e-CIGARETTES HEALTHIER SMOKING https is

e-CIGARETTES „HEALTHIER“ SMOKING ? ? ? https: //is. muni. cz/www/2422/um

DEFINITION w E-CIGARETTES = PRODUCTS USED FOR CONSUMPTION OF NICOTINE-CONTAINING VAPOUR VIA A MOUTH PIECE, w OR ANY COMPONENT OF THAT PRODUCT (CARTRIDGE, TANK, DEVICE) w CAN BE: w DISPOSABLE, REFILABLE, RECHARGEABLE EU Tobacco Products Direction, 2014

David O´Reilly, BAT w Thanks to mass manufacturing, globalization, two world wars and population growth, the 20 th century was the CIGARETTE CENTURY w Thanks to technology, the 21 st century could be the e-CIGARETTE CENTURY w Nicotine is an important, useful, cultural drug. It gets mothers, fathers, professionals stimulations and relax through their stresses in their daily lives. w 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. w The past is past, this is a new era!

Gregory N. Connolly: w THE 20 th CENTURY WAS THE CIGARETTE CENTURY. w NOW, THE 21 st CENTURY IS ABOUT MULTIPLE TOBACCO PRODUCTS. w THEY ARE CHEAP, FLAWORED. w AND SOME OF THEM YOU CAN USE ANYWHERE

E-CIGARETY w Electronic Nicotine Delivery Systems w 1993 in China, w Currently 468 sorts, 7764 flavours w Every month 10 new sorts and more than 240 new flavours w (a) SMOKING CESSATION w (b) SMOKING AT PUBLIC PLACES

PARAMETERS w TUBE – MICROPROCESOR – ATOMIZER – DIODA w FILLING: nicotine, propylenglykol/glycerin, menthol, chocolate, fruit, vanilla, alcohol, caramel aj. ) w SELF- FILLING! (liquid) w TEMPERATURE cca 60 o C

PRODUCTION w SMALL MANUFACTURES, LOW STANDARD OF PRODUCTION w DIFFERENCES FROM DECLARED CONCENTRATIONS ( FDA) w „HOME MADE“ – INDIVIDUAL CREATION of MIXTURES

INTEREST of BIG TOBACCO w ALTRIA (PM) …………. . . MARK TEN w REYNOLDS Am………. . VUSE w BRITISH AM. TOBACCO…VYPE w IMPERIAL TOBACCO …. . RUYAN w LORILLARK ……………. . BLU w SWISHER ………………… E- SCHWISHER

SORTS of e-CIGARETTES w 1 st GENERATION – fixed form w 2 nd GENERATION - change of cartridge, self-filling, new forms and tastes w 3 rd GENERATION - changed galvanic tension => influence on taste and effects

e-cigarettes

„TANK SYSTEM“ w 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 w FORMALDEHYD : similar levels as for classic cigarettes

Dripper

ADVERTISING w „HARM REDUCTION“ = healthier, clean, cheaper alternative of smoking w BACK TO 50. -60. at 20. CENTURY: freedom, sofisticated, new subculture, MAX-imum style) w REDUCTION of CLASSIC CIGARETTES w SMOKING CESSATION w SMOKING on PUBLIC PLACES w TV, internet, press, VIP persons, physicians

ALSO: w National Vaper´s Club w Consumer Advocates for Smoke-free Alternatives Association w Web pages Altria (PM) a R. J. Reynolds: Citizens for Tobacco Rights and Transform Tobacco

E-cigarettes on You Tube w 196 videos: 94 % POSITIVE 4 % NEUTRAL 2 % ANTI POSITIVE: 84, 3 % with web buy contact 71, 4 % with „healthier“declaration

DISPERSION w International Tobacco Control Four-Country Survey 2013: w w 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 3 times between 20122014 w SOCIAL TRENDS: young, higher income

EUROBAROMETR 2012 w 26. 566 persons > 15 years from 27 countries EU, representative samples w 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. 1136 tobaccocontrol-2013 -051394

