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Raspe M, Lo K, Sommer N, Andreas S. [Tobacco cessation: one of the most effective medical measures]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:365-375. [PMID: 38446181 DOI: 10.1007/s00108-024-01683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
Tobacco smoking is widespread in Germany. An increase in the number of teenagers and young adults that smoke has recently been a cause for concern. The high prevalence in Germany is contrasted by inadequate preventive measures compared to international standards. Smoking behavior should always be inquired about and documented in the same way as vital signs. All smokers, regardless of the reason for contact and motivation, should receive short, low-threshold advice, e.g. using the ABC approach (ask, brief advice, cessation). In addition to repeated advice and referral to further services, the use of nicotine replacement or drug therapy is essential for the success of quitting. The combination of long- and short-acting nicotine replacement products doubles the success rate. Electronic nicotine delivery systems are not recommended for smoking cessation.
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Affiliation(s)
- Matthias Raspe
- Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Kevin Lo
- Department für Pneumologie, Medizinische Klinik II, Excellence Cluster Cardio Pulmonary Institute (CPI), Universitätsklinikum Gießen und Marburg (UKGM), Justus-Liebig-Universität Gießen, Aulweg 130, 35392, Gießen, Deutschland
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
| | - Natascha Sommer
- Department für Pneumologie, Medizinische Klinik II, Excellence Cluster Cardio Pulmonary Institute (CPI), Universitätsklinikum Gießen und Marburg (UKGM), Justus-Liebig-Universität Gießen, Aulweg 130, 35392, Gießen, Deutschland
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
| | - Stefan Andreas
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
- Lungenfachklinik Immenhausen, Robert-Koch-Straße 3, 34376, Immenhausen, Deutschland
- Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Franzen K, Pankow W, Andreas S. [The e-cigarette - means of smoking cessation?]. Laryngorhinootologie 2024; 103:107-112. [PMID: 37989216 DOI: 10.1055/a-2194-5666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe.With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented.According to recent studies, e-cigarettes are involved in the pathogenesis of lung disease, cardiac and vascular damage. In addition, their ingredients also have carcinogenic effects. However, clinical studies on long-term use are not yet available.E-cigarettes as a consumer product are not superior to nicotine replacement products and addiction-reducing medications recommended in guidelines. In the therapeutic setting, they are slightly more effective than nicotine replacement products. However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking.Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own.
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Affiliation(s)
- Klaas Franzen
- Medizinische Klinik III (Pneumologie), UKSH am Campus Lübeck
| | - Wulf Pankow
- Pneumologie und Infektiologie, Vivantes-Klinikum Neukölln
- Corona-Behandlungszentrum Jafféstraße, Berlin
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen
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Kroeger K, Buss VH, Shahab L, Storck M. Use of electronic nicotine delivery systems and cigarette smoking-Add-on vs. displacement dual use. Front Public Health 2024; 11:1281999. [PMID: 38239784 PMCID: PMC10794717 DOI: 10.3389/fpubh.2023.1281999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Knut Kroeger
- Department of Angiology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Vera Helen Buss
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Martin Storck
- Department for Vascular and Thoracic Surgery, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
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Urlbauer M. Rauchen – Wissenswertes über Tabak und alternative Produkte. AKTUELLE KARDIOLOGIE 2023. [DOI: 10.1055/a-1979-6777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
ZusammenfassungTabakrauchen ist weltweit die häufigste vermeidbare Ursache für Krankheit und vorzeitigen Tod. Rauchen ist keine Life-Style-Entscheidung oder nur eine (schlechte) Angewohnheit. Es ist eine
chronische Krankheit, die viele Erkrankungen mitverursacht und aggraviert. Durch das psychoaktive Nikotin ist Rauchen zusätzlich eine Suchterkrankung. Bei der Strategie zur Harm Reduction
sollen Raucher die Tabakzigarette durch alternative nikotinhaltige Produkte („Alternative Nicotine Delivery Products“), wie die E-Zigarette oder Tabakerhitzer (Heat-not-burn-Produkte),
ersetzen. Tabakkonzerne bewerben im Rahmen ihrer Marketingstrategie diese Produkte mit einer Schadstoffreduktion um 95%. Jedoch stehen unabhängige Forschungen und Langzeitergebnisse
diesbezüglich aus. Raucher, die zu derartigen Produkten wechseln, sind durch die fortbestehende Nikotinabhängigkeit weiterhin langfristig den Belastungen durch (kardio)toxische und
karzinogene Substanzen ausgesetzt. Die gesundheitlichen Auswirkungen dieser inhalativen Noxen werden dargestellt, wobei die Heat-not-burn-Produkte eine Mittelstellung zwischen der
schädlichsten Tabakzigarette und den (möglicherweise) weniger gesundheitsschädlichen E-Zigaretten einnehmen. Das Fortbestehen einer (wenn auch reduzierten) kontinuierlichen Exposition in
Verbindung mit einer Nikotinabhängigkeit ist keine Alternative zu einer professionellen evidenzbasierten multimodalen Tabakentwöhnung, die endlich flächendeckend (auch in Deutschland)
angeboten werden muss. Ziel sollte der komplette Verzicht auf inhalative Noxen sein, ohne jegliche Toleranz für die Marketingstrategien der Tabakkonzerne.
