Heated tobacco products vs. · Heated tobacco products vs. e-cigarettes Dr Konstantinos Farsalinos...

Toxicant exposureHeated tobacco products

vs.

e-cigarettes

Dr Konstantinos FarsalinosResearcherOnassis Cardiac Surgery Center, GreeceUniversity of Patras, GreeceNational School of Public Health, Athens-Greece

In the past 3 years:

▪ 3 studies funded by non-profit associations (AEMSA in 2013

and Tennessee Smoke-Free Association in 2015)

▪ No funding from tobacco or pharmaceutical industry

COI statement

Heated tobacco productsAn old story

1998, RJ Reynolds launched Premier

▪ Premier replaced by Eclipse

Heated tobacco productsAn old story

▪ Premier replaced by Eclipse

Heated tobacco productsAn old story

▪ Premier replaced by Eclipse

▪ Problems:

▪ Bad taste

▪ Increased carbon monoxide

▪ Unacceptable for smokers

Heated tobacco productsAn old story

▪ IQOS, PMI

▪ > 10 years development

▪ 3 billion dollars investment

▪ Extensive pre-market testing

▪ First marketed in Milan (Italy) and Nagoya (Japan)

▪ Available in about 20 markets today

▪ Products from other manufacturers (Glo-BAT, Ploom-JTI)

Heated tobacco productsNew developments

IQOS

IQOS

IQOS in Japan

IQOS marketing

Virtually no e-cigarettes in Japan

IQOS characteristics▪ Contains tobacco

▪ Stick looks like a short tobacco cigarette

▪ No combustion but heating of tobacco▪ Temperature up to 350oC

▪ Battery lasts 6 minutes▪ Needs 20sec warm-up

▪ 1 stick lasts for 5.5 minutes of use

▪ Puff cutoff at 14 puffs

IQOS

Powerbank

Heating device

IQOS and smoking cessation

IQOS and nicotine delivery to the aerosol

Schaller et al. Regul Toxicol Pharmacol 2016

1,32

1,89

0,0

0,4

0,8

1,2

1,6

2,0

IQOS 3R4F

Nicotine (mg)

Schaller et al. Regul Toxicol Pharmacol 2016

1,32

1,89

2,19

0,49

0,0

0,5

1,0

1,5

2,0

2,5

IQOS 3R4F IQOS (intense puffing) IQOS (ISO)

Nicotine (mg)

IQOS and nicotine delivery to the aerosol

IQOS and nicotine content

0

4

8

12

16

20

HnB regular HnB methol

Nic

oti

ne

lev

els

(mg

/g t

ob

acc

o)

Nicotine levels in the tobacco of the heat-not-burn (HnB) regular and menthol

tobacco sticks (mg/g) - similar to tobacco cigarettes

Farsalinos et al. NTR (in press)

0,0

0,5

1,0

1,5

2,0

2,5

Regular

2 s

Menthol

2 s

Regular

4 s

Menthol

4 s

Vapour 2

2 s

Vapour 2

4 s

Epsilon

2 s

Epsilon

4 s

Nautilus

Mini

2 s

Nautilus

Mini

4 s

Regular

2 s

HnB HnB Ciga-like EC eGo style EC Variable wattage Tobacco

cigarette

Nic

oti

ne

lev

els

(mg

/12 p

uff

s)

• Lower than tobacco cigarette (HCI regime)

• Higher than e-cigarettes at short puff duration (20 mg/ml nicotine)

• Lower than VW at long puff duration (20 mg/ml nicotine)

• No change in nicotine delivery from longer puff duration (puff volume unchanged)

Farsalinos et al. Nicotine Tob Res (in press)

IQOS and nicotine delivery to the aerosol

IQOS and toxins

Nicotine levels in the tobacco of the heat-not-burn (HnB) regular and

menthol tobacco sticks (mg/g).

