Vapatul - pro si contra dpdv al sanatatii

[Valahul]

Electronic cigarette use and harm reversal: emerging evidence in the lung
Riccardo Polosa

Correspondence: Riccardo Polosa polosa@unict.it

Author Affiliations
Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, Università di Catania, Catania, Italy

Dipartimento di Medicina Clinica e Sperimentale – Università di Catania, Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, Università di Catania, Catania, Italy

UOC di Medicina Interna e d’Urgenza, Edificio 4, Piano 3, AOU “Policlinico-V. Emanuele”, Via S. Sofia 78, Catania, 95123, Italy

BMC Medicine 2015, 13:54 doi:10.1186/s12916-015-0298-3

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1741-7015/13/54" onclick="window.open(this.href);return false;


Received: 16 February 2015
Accepted: 17 February 2015
Published: 18 March 2015
© 2015 Polosa; licensee BioMed Central.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0" onclick="window.open(this.href);return false;), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/" onclick="window.open(this.href);return false;) applies to the data made available in this article, unless otherwise stated.

Abstract
Electronic cigarettes (ECs) have been rapidly gaining ground on conventional cigarettes due to their efficiency in ceasing or reducing tobacco consumption, competitive prices, and the perception of them being a much less harmful smoking alternative. Direct confirmation that long-term EC use leads to reductions in smoking-related diseases is not available and it will take a few decades before the tobacco harm reduction potential of this products is firmly established. Nonetheless, it is feasible to detect early changes in airway function and respiratory symptoms in smokers switching to e-vapor. Acute investigations do not appear to support negative respiratory health outcomes in EC users and initial findings from long-term studies are supportive of a beneficial effect of EC use in relation to respiratory outcomes. The emerging evidence that EC use can reverse harm from tobacco smoking should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the e-vapor category.

Keywords: E-cigarette; E-vapor products; Harm reversal; Lung function; Respiratory system; Smoking cessation; Tobacco harm reduction
Background
The electronic cigarette (EC) has been rapidly gaining ground on conventional cigarettes and could surpass consumption of conventional cigarettes within the next decade, according to some prediction analyses [1]. The growing popularity of ECs proves that many adult smokers are keen on using an alternative technologic form of smoking to reduce cigarette consumption or quit smoking and to relieve tobacco withdrawal symptoms [2]. Data from internet surveys [2],[3] and clinical trials [4],[5] have shown that ECs may help smokers quit or reduce their tobacco consumption. Moreover, the popularity of ECs appears to be associated with the fact that they can be used in many smoke-free areas, their prices are competitive, and they are perceived as a much less harmful smoking alternative [3],[6].

Vapor toxicology under normal conditions of use is by far less problematic than that of conventional cigarettes [7], and exclusive EC users have significantly lower urine levels of tobacco smoke toxicants and carcinogens compared to cigarette smokers [8]. Thus, smokers completely switching to regular EC use are likely to gain significant health benefits.

Although a reduction in smoking-related diseases from long-term EC use can be inferred by the positive findings on Swedish snus (a tobacco harm reduction product consisting of refined oral tobacco which is low in nitrosamines) [9], direct confirmation is not available and it will take a few decades before a reduction in individual and population health outcomes due to the regular use of e-vapor products can be firmly established. Nonetheless, it is feasible to detect early changes in airway function and respiratory symptoms in smokers switching to e-vapor.

In this commentary, I discuss the emerging potential of ECs for harm reversal with a specific focus on the respiratory system.

Health outcomes and the respiratory system
The lung is the primary target of the harmful effects of several airborne pollutants and cigarette smoke. Likewise, considering that inhalation is the exposure mechanism for EC use, the respiratory system is also the logical target for investigating any potential harmful effects of chemicals in the e-vapor.

Prospective clinical studies of well-characterized EC users would be the most informative to investigate respiratory health outcomes; however, such studies are quite demanding due to several methodological, logistical, ethical, and financial challenges. In particular, to address the potential of future disease development, hundreds of users would need to be followed for a substantial number of years before any conclusions could be made. A much less challenging approach is to explore cytotoxicity levels, mutagenicity, genotoxicity, oxidative stress, and inflammatory responses in human lung epithelial cell lines. However, these in vitro approaches also have inherent flaws; findings cannot be directly applied in human in vivo studies due to the inability to test the normal consumption exposure conditions of e-vapor products, the fact that standards for vapor production and exposure protocols have not been clearly defined, and the risk of over- or underestimating the interpretation of the toxic effects in these investigational models. Consequently, it is not surprising to find a divergence in the literature, with some authors reporting little or no injury [10], whereas others describing much higher level of toxicity and inflammatory responses despite using same cell lines [11]. Overall, despite the inconsistent and contradictory results, most acute in vitro studies are simply suggestive of non-specific irritant effects from e-vapor exposure. This is consistent with findings from internet surveys and clinical trials reporting transient throat irritation, dry cough, and other symptoms of respiratory irritation in some smokers when switching to ECs (reviewed in [7]).

