Roberto Mazza

Comparison between particulate matter and ultrafine particle emission by electronic and normal cigarettes in real-life conditions.

Aims Electronic cigarettes may be safer than conventional cigarettes as they generate less indoor pollution in terms of particulate matter (PM); however, recent findings in experimental conditions demonstrated that secondhand exposure to PM may be expected from e-cigarette smoking. The aim of the present study was to investigate the emission of PM generated by e-cigarettes and normal cigarettes under real-life conditions. Methods Real-time measurement and comparison of PM and ultrafine particles (UFP) generated by electronic cigarettes with and without nicotine and by normal cigarettes in a 50 m3 office of an Italian comprehensive cancer center was performed. PM mass as PM1, PM2.5, PM7, PM10, total suspended particles (TSP) in μg/m3 and UFP in number of particles per cubic centimeter from 10 to 1,000 nanometers were measured. Outdoor concentrations were measured contemporaneously to compensate for urban background changes. Results Regardless of their nicotine content, e-cigarettes generated lower PM levels than conventional cigarettes. Notably, nicotine-enriched e-cigarettes produced lower PM levels than their nicotine-free counterparts. Conclusion E-cigarettes appear to generate less indoor pollution than normal cigarettes and may therefore be safer. Further studies are required to investigate the long-term health-related effects of secondhand e-cigarette exposure.

Environmental pollution and emission factors of electronic cigarettes, heat-not-burn tobacco products, and conventional cigarettes

ABSTRACT The increasing popularity of electronic cigarettes (e-cigarettes) and, more recently, the new “heat-not-burn” tobacco products (iQOS) as alternatives to traditional tobacco cigarettes has necessitated further documentation of and research into the composition and potential health risks/benefits of these devices. In a recent study, we compared second-hand exposure to particulate metals and organic compounds from e-cigarettes and traditional cigarettes, by conducting continuous and time-integrated measurements in an indoor environment, followed by computing the emission rates of these species using a single-compartment mass balance model. In this study, we have used a similar approach to further expand our previous analyses by characterizing black carbon, metal particles, organic compounds, and size-segregated particle mass and number concentrations emitted from these devices in addition to the newly marketed iQOS. Analysis of the iQOS side-stream smoke indicated that the particulate emission of organic matter from these devices is significantly different depending on the organic compound. While polycyclic aromatic hydrocarbons (PAHs) were mostly non-detectable in the iQOS smoke, certain n-alkanes, organic acids (such as suberic acid, azelaic acid, and n-alkanoic acids with carbon numbers between 10 and 19) as well as levoglucosan were still emitted in substantial levels from iQOS (up to 2–6 mg/h during a regular smoking regimen). Metal emissions were reduced in iQOS smoke compared to both electronic cigarettes and conventional cigarettes and were mostly similar to the background levels. Another important finding is the presence of carcinogenic aldehyde compounds, including formaldehyde, acetaldehyde, and acrolein, in iQOS smoke, although the levels were substantially lower compared to conventional cigarettes. Copyright

Inhaled steroid/tobacco smoke particle interactions: a new light on steroid resistance

BackgroundInhaled steroid resistance is an obstacle to asthma control in asthmatic smokers. The reasons of this phenomenon are not yet entirely understood. Interaction of drug particles with environmental tobacco smoke (ETS) could change the aerodynamic profile of the drug through the particle coagulation phenomenon. Aim of the present study was to examine whether steroid particles interact with smoke when delivered in the presence of ETS.MethodsBeclomethasone-hydrofluoralkane (BDP-HFA) pMDI particle profile was studied after a single actuation delivered in ambient air or in the presence of ETS in an experimental chamber using a light scattering Optical Particle Counter capable of measuring the concentrations of particle sized 0.3–1.0, 1.1–2.0, 2.1–3.0, 3.1–4.0, 4.1–5.0, and > 5.1 μm in diameter with a sampling time of one second. The number of drug particles delivered after a single actuation was measured as the difference between total particle number after drug delivery and background particle number. Two groups of experiments were carried out at different ambient background particle concentrations. Two-tail Students t-test was used for statistical analysis.ResultsWhen delivered in ambient air, over 90% of BDP-HFA particles were found in the 0.3–1.0 μm size class, while particles sized 1.1–2.0 μm and 2.1–3.0 represented less than 6.6% and 2.8% of total particles, respectively. However, when delivered in the presence of ETS, drug particle profile was modified, with an impressive decrease of 0.3–1.0 μm particles, the most represented particles resulting those sized 1.1–2.0 μm (over 66.6% of total particles), and 2.1–3.0 μm particles accounting up to 31% of total particles.ConclusionOur data suggest that particle interaction between inhaled BDP-HFA pMDI and ETS takes place in the first few seconds after drug delivery, with a decrease in smaller particles and a concurrent increase of larger particles. The resulting changes in aerosol particle profile might modify regional drug deposition with potential detriment to drug efficacy, and represent a new element of steroid resistance in smokers. Although the present study does not provide any functional or clinical assessment, it might be useful to advise smokers and non smokers with obstructive lung disease such as asthma or COPD, to avoid to act inhaled drugs in the presence of ETS in order to obtain the best therapeutic effect.

Hospital doctors’ smoking behavior and attitude towards smoking cessation interventions for patients: a survey in an Italian Comprehensive Cancer Centre

Purpose Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians’ smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field. Methods A Web-based survey was sent to 285 physicians. Results The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients’ smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients’ stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward. Conclusions This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians’ smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.

