European Respiratory Society statement on novel nicotine and tobacco products, their role in tobacco control and "harm reduction"

Vaping: Harm Reduction or Chucking Children under the Bus?

Tobacco is one of the great scourges of modern health, and e-cigarettes are suggested to be a means of smoking cessation and harm reduction. This editorial shows that, far from being a source of harm reduction, they are being aggressively marketed to children and young people. The acute effects of e-cigarettes are greater than those of tobacco, and thus we cannot be complacent about the long-term effects. There is accumulating data that e-cigarettes are immunosuppressive, pro-inflammatory and lead to epigenetic effects that are pre-cancerous. There is an urgent need for legislation that is actually enforced to protect children from being the next-generation nicotine addicts.

What Do We Know About the Harms of Electronic Cigarettes?

Electronic cigarettes are commonly misperceived as safe, hence the importance of health care providers understanding the harms of these devices. To date, there is substantial evidence of impaired immune defenses leading to increased risk for severe infections. Electronic cigarette users have increased respiratory symptoms, including bronchitis, cough, and wheeze. There is evidence of emphysema from electronic cigarette use in both laboratory mouse studies and population health surveys. There is evidence of increased cardiovascular disease from electronic cigarettes in both laboratory mouse models and population health surveys. There have been many cases of acute severe lung disease leading to hospitalization and death in electronic cigarette users; although most cases reported were associated with vitamin E acetate in tetrahydrocannabinol-containing products, some cases report exclusive use of nicotine-containing electronic cigarettes. Recently, constrictive bronchiolitis has been found in lung biopsies of electronic cigarette users with dyspnea. There are multiple carcinogenic chemicals in electronic cigarette emissions. Mouse models demonstrate increased rates of lung cancer and carcinogenic chemicals accumulate in the urine of human users. Neurotoxicity has been demonstrated in laboratory mouse models. There is concern about nicotine exposure adversely impacting brain development and serving as a gateway drug for other harmful drug use. Dual use of electronic and combustible cigarettes appears to be more harmful than the use of combustible cigarettes alone. Conclusion: Electronic cigarettes have substantial harms and are not a safe alternative to combustible tobacco use. It is important for health care providers to know these harms and counsel their patients.

Nicotine replacement therapy as a smoking cessation tool for adolescents: an update

Background

Adolescent smoking is a significant public health concern, as early nicotine addiction leads to more severe addiction and reduced cessation success during adulthood. While nicotine replacement therapy (NRT) is an effective smoking cessation tool in adults, its efficacy in adolescents is less clear.

Objective

This systematic review evaluates the effectiveness and safety of NRT for smoking cessation in adolescents.

Methods

A comprehensive search of PubMed and Cochrane Library databases identified 12 studies (randomized controlled trials and observational) examining NRT in adolescents. Outcomes included smoking cessation rates, withdrawal symptom relief, smoking reduction, and adverse events.

Results

NRT demonstrated limited success in long-term smoking cessation among adolescents, with low cessation rates that often declined post-treatment. However, NRT was effective in reducing smoking frequency and in managing withdrawal symptoms in some cases. The safety profile was generally favourable, with mild side effects such as skin irritation, headaches, and nausea.

Conclusion

While NRT can reduce smoking and alleviate withdrawal symptoms, its effectiveness in sustaining long-term cessation in adolescents is limited. Adherence challenges and side effects suggest a need for complementary behavioural support and further research into tailored NRT strategies for this population.

Tobacco and COPD: presenting the World Health Organization (WHO) Tobacco Knowledge Summary

The WHO recently published a Tobacco Knowledge Summary (TKS) synthesizing current evidence on tobacco and COPD, aiming to raise awareness among a broad audience of health care professionals. Furthermore, it can be used as an advocacy tool in the fight for tobacco control and prevention of tobacco-related disease. This article builds on the evidence presented in the TKS, with a greater level of detail intended for a lung-specialist audience. Pulmonologists have a vital role to play in advocating for the health of their patients and the wider population by sharing five key messages: (1) Smoking is the leading cause of COPD in high-income countries, contributing to approximately 70% of cases. Quitting tobacco is an essential step toward better lung health. (2) People with COPD face a significantly higher risk of developing lung cancer. Smoking cessation is a powerful measure to reduce cancer risk. (3) Cardiovascular disease, lung cancer and type-2 diabetes are common comorbidities in people with COPD. Quitting smoking not only improves COPD management, but also reduces the risk of developing these coexisting conditions. (4) Tobacco smoke also significantly impacts children's lung growth and development, increasing the risk of respiratory infections, asthma and up to ten other conditions, and COPD later in life. Governments should implement effective tobacco control measures to protect vulnerable populations. (5) The tobacco industry's aggressive strategies in the marketing of nicotine delivery systems and all tobacco products specifically target children, adolescents, and young adults. Protecting our youth from these harmful tactics is a top priority.

[Medical societies in Germany call for a ban on flavors in e-cigarettes - A Position Paper of the German Respiratory Society (DGP) in cooperation with other professional associations and organizations]

E-cigarettes are primarily used by teenagers and young adults. Flavors in e-cigarettes increase their attractiveness and encourage young people and adults to start using them. This exposes young people in particular to the risk of nicotine addiction and various toxic substances from the aerosol of e-cigarettes. There are indications that various flavors in e-cigarettes are harmful to health, although toxicological studies are still lacking for the majority of flavors. There is a need for independent scientific investigations in this area. The scientific societies involved are calling for a ban on flavors in e-cigarettes, a ban on disposable e-cigarettes, effective regulation of the sale of e-cigarettes and effective control and implementation of the provisions for the protection of minors.