Symptoms of irritation may occur in EC users hypersensitive to propylene glycol present in the e-vapor, but the possibility of unknown contaminants or byproducts contained in the e-vapor causing similar irritant effects cannot be discounted [12]. Likewise, a prompt defensive response against irritants from e-vapor inhalation is the most likely cause for the immediate physiologic changes detected with highly sensitive respiratory functional tests as reported by Vardavas et al. [13]. The question of whether such an irritation could translate into clinically meaningful lung disease remains unanswered, and there certainly is no evidence to date to suggest that there are any clinically significant adverse lung effects, at least acutely.

Moreover, it must be noted that the reported 16% decrease in exhaled nitric oxide levels (i.e., 2.1 ppb in absolute terms) and 11% increase in peripheral flow resistance by impulse oscillometry (i.e., 0.025 kPa/L/s in absolute terms) from baseline after using an EC for 5 minutes were so small and well within test variability, that it is unlikely to have any clinical relevance [14],[15]. Moreover, no significant changes were detected by less sensitive respiratory function parameters (including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV% (FEV1/FVC index), and peak expiratory flow (PEF)) after EC use. Lack of a significant effect on exhaled nitric oxide and airflow obstruction as measured by FEV1, FVC, FEV%, and PEF after short-term EC use has also been confirmed in a more recent study [16]. Finally, switching to EC use universally leads to a near-normalization in toxic levels of exhaled carbon monoxide (reviewed in [7]).

The very few studies mentioned above, which have focused on the acute effect of ECs on lung function, do not appear to support negative respiratory health outcomes in EC users. Nonetheless, only large and carefully conducted studies evaluating the long-term effects of these products will provide a definite answer regarding their impact on lung health.

As mentioned earlier, it would take hundreds of well-characterized EC users to be followed prospectively for a substantial number of years and very large funding to properly address the harm potential of ECs. At the University of Catania, we have structured an integrated clinical research program characterized by a minimalist approach entailing either highly sensitive respiratory functional tests to detect early changes of subclinical injury in ‘healthy’ smokers switching to EC or less sensitive but more robust respiratory function investigations to explore changes in EC users with preexisting lung disease. The initial findings are promising and generally supportive of a beneficial effect of EC use in relation to respiratory outcomes, both in health and disease.

Long-term changes in lung function have been monitored for up to 1 year in a large group of ‘healthy’ smokers who were invited to quit or reduce their tobacco consumption by switching to a first generation EC. Significant early positive changes from baseline of a sensitive measure of obstruction in the more peripheral airways (i.e., forced expiratory flow measured between 25% and 75% of FVC) were already detected at 3 months after switching in those who completely gave up tobacco smoking, with steady progressive improvements being observed also at 6 and 12 months (Polosa R, unpublished observation).

Asthma and chronic obstructive pulmonary disease (COPD) are progressive diseases characterized by persistent inflammatory and remodeling responses of the airways causing respiratory symptoms and progressive decline in lung function [17],[18]. Although it is well-established that the inflammatory response to cigarette smoke plays a key role in COPD pathogenesis, increased morbidity and mortality have been reported in asthmatic individuals who smoke and quitting can significantly improve asthma symptoms and lung function [19]. Consequently, smokers with preexisting asthma and COPD may benefit from regular EC use. In the only clinical study conducted to ascertain efficacy and safety of EC use in asthma, substantial improvements in respiratory physiology and subjective asthma outcomes have been reported [20]. Exposure to e-vapor in this vulnerable population did not trigger any asthma attacks.

To date, no formal efficacy and safety assessment of EC use in COPD patients has been conducted. There is only evidence from a case series of three inveterate smokers with COPD, who eventually quit tobacco smoking on their own by switching to an EC [21]. Significant improvement in quality of life and reduction in the number of disease exacerbations were noted. EC use was well tolerated with no reported adverse events.

