Παρουσίαση του PowerPoint · e-cigarette devices include metals, ceramics and rubber,...
Transcript of Παρουσίαση του PowerPoint · e-cigarette devices include metals, ceramics and rubber,...
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Κουρέα
Καλλιρρόη
Καρδιολόγος
ΕΝΑΛΛΑΚΤΙΚΕΣ ΜΟΡΦΕΣ ΚΑΠΝΙΣΜΑΤΟΣ
E CIGARETTE ENDS:ELECTRONIC NICOTINE DEL IVERY SYSTEM)
ΗΕΑΤ-ΝΟΤ-ΒURN CIGARETTES ( IQOS)
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NICOTINE DELIVERY SYSTEMS
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NICOTINE DELIVERY SYSTEMS
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• 2003: the first commercially successful
electronic cigarette is created in
Beij ing, China by Hon Lik, a 52 year old
pharmacist, inventor and smoker.
• April 2006: Electronic cigarettes
introduced to Europe.
• 2006-2007: Electronic cigarettes
introduced to the U.S.
FIRST COMMERCIALLY SUCCESSFUL
E CIGARETTE
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HOW DOES IT WORK?
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THE THREE GENERATIONS
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E LIQUID
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Nicotine delivery from e-cigarettes (concentration of nicotine -puffing (‘vaping’) technique).
Nicotine delivery is better from second- and third-generation
Experienced vapers VS naive users
The speed of nicotine delivery remains much slower than from cigarettes.
TOXICANTS IN E-CIGARETTENICOTINE
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Propylene glycol glycerol to generate the synthetic
smoke
…acute exposure to propylene glycol has been shown
to induce airway irritation and cough in humans,
together with minor airflow obstruction...
TOXICANTS IN E-CIGARETTE
PROPYLENE GLYCOL AND GLYCERINE
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• Heating propylene glycol or glycerine can cause
decomposition to low- molecular-mass carbonyl
compounds including formaldehyde and acetaldehyde ,
which can be carcinogenic in large doses.
TOXICANTS IN E-CIGARETTECOMPONENTS GENERATED BY VAPORISATION
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e-cigarette devices include metals, ceramics and
rubber, all of which may become aerosolised in the
process of vapour generation, copper particles of
respirable size -levels of nickel and silver that are also
higher than those in tobacco smoke
Potential toxicity: carcinogenicity, cardiovascular
disease and diseases such as COPD and interstitial lung
TOXICANTS IN E-CIGARETTECOMPONENTS GENERATED BY VAPORISATION
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• safe when ingested orally , some are irritant to the
airways and the safety of most flavours after heating
and inhalation is unknown.
• Vapour produced from e-liquids containing flavours has
been demonstrated to be more cytotoxic than
unflavoured vapour
TOXICANTS IN E-CIGARETTE
FLAVOURS
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TOXICANTS IN E-CIGARETTE
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E CIG AND CARDIOVASCULAR SYSTEM
Electronic Cigarette
Smoking Increases
Aortic
Stiffness and Blood
Pressure in Young
Smokers
Vlachopoulos, C, Ioakeimidis, N et al
JACC 2016
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CORRESPONDENCE
Electronic Cigarette Smoking Increases
Arterial Stiffness and Oxidative Stress to a
Lesser Extent Than a Single Conventional
Cigarette
An Acute and Chronic Study
Ignatios Ikonomidis, Dimitrios Vlastos, Kallirrhoe Kourea, Gavriela
Kostelli, Maria Varoudi, George Pavlidis, Panagiotis Efentakis,
Helen Triantafyllidi, John Parissis, Ioanna Andreadou, Efstathios
Iliodromitis, John Lekakis
Circulation. 2018;137:303-306
Originally published January 15, 2018
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FLOW CHART OF THE ACUTE STUDY
Vascular
assessment
blood
samples
E-cig
Co
n-
cig
7min 7min
20min 20min 20min 20min
40min1 month
E-cig
Con-cig
7min7min
20min 20min 20min 20min
40min1 month
Vascular
assessment
blood
samples
Vascular assessment
blood samples
Vascular
assessment
blood
samples
Total washout= 60 min
Vascular assessment
blood samples
Vascular assessment
blood samples
Vascular assessment
blood samples
Vascular assessment
blood samples
N=70 assigned
to
• e-cig with
nicotine n=35
• or without
nicotine n=35
Sham
smoki
ng
7min
Sham smoki
ng
Vascular
assessment
blood
samples
Vascular assessment
blood samples
20min
7min
20min
Total washout= 60 min
In all subjects we measured at acute and
chronic phase of the study:
• Carotid-femoral pulse wave velocity
(PWVc, Complior SP ALAM)
• central systolic blood pressure (cSBP)
• augmentation index (AI) of the aortic
pulse wave (Arteriograph TensioMed).
