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