POLAND STUDY w 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. w w w SMOKER BIG CITY EAST EUROPE 15 -24 years 25 – 39 years „SINGLES“ w w w 11, 88 1, 53 1, 71 5, 26 1, 82 1, 49 (OR)

REASONS : w w 75. 4% smoking reduction 85. 1% smoking cessation 79. 8% believe about safety „DUAL SMOKING“

RESEARCH PROBLEMS w NO STANDARD of TECHNOLOGY w QUICK CHANGES IN w LEVELS of NICOTINE w GALVANIC VOLTS w ADITIVES

NICOTINE w SOURCE: tobacco? Synthetic? w DIFFERENCES IN PHARMACODYNAMIC and PHARMACO KINETIC PROPERTIES? VAPOUR (60 o C) vs BURNING (600 -900 o C)

JUICE w Free available, sweet -smelling bottles with poison, w Increasing number of poisoning (ingestion, transdermal) w Children under 6 y.

TEXAS POISON CENTERS w 225 events: 2 – 2009; 6 – 2010; 11 – 2011; 43 – 2012; 123 – 2013; 40 up to Feb. 2014 w 53 % < 5 years; 41 % > 20 years; 6 % rest w 73 % by ingestion; 95 % at home w 20 % vomiting; 10 % nauzea; 5 % irritation, headache; lethargy, dizziness Ordonez JE et al. Nicotine Tob Res 2014; doi: 10. 1093/ntr/ntu 223

SYMPTOMS w Cholinergic crisis: - Secretion, vomiting - Neuromuscular block - Respiratory fail - Death - Bassett RA aj. Nicotine poisoning in an infant. NEJM 2014; 370: 2249 -2250

PROPYLENGLYCOL/ GLYCERIN w Irritation (eyes, respiratory, nausea, vomiting); damages of CNS, spleen w Lipoid pneumonia w Propylenglycol=>PROPYLEN OXID (2 B carcinogen – IARC) w Glycerin => AKROLEIN (irritant, 2 B lung carcinogen) w MERCAPTURIC ACIDE

EXPLOSION of e-CIGARETTES w D. Aspinall, 48 let, Manchester: hluboké poranění nohy, ztráty krve, požár – vrátil se ke kouření, protože „cigarety jsou bezpečnější“ w D. Thomson, 62 let, Merseyside – zemřel při výměně (požár) w J. Booth, 65 let, Manchester – vážná popálení w L. Batty, 18 let, Londýn – popálení w Žena, Londýn – požár, popálení

E-cig. – FORCE RISKS? w FIRES FROM LITHIUM BATTERIES : - 2009 aeroport San. Paulo, Minneapolis - 2013 Japon aerolinies - 2014 aeroport Boston

OTHER CHEMICALS: w NITROSAMINES w POLYCYKLIC CHLORINATED H. w POLYCYKLIC AROMATIC H. w METALS: Ni, Cr, Cu, Sn, Pb, Cd, Ag, Fe – levels are higher than from classic cigarettes

DUST MATTERS PM 2, 5 w CLASSIC CIG. 4 x 109 /cm 3 w E-CIGARETTES: 4. 39 x 109 /cm 3 CORELATION WITH NIKOTINE CONTENT, CYTOTOXIC and MUTAGENIG EFFECTS IN VITRO

CYTOTOXICITY w Human pulmonal fibroblasts w Human embryonal stem cells ! (pregnancy!) w Neural stem cells (mice) w 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: w URINARY NICOTINE, COTININE – SIMILAR LEVELS as in classic cigarettes smokers w URINARY 1 -HYDROXYPROPYLENE, NNAL, MERCAPTURIC ACIDES – LOWER LEVELS w NO KNOWLEDGE ABOUT HEALTH EFFECTS FROM CHRONIC USE

„SECONDHAND VAPING“ w ETS CONTENT (comparred with classic cigarettes emisions) - NH 4 OH lower by 41 % - CO as in no-smoking environment - Nicotine 10 x lower(3. 32 vs. 31. 6 um/m 3)

…but IDENTIFICATION of w Formaldehyde, acetone, 2 butadiene, propylenglycol, glycerine, aluminium, 7 polycyclic aromatic h. w Serum Cotinine levels of exposed nosmokers similar (0. 5 ug/ml –e. cig, 0. 8 ug/mlclassic cig. )

