Challenges in Predicting the Change in the Cumulative Exposure of New Tobacco and Related Products Based on Emissions and Toxicity Dose-Response Data

The Product Science of Electrically Heated Tobacco Products: An Updated Narrative Review of the Scientific Literature

Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers who would otherwise continue to smoke cigarettes, as their use should result in exposure to substantially fewer and lower levels of toxicants. This update represents a two-year extension to our previous narrative review, which covered peer-reviewed journal articles published up to August 31, 2021. The scientific evidence published between 2021 and 2023 continues to indicate that aerosols produced from heated tobacco products contain fewer and substantially lower levels of harmful and potentially harmful constituents and that these observed reductions consistently translate to reduced biological effects in both in vitro and in vivo toxicological studies. Biomarker and clinical data from studies in which product use is controlled within a clinical setting continue to suggest changes in levels of biomarkers of exposure, biomarkers of potential harm, and clinical endpoints indicating the potential for reduced harm with switching to exclusive use of heated tobacco products in adult smokers. Overall, the available peer-reviewed scientific evidence continues to indicate that heated tobacco products offer promise as a potentially less harmful alternative to cigarettes, and as such, the conclusions of our original narrative review remain valid.

Rauchen – Wissenswertes über Tabak und alternative Produkte

Tabakrauchen 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.

Methodological Approaches for Risk Assessment of Tobacco and Related Products

Health risk assessment of tobacco and related products (TRPs) is highly challenging due to the variety in products, even within the product class, the complex mixture of components in the emission and the variety of user behaviour. In this paper, we summarize methods that can be used to assess the health risks associated with the use of TRPs. The choice of methods to be used and the data needed are dependent on the aim. Risk assessment can be used to identify the emission components of highest health concern. Alternatively, risk assessment methods can be used to determine the absolute risk of a TRP, which is the health risk of a product, not related to other products, or to determine the relative risk of a TRP, which is the health risk of a TRP compared to, for example, a cigarette. Generally, health risk assessment can be based on the effects of the complete mixture (whole smoke) or based on the (added) effects of individual components. Data requirements are dependent on the method used, but most methods require substantial data on identity and quantity of components in emissions and on the hazards of these components. Especially for hazards, only limited data are available. Currently, due to a lack of suitable data, quantitative risk assessment methods cannot be used to inform regulation.