A role for lung retention in the sense of retronasal smell

Exhalation of alternative tobacco product aerosols differs from cigarette smoke-and may lead to alternative health risks

BACKGROUND

Variation in alternative tobacco product (ATP) constituents, heating potential, and consumer behaviors have made it difficult to characterize their health risks. To date, most toxicity studies of ATPs have used established cigarette endpoints to inform study design. Furthermore, to assess where ATPs fall on the tobacco harm continuum, with cigarettes representing maximum potential risk, studies have tended to compare the relative biological responses to ATPs against those due to cigarettes.

OBJECTIVES

1) To characterize the exhalation profiles of two popular ATPs: electronic cigarettes (e-cigarettes) and hookah waterpipes (hookah) and 2) to determine if ATP exhalation patterns were representative of cigarette exhalation patterns.

METHODS

Exhalation patterns were recorded (mouth only, nose only, or both mouth and nose) among individuals observed in the New York City tri-state area using a recognizable tobacco product (cigarette, e-cigarette, or hookah). Cigarette smokers and e-cigarette vapers were observed on city streets; water-pipe smokers were observed inside Manhattan hookah bars.

RESULTS

E-cigarette vapers practiced exclusive nasal exhalation at far higher rates than did cigarette smokers (19.5% vs 4.9%). Among vapers, e-cigarette device type was also significantly associated with exhalation profile. Overall, cigarette smokers exhaled from their nose approximately half to one-third as often as ATP users (hookah and e-cigarettes, respectively).

CONCLUSIONS

Nasal exhalation of tobacco emissions appears to be a shared characteristic across several types of ATPs. It is therefore plausible that ATP-specific consumer behaviors may foster unique upper respiratory health consequences that have not been observed in smokers. Thus, product-specific behaviors should inform the prioritization of biological endpoints used in studies evaluating ATP toxicity and health effects.

Non-food odors and the duality of smell: Impact of odorant delivery pathway and labeling convention on olfactory perception

The olfactory system encompasses two perceptual pathways (orthonasal and retronasal) that activate the same receptors in the olfactory epithelium yet are thought to elicit different perceptions. Presently, a novel matching paradigm was employed using a non-food flavor set with low retronasal familiarity (honeysuckle, lavender, rose, and jasmine) to evaluate the effect of odor type on the Duality of Smell. Additionally, the influence of cognitive strategies used by subjects was assessed by manipulating the naming convention seen by the subjects: familiar (Honeysuckle, Lavender, Rose, Jasmine), unfamiliar (Inodora, Pedunculata, Beggeriana, Didymum), and generic (A, B, C, D). Subjects were presented with a reference, either in a vial (orthonasal delivery, ON) or a 2 oz. cup (retronasal delivery, RN) and instructed to match the same aroma from four unknowns, evaluated either by the same delivery route (congruent, e.g., ON-ON, RN-RN) or different route (incongruent, e.g., ON-RN, RN-ON) than the reference evaluation. All possible combinations of orthonasal and retronasal delivery for the reference and unknowns (e.g. ON-ON, RN-RN, ON-RN, RN-ON) were assessed by all subjects. Matching performance and signal detection measures indicated that, on average, subjects performed significantly better in the congruent conditions than in the incongruent conditions. These results suggest perceptual quality of aromas is route dependent and extend the Duality of Smell hypothesis to samples with low retronasal familiarity such as non-food odors. Labeling convention also had an impact on performance but, surprisingly, not in the direction anticipated. Indeed, as the information contained in the label decreased from familiar to generic reference names, performance increased. Moreover, depending on the labeling convention used, certain aromas were easier to match than others. The present research suggests odorant matching is a function of stimulus quality, cognitive strategy, and labeling convention.

Self-reported Gastrointestinal Side Effects of Antifibrotic Drugs in Dutch Idiopathic Pulmonary Fibrosis patients

Purpose

Idiopathic pulmonary fibrosis (IPF) is an inexorably progressive disease, which has a great impact on patients’ lives. Pirfenidone and nintedanib are approved and recommended antifibrotic drugs for patients with IPF. The aim of this study was to evaluate self-reported gastrointestinal side effects of antifibrotic drugs in 176 Dutch IPF patients.