ETS from e-CIGARETTES w IS NOT ONLY „SAFE“ WATER STEAM, w IT INCLUDE MANY DANGEROUS CHEMICALS , w IN DETECABLE – EVEN LOWER LEVELS

SMOKING CESSATION w THE EFFECTS of e-CIGARETTES ARE LOWER THAN THOSE of NNT w Meta analysis: w OR 0. 61 (95% CI 0. 50 – 0. 75)

ARE e-CIG. MEDICINES? w THE PRINCIPLES for EVALUATION of the DRUG w FUNCTION w PRESENTATION of cure powerty according to the previous prescribed and expensive tests

E-CIGARETTES w Are declared as ALTERNATIVE OF SMOKING (not for the breakdown of dependence) w NICOTINE is taken for „PLEASURE“ (it is not true for drugs) w NICOTINE is taken AD LIBIDUM (doses for drugs are established)

ACTUAL CONCLUSIONS: w E-CIGARETTE EMISES LOWER LEVELS of SOME CHEMICALS w DUAL USE IS NOT THE WAY TO STOP SMOKING w RE-NORMALISATION of SMOKING IN THE SOCIETY

NICOTINE - GATEWAY w FOR OTHER DRUGS w THE CRITICAL ROLE IN w SPECIFIC GENES TRANSKRIPTION (FOSB and its isoforms) w And THEIR ACCUMULATION in STRIATUM Kandel: A molecular basis for nicotine as a gateway drug. NEJM 2014; 371: 932 -943

NICOTINE-EPIGENETIC CARCINOGEN w INHIBITION of APOPTOSIS w REVASCULARIZATIN of ONCOGENIC TISSUE w LOWERING of CELL ADHERENCY => METASTASES

NICOTINE –CA INICIATOR? w PARTIAL METABOLIC TRANSFORMATION on NNK w ENHANCED PRODUCTION of FREE RADICALS in TISSUE

PRENATAL EXPOSURE w FETAL ORIGIN of CVD (PROGRAMING) w NEUROTERRATOGEN (ADHD) w SIDS

REGULATION w PROHIBITE: Brazilie, Singapore, Canada, Seychelly, Uruguay w w - 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 w w 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 w Ban of using sweet-smell additives (sweets, alcohol) w Ban of publicity as the help for smoking cessation w Ban of publicity as the „healthier smoking“ w Establishment of standards w COMMON WITH CLASSIC TOBACCO CONTROL

If e- cigarettes w LOOK LIKE CLASSIC CIGARETTES, w CALL „CIGARETTES“ w ARE SMOKING LIKE CLASSIC CIGARETTES w THE PRINCIPLES FOR THEIR CONTROL MUST BE THE SAME AS FOR CLASSIC CIGARETTES

Tom Frieden – chief US CDC w If they get another generation of kids more hooked on nicotine and more likely to smoke cigarettes, w THAT´S MORE HARM THAN GOOD

Tom Frieden: w If they get smokers who would like to quit to keep smoking instead quitting w THAT´S MORE HARM THAN GOOD

Tom Frieden w If they get ex-smokers who have been off nicotine to go back on nicotine and then back to cigarettes, w THAT´S MORE HARM THAN GOOD

Tom Frieden w 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, w THAT´S MORE HARM THAN GOOD

Tom Frieden w If they re-glamorize smoking, w THAT´S MORE HARM THAN GOOD Los Angeles Times, April 29, 2014

CONCLUSSION 1 w E-CIGARETTES ARE PRESENTED AS THE SAFE SMOKING w IT MUST BE CONFIRMED OR CONTROVERT BY RESEARCH w USING OF e-CIGARETTES LOWERES THE COMMON EFFORT TO REDUCE NICOTINE/TOBACCO USING

CONCLUSSION 2 w NICOTINE IS: w COMPLEETE CARCINOGEN w HUMAN TERRATOGEN w POTENT DRUG

THANK YOU FOR ATTENTION