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 38.0 Goniewicz 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, dizziness Ordonez 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

STRIATUM Kandel: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 GOOD

Los 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