• Malondialdehyde (MDA) and protein
carbonyls (PCs) plasma levels.
• Exhaled CO concentration
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p=0.01
p=0.8
Electronic Cigarette Smoking Increases Arterial Stiffness
and Oxidative Stress to a Lesser Extent Than a Single
Conventional Cigarette
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10
11
12
13
14
15
16
baseline e-cig tobacco
CO
both groups
Electronic Cigarette Smoking Increases Arterial Stiffness
and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette
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0.9
1
1.1
1.2
1.3
1.4
1.5
baseline e-cig tobacco
MDA
Electronic Cigarette Smoking Increases Arterial Stiffness
and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette
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60
6
34
compliance
e-cig tobacco double0
5
10
15
20
25
baseline 1 month
CO
Electronic Cigarette Smoking Increases Arterial Stiffness
and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette
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20
22
24
26
28
30
32
34
baseline 1 month
Aix
0.8
0.9
1
1.1
1.2
1.3
1.4
baseline 1 month
MDA
Electronic Cigarette Smoking Increases Arterial Stiffness
and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette
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E-cigarettes 'less harmful' than cigarettes?
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AIDS USED IN MOST RECENT QUIT ATTEMPT
26
0
5
10
15
20
25
30
35
40
45
50
Pe
rce
nt
of
sm
ok
ers
try
ing
to
sto
p
E-cigs
NRT OTC
NRT Rx
Champix
Beh'l supp
N=11976 adults who smoke and tried to stop or who stopped in the past year; method is
coded as any (not exclusive) use
E-cigarette use for quitting is still increasing
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•The main f indings
· vaping poses only a small f raction of the r isks of smoking and
switching completely from smoking to vaping conveys substantial
health benefits
• e-cigarettes could be contr ibuting to at least 20,000 successful
new quits per year and possibly many more
• e-cigarette use is associated with improved quit success rates over
the last year and an accelerated drop in smoking rates across the
country
• the evidence does not support the concern that e -cigarettes are a
route into smoking among young people (youth smoking rates in
the UK continue to decline, regular use is rare and is almost entirely
confined to those who have smoked)
EVIDENCE REVIEW OF E-CIGARETTES AND HEATED
TOBACCO PRODUCTS 2018: EXECUTIVE SUMMARYP U B L I S H E D 6 F E B R U A R Y 2 0 1 8
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FDA REGULATION OF ENDS: AUGUST 2016
The FDA now regulates all
tobacco products,
including (as shown):
hookah, e-cigarettes,
dissolvables, smokeless
tobacco, cigarettes, all
cigars, roll-your-own
tobacco, pipe tobacco,
and future tobacco
products that meet the
statutory definition of a
tobacco product.
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Manufacturing ENDS and E-Liquids
Beginning in 2018, the product packages and
advertisements of all newly-regulated covered tobacco
products must bear the following warning statement:
“WARNING: This product contains nicotine. Nicotine is
an addictive chemical .”
FDA REGULATION OF ENDS
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Focusing on YouthThe new rule aims to deter
youth initiation through restricting youth access to these products by:o Not allowing products to be
sold to persons under the age of 18 years;
o Requiring age verif ication by photo ID;
o Not allowing the sell ing of tobacco products in vending machines (unless in an adult-only facil ity);
o Not allowing the distr ibution of free samples.
FDA REGULATION OF ENDS
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From 20th May 2016 e-cigarettes containing nicotine will be regulated in the Europe Union
under Article 20 of the Tobacco Products Directive
EUROPEAN UNION TOBACCO
PRODUCTS DIRECTIVE
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WHAT REDUCED-RISK PRODUCTS (“RRPS”) ARE ?