Level of nicotine in unused tobacco similar to tobacco cigarettes

IQOS and toxins

IQOS and toxinscompared to tobacco cigarettes

5,5

56,5

0

10

20

30

40

50

60

IQOS 3R4F

Formaldehyde (μg)

205

1555

0

400

800

1200

1600

2000

IQOS 3R4F

Acetaldehyde (μg)

Schaller et al. Regul Toxicol Pharmacol 2016

IQOS and toxinscompared to tobacco cigarettes

9,15

154

0

40

80

120

160

200

IQOS 3R4F

Acrolein (μg)

13,7

309

0

50

100

150

200

250

300

350

IQOS 3R4F

NNN (ng)

Schaller et al. Regul Toxicol Pharmacol 2016

IQOS and toxinscompared to tobacco cigarettes

Auer et al. JAMA Intern Med 2017

Literature data on tobacco cigarettes

4,3

74,0

0

20

40

60

80

Auer et al. Counts et al.

Formaldehyde in tobacco cigarettes

610

1240,3

0

400

800

1200

1600

Auer et al. Counts et al.

Acetaldehyde in tobacco cigarettes

Counts et al. Regul Toxicol Pharmacol 2005

Literature data on tobacco cigarettes

1,1

120,4

0

20

40

60

80

100

120

140

Auer et al. Counts et al.

Acrolein in tobacco cigarettes

PMI vs. non-PMI data

Farsalinos et al. (unpublished data)

205

176

0

40

80

120

160

200

240

PMI Farsalinos et al.

Acetaldehyde

5,5

6,4

0

2

4

6

8

PMI Farsalinos et al.

Formaldehyde

PMI vs. non-PMI data

Farsalinos et al. (unpublished data)

10,9 10,8

0

2

4

6

8

10

12

14

PMI Farsalinos et al.

Acrolein

IQOS vs. e-cigarettes

▪ Depends on the e-cigarette

▪ 1st generation (cartomizers) vs. tank systems

▪ Low vs. high power

▪ Silica vs. cotton wick

▪ Depends on puffing conditions

▪ Realistic

▪ Dry puffs

IQOS vs. e-cigarettes

13,6 6,4 0,5

413,5

0

100

200

300

400

500

E-cigarette-silica-realistic(10 W)

IQOS E-cigarette-cotton-14W E-cigarette-dry puff

Formaldehyde (μg)

Farsalinos et al. (unpublished data)

Farsalinos et al., Addiction 2015

IQOS vs. e-cigarettes

Farsalinos et al. (unpublished data)

Farsalinos et al., Addiction 2015

5,4

176

0,4

247,6

0

50

100

150

200

250

300

E-cigarette-silica-realistic(10 W)

IQOS E-cigarette-cotton-14W E-cigarette-dry puff

Acetaldehyde (μg)

IQOS vs. e-cigarettes

Farsalinos et al. (unpublished data)

Farsalinos et al., Addiction 2015

1,210,8

1,1

210,4

0

50

100

150

200

250

E-cigarette-silica-realistic(10 W)

IQOS E-cigarette-cotton-14W E-cigarette-dry puff

Acrolein (μg)

IQOS vs. e-cigarettes

Farsalinos et al. IJERPH 2015

Schaller et al. Regul Toxicol Pharmacol 2016

013,7

309

0

50

100

150

200

250

300

350

E-cigarettes IQOS Tobacco cigarette

NNN

0 5,9

266

0

50

100

150

200

250

300

E-cigarettes IQOS Tobacco cigarette

NNK

Biomarkers of exposure

Biomarkers of exposure

Haziza et al. Regul Toxicol Pharmacol 2016

IQOS vs. e-cigarettes

Farsalinos et al. IJERPH 2015

Schaller et al. Regul Toxicol Pharmacol 2016

5,70

161

70

37

3,2 0 00

40

80

120

160

200

E-cigarette IQOS Tobaccocigarette

E-cigarette IQOS Tobaccocigarette

E-cigarette IQOS Tobaccocigarette

Cadmium (ng) Lead (ng) Nickel (ng)

▪ Heated tobacco products is an old (and initially failed) concept

▪ New developments and products (some already marketed in many countries, others to follow)

▪ Resemble tobacco cigarettes in patterns of use

▪ No visible side-stream smoke, but bad smell (very similar to smoking)

▪ “Side-stream smell”, implying emissions

▪ Lower throat hit compared to tobacco cigarettes

▪ Significantly lower toxic emissions than smoking, but higher than new-generation e-cigarettes

▪ They seem to represent a harm-reduction option for dual users or smokers who cannot quit

with e-cigarettes

▪ Not satisfactory (probably disgusting) for established e-cigarette users

▪ Independent studies needed

Conclusions

Thank

you