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Abstract
This paper deals with the question of whether electronic cigarettes (e-cigarettes) can minimize the proven harm of smoking tobacco or may lead to a long-term harm. While the British Royal College of Physicians recommends smokers to use e-cigarettes as a substitute for tobacco products, the German Society for Pneumology and Respiratory Medicine advises smokers against using e-cigarettes. The harm reduction strategy is based on three hypotheses. Hypothesis 1: It is assumed that e-cigarettes cause less damage to health than tobacco cigarettes. Hypothesis 2: It is postulated that smokers are motivated to switch from conventional cigarettes to e-cigarettes. Hypothesis 3: It is assumed that e-cigarettes are an effective means for quitting smoking with few side effects. Although the long-term health consequences of e-cigarette use remain unknown, there is increasing evidence that e-cigarettes are toxic, harmful to cardiovascular system, respiratory health and potentially carcinogenic. Population-representative epidemiological surveys have shown that three-quarters of all current e-cigarette users in Germany smoke tobacco at the same time. In a few randomized clinical trials, e-cigarettes showed higher success rates compared to nicotine replacement products. As over-the-counter consumer products, a large number of studies have found no advantage for e-cigarettes under real conditions. In addition, e-cigarettes prolong nicotine dependence compared to nicotine replacement products. According to the current state of knowledge, the hypotheses behind the harm minimization strategy using e-cigarettes must be regarded as refuted. It therefore appears ethically problematic when doctors recommend e-cigarettes to their patients as a substitute for smoking.
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Affiliation(s)
- Reiner Hanewinkel
- Institut für Therapie- und Gesundheitsforschung, IFT-Nord gGmbH, Kiel, Deutschland
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Krabbe B, Espinola-Klein C, Malyar N, Brodmann M, Mazzolai L, Belch JJF, Müller OJ, Heiss C. Health effects of e-cigarettes and their use for smoking cessation from a vascular perspective. VASA 2023; 52:81-85. [PMID: 36734252 DOI: 10.1024/0301-1526/a001056] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tobacco consumption is one of the most important risk factors for cardiovascular disease. Despite all efforts to curb any form of smoking, the number of e-cigarette users is still rising more than tabacco smoking decreases. E-cigarettes are often advertised as less harmful than regular cigarettes and helpful for smoking cessation. But e-cigarettes are not risk-free and their use causes vascular damage. There is concern about long-term health risks of e-cigarettes or when non-smokers use them as first nicotine contact. Furthermore, their use for smoking cessation is discussed controversially. To optimize treatment and medical counselling of current smokers and e-cigarette users, we present an evidence-based overview of the most important issues of e-cigarette use from a vascular medicine point of view. The key messages are presented as a position statement of the German Society of Vascular Medicine and endorsed by the European Society of Vascular Medicine.
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Affiliation(s)
- Bernd Krabbe
- Herz-Kreislaufmedizin/Angiologie, UKM-Marienhospital Steinfurt, Germany
| | | | - Nasser Malyar
- Klinik für Kardiologie 1/Angiologie, Universitätsklinikum Münster, Germany
| | | | - Lucia Mazzolai
- Angiology Department, Lausanne University Hospital (CHUV), Lausanne University (UNIL), Switzerland
| | - Jill J F Belch
- Division of Molecular and Clinical Medicine, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Oliver J Müller
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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Franzen K, Pankow W, Andreas S. [The e-cigarette - means of smoking cessation?]. Dtsch Med Wochenschr 2022; 147:1481-1487. [PMID: 36318912 DOI: 10.1055/a-1860-5696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe.With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented.According to recent studies, e-cigarettes are involved in the pathogenesis of lung disease, cardiac and vascular damage. In addition, their ingredients also have carcinogenic effects. However, clinical studies on long-term use are not yet available.E-cigarettes as a consumer product are not superior to nicotine replacement products and addiction-reducing medications recommended in guidelines. In the therapeutic setting, they are slightly more effective than nicotine replacement products. However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking.Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own.
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