Tobacco harm reduction: are smokers becoming more hardcore?

We undertook a systematic review to identify and summarise studies on hardcore smoking and hardening to: determine the degree of variability in definitions of hardcore smoking and hardening; assess the evidence for claims that smokers are becoming increasingly hardened within the context of harm reduction as a policy initiative; and identify the determining characteristics of a hardcore smoker. We searched five electronic databases from 1970 to mid-April 2018 using the search term "smok* AND hard* AND (tobacco OR cigar* OR nicotin*)". We included studies if they included a definition of hardcore smokers and/or hardening, and provided a prevalence rate for hard core smokers or empirical evidence for hardening. Definitions of hardcore smoker varied substantially across studies. Hardening was not evident in the general smoking population and we found mounting evidence of softening occurring in smoking populations. These results indicate that hardening of smokers is not occurring and that calls for policy interventions on this basis should be challenged.

Electronic cigarettes: A position statement from the Thoracic Society of Australia and New Zealand

The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.

Innate immunity to influenza in chronic airways diseases

Influenza presents a unique human infectious disease that has a substantial impact on the public health, in general, and especially for those with chronic airways diseases. People with asthma and chronic obstructive pulmonary disease (COPD) are particularly vulnerable to influenza infection and experience more severe symptoms with the worsening of their pre-existing conditions. Recent advances in reverse genetics and innate immunity has revealed several influenza virulence factors and host factors involved in influenza pathogenesis and the immune responses to infection. Early innate immunity plays a critical role of limiting viral infection and spread; however, the underlying mechanisms that lead to enhanced susceptibility to influenza infection and severe symptoms in those with asthma and COPD to infection remain un-investigated. This review will explore the importance of early innate antiviral responses to influenza infection and how these responses are altered by influenza virus and in those with chronic airways diseases.

Peripheral blood monocytes (PBMCs) display innate antiviral response to rhinovirus (RV) infected bronchial epithelial cells (133.44)

Rhinovirus (RV) infection is an important trigger of acute asthma and COPD.

Study objectives; were to characterise the response of PBMCs and CD8 lymphocytes when exposed to RV infected bronchial epithelial cells.

Methods; Human Calu3 cells were used as a model for bronchial epithelial cells and infected with RV-43 and RV-1B. PBMCs were obtained from healthy individuals and separated by Ficoll-Paque centrifugation. CD8 lymphocytes were identified as CD3+, CD8+ by flow cytometry. PBMCs were exposed to infected Calu3 cells, cells exposed to UV inactive RV, PHA and TLR3 agonist PolyI:C. Response was measured by ELISA for release of interferon(IFN)-γ and TNF-α. CD8 activation with expression of perforin or proliferation measured by carboxyfluorescein succinimidyl ester assay.

Results: Exposure of PBMCs to Calu3 cells infected with both RV led to significant release of IFN-γ and TNF-α, smaller release was seen in response to UV inactive RV. Exposure to PolyI:C also led to a similar release. CD8+ cells were found to be the primary source of IFN-γ release. CD8+ cells did not show an increase in perforin expression or evidence of proliferation.

Conclusions; exposure of PBMCs and CD8+ cells to an RV infected bronchial epithelium alone results in an innate immune response mediated by TLR3 without evidence of a CD8 adaptive immune response.