Carbon monoxide, cigarettes and family doctors

Aims and Background General practitioners could play a key role in preventive programs against tobacco-related diseases. However, they seldom take action in the office even with minimal advice counselling. Such behaviour might reflect the lack of academic teaching and the lack of practice with motivational and dependence questionnaires, considered basic tools to help smokers to quit successfully. The study was aimed to investigate the awareness of a sample of Italian family doctors as regards tobacco epidemiology and smoking cessation strategies. Methods A total of 428 family doctors were administered a questionnaire with a set of questions on their personal smoking habits and on personal initiatives in the office towards smokers. Another set of questions regarded their knowledge on tobacco issues, with special attention to carbon monoxide, which is widely perceived as a very dangerous poison and works as a motivational tool on smokers and adolescents. Carbon monoxide measurement was carried out on all participants to obtain objective data on smoking and to show the feasibility of the test. Results The percentage of self-reported current smokers among general practitioners was 24%, with a high prevalence of ex-smokers (46%), and 29% of never smokers. Family doctors were more keen to counsel adolescents than adults about tobacco, and they were very interested in continuing medical education on the issue. The doctors who took part in our study showed a surprising limited knowledge of all the issues associated with smoking cessation and prevention such as epidemiology, cigarette characteristics, success rate of smoking cessation programs, Fagerströms tolerance questionnaire, safety of nicotine replacement therapy and the knowledge of carbon monoxide as a product of cigarette smoke. Conclusions The scenario depicted by our survey underscores the necessity to improve the knowledge and performance of primary care physicians on tobacco-related issues in order to implement primary and secondary prevention in clinical practice.

The electronic cigarette: potential health benefit or mere business

Electronic cigarettes (e-cigarettes) have attracted considerable attention as a possible alternative to tobacco cigarettes, but uncertainties about their impact on health and indoor air quality as well as their commercial success without a clear regulatory framework are arousing concern. We have therefore tried to summarize the health-related implications of the use of e-cigarettes in order to help physicians and health professionals provide accurate information on this device. Given the lack of unequivocal scientific data on their toxicity and safety, we conclude that at the moment there is no reason to approve e-cigarettes as a safe alternative to tobacco smoke.

The tobacconist boutique, an inviting (and misleading) marriage between smoking and culture.

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Outdoor second-hand cigarette smoke significantly affects air quality

Second-hand smoke (SHS) may be significantly elevated outdoors and when adjacent to smoking areas [1, 2]. This is of concern as SHS exposure is linked to adverse health outcomes, including respiratory disorders, cardiovascular diseases, and lung cancer [3–5]. Exposure to cancer-causing chemicals in outdoor areas is likely to occur in the presence of cigarette smoke [6], and worryingly, short periods of exposure to SHS are related to detectable levels of carcinogenic tobacco-specific nitrosamines in nonsmoking subjects [7]. Air quality is worse in a pedestrian area frequented by smokers compared with a high-traffic zone http://ow.ly/DMW83007Xmo

A pilot study with early adolescents: dealing with diet, tobacco and air pollution using practical experiences and biological markers

BackgroundTobacco use and the Western diet are two of the most important and investigated topics in relation to adolescents’ health. In addition, air pollution is a crucial subject for future generations. School is a key social environment that should promote healthy behaviors in children and adolescents. In this field many different programs have been conducted, with mixed results and effectiveness. Research data suggest that comprehensive and multicomponent approaches may have a greater effect on tobacco use and diet, especially when integrated into a community-wide approach.MethodsThe present work describes a multi-area pilot study called “La Scuola della Salute” (the School of Health) with a focus on the methodological aspects of the intervention. In our study we assessed different web-based and practical experiences related to adolescents’ smoking and dietary behaviors and awareness of smoke-related air pollution. Furthermore, to make adolescents more conscious of smoking and dietary behaviors, we conducted experiential workshops that addressed smoking and environmental pollution, food education, and lifestyle. Teachers and school administrators were involved in the project.ResultsAt baseline we investigated dietary habits, tobacco use, and individual and social characteristics by means of lifestyle questionnaires. In addition, we collected anthropometric parameters and performance indicators such as exhaled carbon monoxide and urinary fructose to assess smoking and nutrition habits. At the end of the intervention lifestyle questionnaire and biological markers were collected again: knowledge about these topics was significantly improved, and the urinary fructose was able to estimate the levels of obesity in the classes.ConclusionsThe integrated approach, combined with the use of biological markers, could be an innovative approach to the promotion of healthy lifestyles among adolescents, but further research is needed.

Breast change perception in women after smoking cessation. A pilot study.

AIMS AND BACKGROUND There are several barriers to smoking cessation that are unique to women. Compared to men, women report lower levels of motivation to quit and greater perceived difficulty with cessation. However, recent studies might favor commitment by women to quit through higher risk perception related e.g. to the development of premature facial wrinkling or the decrease in mammographic density due to cigarette smoking. METHODS A pilot study to evaluate the perception of breast change after cessation and its possible motivational effect on maintenance was carried out. We interviewed 25 premenopausal women who had quit ≥1 year before. We obtained information from the women and discussed changes in breast size and fullness. The two groups of women with and without breast change were statistically compared using the nonparametric Mann-Whitney test (continuous variables) and the Fisher test (categorical variables). RESULTS Median age was 41 years (range, 30-49 years). Median carbon monoxide (CO) before quitting was 18 ppm and median pack years (PY) was 22.5; both parameters characterize a category of mild smokers. Sixteen women (64%) reported breast changes 6 months after quitting smoking. This outcome was paralleled by only moderate effects on weight or body mass index (BMI) increase after quitting. Notably, of the 16 women with breast change, only 3 (19%) with a normal baseline BMI showed a BMI increase to >25. CONCLUSIONS Within the limitations of the small size of a pilot study, these results indicate that premenopausal women experience subjective perception of change in breast size after smoking cessation, which may not be totally explained by weight gain. Further studies are needed to understand the effect, if any, of such perception on the motivation to quit smoking.