Methods

A cross-sectional web-based anonymous survey about complaints and side effects was conducted among IPF patients in the Netherlands. Logistic regression was used to quantify whether pirfenidone and nintedanib caused complaints of nausea, vomiting, diarrhoea, appetite loss, weight loss or loss of taste or smell perception.

Results

The questionnaire was completed by 176 IPF patients, 71 of whom used pirfenidone and 85 nintedanib, while 20 patients did not use any antifibrotic drugs. Nintedanib users reported complaints of diarrhoea, vomiting, weight loss and loss of appetite (p < 0.01). Nausea was a significant adverse reaction (p < 0.05). Pirfenidone caused increased appetite loss (p < 0.01) and the risk of weight loss (p < 0.05). The increase in loss of appetite and weight loss did not differ significantly between the two drugs.

Conclusion

The current study showed that nintedanib causes a significant increase in diarrhoea, vomiting, weight loss and loss of appetite, while pirfenidone led to loss of appetite. Our results suggest new avenues regarding dietary recommendations for IPF patients.

Different Olfactory Percepts Evoked by Orthonasal and Retronasal Odorant Delivery

The Duality of Smell hypothesis suggests odorants delivered orthonasally elicit different sensations compared with those delivered retronasally despite activating the same receptors in the olfactory epithelium. Presently, we investigated this further using a matching paradigm free from odorant or semantic memory bias. Subjects were asked to evaluate an aroma delivered in one condition (orthonasal or retronasal delivery) and match the same aroma from 4 unknowns evaluated in the same or different delivery conditions. Panelists matched flavors in 4 delivery conditions: orthonasal-orthonasal, retronasal-retronasal, retronasal-orthonasal, and orthonasal-retronasal. For orthonasal presentation, panelists smelled samples using their nostrils, and for retronasal presentation, panelists swallowed aqueous flavors. In Experiment 1, panelists were instructed to match familiar flavors (banana, grape, orange, raspberry). In Experiments 2 and 3, panelists used the same experimental design with either 4 unfamiliar flavors (kinnow, longan, pawpaw, prunus) or 4 distinct subtypes of a strawberry flavor (woody, green, ripe, candy). In Experiment 1, the number of correct matches in each condition did not significantly differ suggesting stability in the perceptual construct across delivery routes. However, in Experiments 2 and 3, significantly more samples were correctly matched in the orthonasal-orthonasal and retronasal-retronasal conditions compared with the retronasal-orthonasal or orthonasal-retronasal conditions suggesting aroma perception is dependent on delivery route. Additionally, across the 4 delivery methods, the ability to correctly match flavors decreased as flavor familiarity decreased or similarity increased and may reflect the different cognitive strategies employed by subjects when matching these stimuli. Our results suggest odorant percepts are route-dependent and consistent with the Duality of Smell phenomenon.

Olfactory Adaptation is Dependent on Route of Delivery

Odorants are perceived orthonasally (nostrils) or retronasally (oral cavity). Prior research indicates route of delivery impacts odorant perception, pleasantness, and directed behaviors thus suggesting differential processing of olfactory information. Adaptation is a form of neural processing resulting in decreased perceived intensity of a stimulus following prolonged and continuous exposure. The present study objective was to determine whether route of delivery differentially impacts olfactory adaptation and whether cross-adaptation occurs between orthonasal and retronasal pathways. Linalool (12%) or vanillin (25%) were delivered orthonasally [6 L/min (LPM)] and retronasally (8 LPM) in air phase through a custom-built olfactometer. Perceived odorant intensity was collected every 5 min over 10-min exposure. Immediately following the exposure period, cross-adaptation was assessed by shunting the delivery of the odorant from the nostrils to the oral cavity, or vice versa. A control study was also completed in which subjects underwent the orthonasal adaptation protocol using stimulus concentrations matched to the intensity of restronasal stimuli (e.g., 1.5% linalool and 6.25% vanillin). Following orthonasal delivery of both high and low vanillin concentrations, results showed perceived intensity decreased significantly at 5 and 10 min. High concentrations of orthonasal linalool similarly decreased significantly whereas lower concentrations decreased but did not reach statistical significance. Linalool and vanillin delivered retronasally did not adapt as perceived intensity actually increased significantly following a 10-min exposure. In addition, evidence of cross-adaptation was not obvious following extended odorant exposure from either delivery pathway. This study suggests that olfactory processing may be affected by the route of odorant delivery.