The reported improvements of respiratory patients who have become regular ECs users are consistent with findings from a large internet survey of regular EC users diagnosed with asthma and COPD [2]. An improvement in symptoms of asthma and COPD after switching was reported in 65.4% and 75.7% of the respondents, respectively. Compared to dual users, improvement in symptoms of asthma and COPD were more often reported by exclusive EC users. After switching, medications were stopped in 460/2,498 (18.4%) respondents with asthma and COPD. Worsening after switching was only reported in 1.1% of the asthmatics and in 0.8% of the COPD respondents. Taken together, these findings provide emerging evidence that EC use can reverse harm from tobacco smoking.

Conclusions and implications for policymaking
Compared to combustible cigarettes, e-vapor products are at least 96% less harmful and may substantially reduce individual risk and population harm [22]. Future research will better define and further reduce residual risks from EC use to as low as possible by establishing appropriate quality control and standards. Although large longitudinal studies are warranted to elucidate whether ECs are a less harmful alternative to tobacco cigarettes and whether significant health benefits can be expected in smokers who switch from tobacco to ECs, the emerging evidence that EC use can reverse harm from tobacco smoking should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the e-vapor category [23].

Abbreviations
COPD: Chronic obstructive pulmonary disease

ECs: Electronic cigarettes

FEV%: FEV1/FVC index

FEV1: Forced expiratory volume in the first second

FVC: Forced Vital Capacity

PEF: Peak Expiratory Flow

Competing interests
RP has received grant support from respiratory drug manufacturers including CV Therapeutics, NeuroSearch A/S, Sandoz, Merck Sharp & Dohme, and Boehringer-Ingelheim; he has served as a speaker for CV Therapeutics, Novartis, Merck Sharp & Dohme, and Roche and as a consultant for CV Therapeutics, Duska Therapeutics, Neuro-Search A/S, Boehringer-Ingelheim, and Forest Laboratories. He has received payment for developing educational presentations from Merck Sharp & Dohme, Novartis, and Almirall. RP has also received lecture fees and research funding from manufacturers of stop smoking medications including GlaxoSmithKline and Pfizer and served as a consultant for Pfizer, Global Health Alliance for treatment of tobacco dependence, Arbi Group Srl (an Italian e-cigarette distributor) and ECITA (Electronic Cigarette Industry Trade Association, in the UK).

Author information
RP is Full Professor of Internal Medicine with tenure supported by the University of Catania, Italy. RP serves as scientific advisor for LIAF (acronym for Italian Anti-Smoking League).

Acknowledgments
RP’s research on smoking, electronic cigarettes, and asthma is currently supported by the University of Catania and LIAF (acronym for Italian Anti-Smoking League).

SURSA.

[crystal]

Se zice ca Diacetyl-ul care da aroma ar fi cu ceva probleme. https://www.youtube.com/watch?v=G5RzMPCnWbc

diacetilul e "prea faimos" ca sa fie folosit de orice firma respectabila . evita chestiile cu aroma de unt daca vrei sa fi mai catolic decat papa.
parerea mea si a multor medici inclusiv din cate stiu a domnului farsalinos e ca aromele sunt/pot fi buba. eu am un amic care s-a lasat de tigari cu tigara electronica si in prima saptamana a fumat ecopure rich , dupa baza simpla ... cred ca asta e cel mai curat vapat. long term din pacate nu e fezabil pentru multi. eu personal si acum trag baza ~3mg din orchid 1ohm ,20w , dar n-am rezistat tentatiei sa dau o comanda de multe arome la un magazin. vreau sa mai dau o sansa aromelor PA din cauza cantitatii mici folosite.

un lucru misto/bun demonstrat de doctorul farsalinos a fost ca vapatul nu e un factor aterogen la fel ca fumatul , deci teoretic asa citind printre randuri riscul cardiovascular al vapatului ar fi semnificativ mai mic. intr-o sectie de cardiologie care se ocupa de infarcturi STEMI daca mergi printre pacienti aproape ca toti sunt ori fumatori , ori diabetici , ori ambele. sa fii gras nu e la fel de rau pt inima ca fumatul de exemplu , sigur si obezitatea/dislipidemia e factor de risc semnificativ.

problema cu plamanii e alta. era tin minte intr-un curs prin facultate ceva de genul "o tigara/5 tigari (nu mai stiu exact ) = o mutatie genetica" , acuma daca stam sa ne gandim cat de toxice sunt materialele din care sunt facute firele ... orice dryhit nu pica bine. toate materialele din care sunt facute sarmele mai putin aluminiul sunt demonstrate a fi carcinogene , iar aluminiul creste riscul de dementa.

m-am lungit foarte mult si imi pare rau daca e greu de citit . ca o concluzie , folositi cat mai putina aroma , preferabil menthol si evitati dry hiturile. o zi cat mai placuta tuturor !

