Electronic cigarettes: a short review.

Marketed since 2004 as an alternative to nicotine delivery and advertised as a valid means to smoking cessation, the electronic (e)-cigarette has been the subject of much controversy but very little experimental study. This review provides a brief summary of the current knowledge of this product. Propylene glycol and glycerol, the main ingredients of the fluid that is vaporized, have proved to be harmless in the fog machines of the entertainment industry. However, in the case of the e-cigarette fluid, the composition is not properly labeled: additives like nicotine and flavors vary between and within brands and contamination with various chemicals has been detected. The short-term toxicity seems low, but the long-term toxicity is unknown. The usefulness of the e-cigarette in smoking cessation has still to be clinically established.

Transdermal nicotine in non-smokers: A systematic review to design COVID-19 clinical trials.

Recent data show an interaction between COVID-19 and nicotine and indicate the need for an assessment of transdermal nicotine use in non-smokers. Assessments have been conducted into the short-term cognitive effects of nicotine and into diseases such as Parkinson's, Tourette syndrome, ADHD or ulcerative colitis. METHODS: Analyses of nicotine administration protocols and safety were conducted after reviewing Medline and Science Direct databases performing a search using the words [transdermal nicotine] AND [non-smoker] AND selected diseases. RESULTS: Among 298 articles identified, there were 35 reviewed publications reporting on 33 studies of non-smokers receiving transdermal nicotine for >48hours. In the 16 randomized trials, 7 crossover, 1 case/control and 9 open studies patients received an initial nicotine dose of between 2.5mg and 15mg/day. In 22 studies, daily doses increased by 2 to 7 steps in 3 to 96 days until the dose was between 5mg and 105mg/day. The target nicotine dose was 19.06±20.89mg/day. The 987 non-smokers (534 never-smokers, 326 ex-smokers and 127 classified as "non-smokers") received or did not receive nicotine. The most common side-effects were nausea and skin itching. Forty-three (7.1%) non-smokers stopped treatment because of an adverse event of nicotine. No hospitalization related to nicotine side-effects were reported. CONCLUSION: Despite a relatively safe tolerance profile, transdermal nicotine therapy in non-smokers can only be used in clinical trials. There is a lack of formal assessment of the potential risk of developing a tobacco addiction. This review offers baseline data to set a transdermal nicotine protocol for non-smokers with a new purpose.

Second-hand smoke exposure in a sample of European hospitals.

Smoking in hospitals is banned in many European countries; nevertheless, the level of compliance is diverse, and, in some cases, smoking areas remain. The present study describes the levels of second-hand smoke, as derived from respirable suspended particle measurements, in a sample of European hospitals during the year 2007. The present study was a multicentric descriptive cross-sectional study carried out in 30 hospitals in seven European countries (Austria, Belgium, France, Germany, Greece, Romania and Spain). Particulate matter with a 50% cut-off aerodynamic diameter of 2.5 microm (PM(2.5)) concentration was measured by means of a hand-held laser-operated monitor of particle size and mass concentration in six selected indoor locations. Medians and interquartile ranges of PM(2.5) concentration were computed in order to describe the data by country and location of measurement. The median PM(2.5) concentration in all countries and locations was 3.0 microg x m(-3), with half of the measurements ranging 2.0-7.0 microg. x m(-3). PM(2.5) levels were similar across countries. Eleven (5.5%) measurements were >25.0 microg x m(-3), which is the 24-h mean limit recommended by the World Health Organization outdoor air quality guideline. The present results show that exposure to second-hand smoke in this sample of European hospitals is very low, and can be easily monitored in order to ensure smoke-free legislation compliance.

[Systematic analysis of the scientific literature on heated tobacco]. / Le tabac chauffé : revue systématique de la littérature.

INTRODUCTION: The tobacco industry (TI) reports that heated tobacco reduces risk of tobacco use and will replace cigarettes. An analysis of the scientific literature was conducted in order to enlighten professionals and decision-makers. METHOD: After a Medline query in February 2018, a systematic analysis was conducted. RESULTS: Of the 100 papers published in 2008-2018, 75 have authors affiliated or linked to TI. Emissions contain gases, droplets and solid particles, so are smokes. The main products are: THS2.2 (Iqos®) which heats mini-cigarettes at 340°C, the THP1.0 (Glo®) which heats at 240°C sticks delivering about half as much nicotine, Ploom® which uses reconstituted tobacco microcapsules heated at 180°C. Under the experimental conditions, there is a reduction of toxic emissions and biological effects, but the expected risk reduction is not demonstrated. Symptoms related to passive smoking are described. The 4 epidemiological articles report that heated tobacco is used in 10 to 45% of cases by non-smokers and demonstrate the effectiveness of TI promotion campaigns. Thus, the THS2.2 is more a gateway to smoking (20%) than an exit door (11%); moreover, it is not expected risk reduction among the 69% who are mixed users. CONCLUSIONS: While reducing emissions is documented, reducing the risk to the smoker who switches to heated-tobacco remains to be demonstrated. On the other hand, the worsening of the global tobacco risk related to the promotion of the products by the TI is anticipated, justifying that the authorities take the appropriate measures to control the promotion of heated tobacco.

Multidisciplinary advisory teams to manage multidrug-resistant tuberculosis: the example of the French Consilium.

