Reduced Exposure to Harmful and Potentially Harmful Smoke Constituents With the Tobacco Heating System 2.1

Abstract

Introduction:Heating rather than burning tobacco reduces levels of harmful and potentially harmful constituents, and consumer products using this approach aim to reduce exposure to tobacco toxicants. The Tobacco Heating System (THS) version 2.1 has been enhanced from earlier prototypes with an improved heat control and sensorial experience and thereby user acceptance. Exposure measurements are required to determine whether it may be possible to reduce the individual health risk compared to smoking combustible cigarettes (CCs).Methods:This controlled clinical study randomly assigned 40 smokers to either a group continuing to use of their own CC brand (n = 20) or a group switching to THS 2.1 (n = 20) for 5 days. Biomarkers of exposure were measured at baseline and on day 1 through day 5. Product consumption, Human Puffing Topography, the occurrence of adverse events, and an assessment of subjective effects, such as smoking satisfaction and enjoyment of respiratory tract sensations, were also determined.Results:The group of smokers who switched to THS 2.1 adapted their puffing behavior initially through longer puff duration and more puffs. During the duration of the study, total puff volume returned to baseline levels and the mean daily product consumption increased but with similar nicotine exposure compared to baseline CC use. Biomarkers of exposure to tobacco smoke toxicants which inform product risk assessment were significantly reduced with THS use compared to the CC group. THS 2.1 users experienced less reinforcing effects with THS 2.1 than with their own cigarette brand.Conclusions:THS 2.1 is a promising alternative to smoking CCs. Notwithstanding possible use adaption through consumption or puffing behavior, the exposure to harmful smoke constituents was markedly reduced with the new heated tobacco platform.Implications:Exposure markers to harmful and potentially harmful smoke constituents were lowered with the THS 2.1. Heating tobacco instead of burning can offer a potentially lower risk of delivering nicotine compared to CCs.

New ideas, old problems? Heated tobacco products – a systematic review

“…The use of IQOS or glo reduced the exposure to smoke toxicants in a manner comparable to quitting tobacco use [74,75]. After switching from conventional cigarettes to HTPs (IQOS or glo), a significant reduction in the levels of biomarkers of exposure to harmful and potentially harmful constituents was observed [76][77][78].…”

“…The results of in vitro and in vivo studies indicate that HTP aerosols have lower toxicity and no new hazards compared to conventional cigarette smoke [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. The results of humanbased studies also suggest that switching from conventional cigarettes to IQOS or glo leads to reductions in exposure to smoke toxicants in a manner comparable to quitting tobacco use [74][75][76][77][78]. However, there have been no independent studies regarding short-term and longterm health consequences of HTP use.…”

Informing iQOS Regulations in the United States: A Synthesis of What We Know

“…A World Health Organization (WHO) report on HTPs highlighted that HTP marketing acknowledges the health risks of traditional cigarettes and indicates that HTPs are “cleaner,” “reduced-risk” products ( WHO, 2018 ). Initially, most published research regarding iQOS were funded by PMI and its affiliates ( Glantz, 2018a ), indicating lower harmful tobacco carcinogen levels ( Brossard et al, 2017 ; Jaccard et al, 2017 ; Ludicke et al, 2017 , 2018 ; Martin Leroy et al, 2012 ; Pratte et al, 2017 ; Roethig et al, 2005 , 2007 ). However, independent analyses of PMI’s research ( Glantz, 2018a ) elucidated that (a) PMI’s list of 58 harmful and potentially harmful constituents was lower in iQOS emissions compared with cigarette smoke ( St. Helen et al, 2018 ); (b) PMI only reported on 40 of 93 constituents on the FDA’s list for iQOS ( St. Helen et al, 2018 ); (c) 56 other constituents not included on either list were higher in iQOS emissions ( St. Helen et al, 2018 ); (d) iQOS and conventional cigarettes showed no difference in most biomarkers of potential harm ( Glantz, 2018b ); and (e) iQOS has possible hepatotoxicity and potential for unexpected organ toxicity not previously associated with cigarettes ( Chun et al, 2018 ).…”

Nicotine Population Pharmacokinetics in Healthy Adult Smokers: A Retrospective Analysis

“…By heating instead of burning tobacco, THS avoids or reduces the formation of many toxic combustion products. Clinical studies have shown favorable biological effects in smokers who switched from cigarette to different non-combusted products [ 4 – 6 ]. While this makes risk reduction at the individual level possible, a population health benefit additionally depends on smokers actually switching from cigarettes to THS.…”