[Tyrex]

Eu cred asta : Unul care fumeaza tutun face cancer la plamani si moare, unul care vapeaza face cancer la plamani si moare( inca nu se stie sigur ) , unul care nu fumeaza si nu vapeaza baga in el shaorma si face cancer la colon nu la plamani..... deci moare. Toti murim. Pentru mine un lucru e clar. Am 1,92 si 110 kg . Cat am bagat tutun daca alergam 50 metri respiram de parca aveam deja cancer pulmonar. Nu vapez de mult dar diferenta de rezistenta la efort fizic este usor de observat. Cu siguranta mai sigur e sa respiri aer de munte decat sa vapezi , dar daca tot completez oxigenul cu ceva prefer sa o fac cu ceea ce am simtit ca e mai bine pentru mine.

[Khaan]

Corect @Tyrex, exact asa gandesc si eu ! Oricum, vapatul a devenit habbit ca si tigara normala...aia cu te ajuta sa te lasi de tigari e vrajeala..majoritatea ajungem dependenti de vapat !

[slavyk]

Nu este vrăjeală pentru că nu mai fumezi! Că a rămas ticul de a face ceva cu mîinile, este altă poveste.

S500 tap-tap

[Tyrex]

Corect @Tyrex, exact asa gandesc si eu ! Oricum, vapatul a devenit habbit ca si tigara normala...aia cu te ajuta sa te lasi de tigari e vrajeala..majoritatea ajungem dependenti de vapat !

Totusi.... am obserat ca fara sa vapez pot sta o perioada de timp dar inainte cand fumam , daca nu aveam tigari faceam spume. Posibil sa fi inlocuit o dependenta cu alta dar , in cazul meu macar NU MAI PUTE LA LOCUL DE MUNCA

[Gigi43]

Totusi.... am obserat ca fara sa vapez pot sta o perioada de timp dar inainte cand fumam , daca nu aveam tigari faceam spume.

Nu cred ca esti singurul care a observat acest lucru.
De aici am putea interpreta, ca nivelul de nicotina asimilat prin vapat este mai mic decat prin fumat, ceea ce duce la o dependenta mai scazuta.
Zic si eu...

[Catalin]

Dupa 2 ani de vapat am ajuns la spitalul de contagioase pentru un consult mai amanuntit, cauza fiind o tuse convulsiva care nu imi mai dadea pace. Discutand cu sefa sectiei de pneumo si explicandui ca nu mai fumez de 2 ani dar ca vapez... a inceput "dansul", ca nu e bine ca bla bla bla ca la nu stiu ce conferinte a participat ea, se discuta pe tema tigarilor electronice si ca sunt la fel ca si tigarile, ce sa mai teoria batului de chibrit. Degeaba am incercat sa port o discutie normala cu individa. Intr-un final imi spune hai sa-ti arat plamanii tai sa-i vezi cat sunt de incarcati... si ce sa vezi, stupoare, plamanii mei aratau curati ca lacrima. Isterica a ramas fara cuvinte iar eu am plecat linistit acasa primind un tratament cu gentamicina si alte porcarii. Deocamdata pot sa spun ca VAPATUL NU DAUNEAZA GRAV SANATATII. Bafta si aburi pufosi va doresc.


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[Daddy]

Pentru cei care mai au intrebari :

http://onvaping.com/the-ultimate-list-o ... ir-safety/" onclick="window.open(this.href);return false;

[HORATUCU]

http://www.ecigarettedirect.co.uk/ashtr ... lavourings" onclick="window.open(this.href);return false;

[maxcad]

eu am inteles ca dupa 10 ani se observa la o radiografie ca nu mai fumezi.

[slavyk]

Documentar serios, de firmă... Mulțumim, Adi Mincă pentru traducere!
[youtube][/youtube]

[DaniN]

Corect @Tyrex, exact asa gandesc si eu ! Oricum, vapatul a devenit habbit ca si tigara normala...aia cu te ajuta sa te lasi de tigari e vrajeala..majoritatea ajungem dependenti de vapat !

Totusi.... am obserat ca fara sa vapez pot sta o perioada de timp dar inainte cand fumam , daca nu aveam tigari faceam spume. Posibil sa fi inlocuit o dependenta cu alta dar , in cazul meu macar NU MAI PUTE LA LOCUL DE MUNCA

Aceeasi reactie am avut-o si eu, desi in cazul mirosului nu eram deranjat prea tare de el.