Transcript VODNÍ DÝMKA, e-CIGARETY

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 20122014
 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.






SMOKER
BIG CITY
EAST EUROPE
15-24 years
25 – 39 years
„SINGLES“


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


11,88
1,53
1,71
5,26
1,82
1,49
(OR)
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, 2butadiene, propylenglycol, glycerine,
aluminium, 7 polycyclic aromatic h.
 Serum Cotinine levels of exposed nosmokers similar (0.5 ug/ml –e.cig, 0.8 ug/mlclassic 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