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e-CIGARETTES

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

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e-CIGARETTES

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

  2. 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 TobaccoProductsDirection, 2014

  3. 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!

  4. 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

  5. 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

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

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

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

  9. 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

  10. e-cigarettes

  11. „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

  12. Dripper

  13. 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

  14. 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

  15. E-cigarettes on You Tube • 196 videos: 94 % POSITIVE 4 % NEUTRAL 2 % ANTI POSITIVE: 84,3 % with web buycontact 71,4 % with „healthier“declaration

  16. 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

  17. 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

  18. POLAND STUDY • REPRESENT. Sample, age 15-19 y 2010/11 2013/14 Evertried (%) 16.8 62.1 Currentusers 5.5 29.9 Dualsmokers 3.6 21.8 Cassiccig. Smoke 23.9 38.0 Goniewicz ML. Et al. Rise in electroniccigarette use amongadolescents in Poland. J Adolesc.Health 2014;55:713-715

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

  20. REASONS : • 75.4% smoking reduction • 85.1% smoking cessation • 79.8% believe about safety • „DUAL SMOKING“

  21. RESEARCH PROBLEMS • NO STANDARD of TECHNOLOGY • QUICK CHANGES IN • LEVELS of NICOTINE • GALVANIC VOLTS • ADITIVES

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

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

  24. 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 % athome • 20 % vomiting; 10 % nauzea; 5 % irritation, headache; lethargy, dizziness Ordonez JE et al. NicotineTob Res 2014; doi:10.1093/ntr/ntu223

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

  26. 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

  27. 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

  28. E-cig. – FORCE RISKS? • FIRES FROM LITHIUM BATTERIES : • 2009 aeroport SanPaulo, Minneapolis • 2013 Japon aerolinies • 2014 aeroport Boston

  29. 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

  30. 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 DUST MATTERS PM2,5

  31. CYTOTOXICITY • Human pulmonal fibroblasts • Human embryonal stem cells ! (pregnancy!) • Neural stem cells (mice) • Heart myoblasts (rats)

  32. HEALTH EFFECTS *AC. RESPONSE from HEART and LUNGS SIMILAR as by classic cigarettes *DEPENDENCE (both physical and behavioral) *SIDE EFFECTS: headache, nauzea, irritation,

  33. 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

  34. „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)

  35. …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.)

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

  37. SMOKING CESSATION • THE EFFECTS of e-CIGARETTES ARE LOWER THAN THOSE of NNT • Meta analysis: • OR 0.61 (95% CI 0.50 – 0.75)

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

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