% CI 0.50 – 0.75)
ARE e-CIG. MEDICINES?
THE PRINCIPLES for EVALUATION of the DRUG
FUNCTION PRESENTATION of cure powerty
according to the previous prescribed and expensive tests
E-CIGARETTES
Are declared as ALTERNATIVE OF SMOKING (not for the breakdown of dependence)
NICOTINE is taken for „PLEASURE“ (it is not true for drugs)
NICOTINE is taken AD LIBIDUM (doses for drugs are established)
ACTUAL CONCLUSIONS:
E-CIGARETTE EMISES LOWER LEVELS of SOME CHEMICALS
DUAL USE IS NOT THE WAY TO STOP SMOKING
RE-NORMALISATION of SMOKING IN THE SOCIETY
NICOTINE - GATEWAY
FOR OTHER DRUGS THE CRITICAL ROLE IN SPECIFIC GENES TRANSKRIPTION
(FOSB and its isoforms) And THEIR ACCUMULATION in
STRIATUMKandel:A molecular basis for nicotine as a gateway drug. NEJM 2014; 371: 932-943
NICOTINE-EPIGENETIC CARCINOGEN
INHIBITION of APOPTOSIS REVASCULARIZATIN of ONCOGENIC
TISSUE LOWERING of CELL ADHERENCY =>
METASTASES
NICOTINE –CA INICIATOR?
PARTIAL METABOLIC TRANSFORMATION on NNK
ENHANCED PRODUCTION of FREE RADICALS in TISSUE
PRENATAL EXPOSURE
FETAL ORIGIN of CVD (PROGRAMING) NEUROTERRATOGEN (ADHD) SIDS
REGULATION
PROHIBITE: Brazilie, Singapore, Canada, Seychelly, Uruguay
USA: not unified: state/ city legislative
EU Tobacco Product Directive (February 2014):
- nicotine up to 20 mg/ml = tobacco product
- Higher doses of nicotine = pharmaceutic product
- List of aditives, health warnings
- Self-changed cartridge up to 2 ml is allowed; possible later prohibition
RECOMMENDATIONS
Ban of using e-cig. at public places Ban of sale – similar as for tobacco products Ban of advertising - similar as for tobacco
products Ban of offer supporting the dual smoking
RECOMMEND. - continue
Ban of using sweet-smell additives (sweets, alcohol)
Ban of publicity as the help for smoking cessation
Ban of publicity as the „healthier smoking“ Establishment of standards COMMON WITH CLASSIC TOBACCO
CONTROL
If e- cigarettes
LOOK LIKE CLASSIC CIGARETTES, CALL „CIGARETTES“ ARE SMOKING LIKE CLASSIC
CIGARETTES THE PRINCIPLES FOR THEIR CONTROL
MUST BE THE SAME AS FOR CLASSIC CIGARETTES
Tom Frieden – chief US CDC
If they get another generation of kids more hooked on nicotine and more likely to smoke cigarettes,
THAT´S MORE HARM THAN GOOD
Tom Frieden:
If they get smokers who would like to quit to keep smoking instead quitting
THAT´S MORE HARM THAN GOOD
Tom Frieden
If they get ex-smokers who have been off nicotine to go back on nicotine and then back to cigarettes,
THAT´S MORE HARM THAN GOOD
Tom Frieden
If they get people who want to quit smoking and would have taken medicines to think e-cigarettes are going to help, but they don´t,
THAT´S MORE HARM THAN GOOD
Tom Frieden
If they re-glamorize smoking, THAT´S MORE HARM THAN GOODLos Angeles Times, April 29, 2014
CONCLUSSION 1
E-CIGARETTES ARE PRESENTED AS THE SAFE SMOKING
IT MUST BE CONFIRMED OR CONTROVERT BY RESEARCH
USING OF e-CIGARETTES LOWERES THE COMMON EFFORT TO REDUCE NICOTINE/TOBACCO USING
CONCLUSSION 2
NICOTINE IS: COMPLEETE CARCINOGEN HUMAN TERRATOGEN POTENT DRUG
THANK YOU FOR ATTENTION