Reduced-Risk Products (“RRPs”) is the term used
to refer to products that present, are likely to
present, or have the potential to present less risk
of harm to smokers who switch to these
products versus continued smoking.
HARM
REDUCTION
PRODUCT
ACCEPTANCE
AND USAGE
REDUCED-RISK
PRODUCT = X
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Heat not burn cigarettes-heat sticks
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35
Impact of the temperature on the formation of toxicants
www.pmiscience.com
Energy source
CO2 ; CO ; H2O
Transfer fromtobacco into smoke
Nicotine
Aromas
« The chemical factory »(5000+ compounds)
Decomposition of biopolymers,
proteins...HPHCs
Benzo[a]pyrene
Combustion> 750°C
Pyrolysis~ 300 - 700°C
Distillation< 300°C
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36
Demonstrated that the operation of THS2.2 does not
result in the combustion of tobacco.
THS 2.2 stands for Tobacco Heating System version 2.2 and refers to a commercialized version of iQOS.
(a) Aerosol collection with Intense Health Canada’s Smoking Regime (55 mL puff volume, 2 second puff duration, 30 second interval puff);
Comparison on a per-stick basis Reduction calculations exclude Nicotine, Glycerin and Total Particulate Matter
(b) The PMI 58 list includes the FDA 18 and (c) the 15 carcinogens of IARC Group 1
100%
75%
50%
25%
0%FDA 18
(18 chemicals)
PMI 58(b)
(58 chemicals)
Carcinogens(c)
(15 chemicals)
> 90%
reducti
on
> 90%
reducti
on
> 95%
reducti
on
Air
3R4F
Photographs of the Cambridge filter
pads after the collection of:
THS2.2
cigarette smoke
THS 2.2 aerosol
Average reductions in formation of harmful or potentially
harmful constituents for THS2.2 compared to levels
measured in smoke from the 3R4F reference cigarette*
Aerosol Chemistry: Reduced Formation
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37
Adult
smokers used
the products
ad libitum
Adult smokers
randomized to
cigarettes or
THS2.2 were free
to use the
product as often
as they wished, in
confinement
(5 days) and then
ambulatory
(85 days) 0
200
400
600
800
1000
0 20 40 60 80
Time (days)
Acrolein - 3-HPMA (ng/mg creat)
0 1 2 3 4 5 30 60 90
0
1
2
3
4
5
6
7
0 20 40 60 80
Time (days)
Carbon Monoxide - COHb %
0 1 2 3 4 5 30
60 90
0
400
800
1200
1600
2000
0 20 40 60 80
Time (days)
Benzene - S-PMA (pg/mg creat)
0 1 2 3 4 5 30 60 90
0
200
400
600
800
1000
1200
0 20 40 60 80
Time (days)
1,3-Butadiene – MHBMA (pg/mg creat)
0 1 2 3 4 5 30
60 90
CO
Hb
(%)
3-H
PM
A (
ng
/mg
cre
at)
S-P
MA
(n
g/m
g c
reat)
HM
BM
A (
ng
/mg
cre
at)
THS
Note: These data alone do not represent a claim of reduced risk.
Source: PMI Research and Development. Registered on clinicaltrials.gov: NCT01970995
Clinical Assessment: Reduced Exposure
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HEATST ICKS NOT SUCH A HOT SOLUT ION
TO TOBACCO-RELATED D ISEASE
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a note of caution about many issues,
including whether the perception that it
is less risky and that its iPhone-like design
might entice adolescents to start
smoking, as well as the fact that IQOS
users might continue to smoke
cigarettes.
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• enthusiastic about the potential for IQOS to reduce smoking-related harms
• heating blade in the holder r ises to 662 ° F, vaporizing the tobacco. A conventional cigarette burns tobacco at 1200 ° F.
• cigarette smoke contains some 4330 chemicals, the IQOS aerosol has just 750.
• The committee was more ful ly convinced — voting 8 to 1 —that IQOS "significantly reduces your body's exposure to harmful or potentially harmful chemicals."
HEATST ICKS NOT SUCH A HOT SOLUT ION
TO TOBACCO-RELATED D ISEASE
JANUARY 26 , 2018
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HARM REDUCTION
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HARM REDUCTION
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