SETTING: The World Health Organization (WHO) recommends that multidrug-resistant tuberculosis (MDR-TB) treatment should be managed in collaboration with multidisciplinary advisory committees (consilia). A formal national Consilium has been established in France since 2005 to provide a centralised advisory service for clinicians managing MDR-TB and extensively drug-resistant (XDR-TB) cases.OBJECTIVE: Review the activity of the French TB Consilium since its establishment.DESIGN: Retrospective description and analysis of the activity of the French TB Consilium.RESULTS: Between 2005 and 2016, 786 TB cases or contacts of TB cases were presented at the French TB Consilium, including respectively 42% and 79% of all the MDR-TB and XDR-TB cases notified in France during this period. Treatment regimens including bedaquiline and/or delamanid were recommended for 42% of the cases presented at the French TB Consilium since 2009. Patients were more likely to be presented at the French TB Consilium if they were born in the WHO Europe Region, had XDR-TB, were diagnosed in the Paris region, or had resistance to additional drugs than those defining XDR-TB.CONCLUSION: The French TB Consilium helped supervise appropriate management of MDR/XDR-TB cases and facilitated implementation of new drugs for MDR/XDR-TB treatment.

[A survey of nebulization practices in France conducted in 2004 by the GAT]. / NUAGES: une enquête sur la pratique de la nébulisation en France.

METHODS: A questionnaire was sent to 50 000 general practicioners (GP) and specialists. RESULTS: 4,898 physicians (9.4%) responded, including 59.1% GP, 16.9% pneumologists, 13% pediatricians and about 10% other specialists, ENT, allergologists, and intensivists. The main reason for pneumologists to prescribe nebulization was the efficiency on long term of approved drugs. GP prescribe nebulization for its local effects, using unapproved drugs, on short periods of time, especially in COPD, asthma, bronchitis and tracheitis/laryningitis. Although pneumologists have been trained during their fellowship and do not ask for further education, MG have learned by their own experience and are asking for further education. CONCLUSION: This study should help to develop teaching programs on nebulization with the aim to optimize its practice.

[Particle size in water pipe smoke]. / Tailles particulaires de la fumée de chicha.

INTRODUCTION: It is a popular perception that narghile (water pipe) smoking is less harmful to the lungs than cigarettes in both active and passive smokers. METHODS: Using a sinusoidal pump we simulated water pipe smoking in conditions close to users' habits. The particle sizes and concentrations in the smoke streams were measured with an electrical low pressure impactor (ELPI), sorting particle numbers and size into 12 classes ranging from 0.028 to 10 microm in diameter. RESULTS: Water pipe smoke contains microparticles and nanoparticles. The main inhaled smoke stream (C1) contains particles in a concentration of 3.55 x 10(6) ml(-1) with a median particle diameter (D50) of 0.34microm before bubbling through water. After bubbling, it retains 1.20 x 10(6) ml(-1) particles with a D50 of 0.27 mm, indicating that 2/3 of the particles are retained in the water, the smallest being trapped the less. Compared with C1, the D50 of the side stream smoke (C2) is smaller (0.11mm) while the D50 of the expired stream (C3) is similar (0.25mm). CONCLUSION: After bubbling, C1 particle sizes are similar to those measured in cigarette smoke but the volumes inhaled by a water pipe smoker are higher allowing prediction of greater deposition in the respiratory tract than with cigarette smoking.

[Understand the tobacco industry's strategy for recruiting teens: Lessons from a 1973 marketing document]. / Comprendre la stratégie de l'industrie du tabac pour recruter les adolescents : leçons actuelles d'un document marketing de 1973.

For years, the tobacco industry has organized the inoculation of tobacco addiction to adolescents. METHOD: The analysis of a 1973 RJReynols® document identified ten physical and psychological factors in order to increase the number of young users for a brand of cigarettes. These young people are classified into three groups: pre-smokers, learners and smokers. RESULT: The taste for pre-smokers and learners and nicotine for smokers are main physical parameters. The industry clearly knows that tobacco is mainly consumed because of nicotine addiction, so it is necessary to make adolescents addict. It is interesting to note that cigarette pack was in 1973 a positive factor to attract young smokers, whereas now with the arrival of the neutral packaging, the tobacco industry declares that packaging has no influence to attract teenagers ! Of the psychological factors, the only negative factor is the self-image of the smoker. The tobacco industry already recognized in 1973 that smokers were unhappy about smoking. For learners, self-image and the experience of adults are most important factor, which is why the industry strives to create a positive image and convey message that smoking initiation is a ritual to become adult. According to the tobacco industry, stress and alleviation of boredom are also important points in turning pre-smokers into learners and learners into smokers. CONCLUSION: This article aims to provide practical tools for understanding industry initiatives targeting adolescents. The attached tool can be used by the teens or adults involved to understand the optimization of teenagers tobacco marketing.

[Old and new tobacco products]. / Les anciens et nouveaux produits du tabac.

Tobacco use is not just about manufactured cigarettes. Rolling tobacco, highly prized in the wake of price increases, is estimated to carry more toxic agents than its counterpart. This study shows that the use of cigar, pipe, cigarillos and narghile also leads to a cohort of pathologies similar to or more than what is known for smoking single cigarettes. Exotic, liquid or heated forms do just as much. The non-smoked tobacco, often fallen into disuse in France is very used in the United States and especially in Scandinavia. Denuded of inhaled products, it is often pointed as a form of reduction of smoking risks. Its use by athletes in all countries as a doping attitude, especially in ski disciplines, required a campaign of prevention within the federations concerned.

[Helping smoking cessation in COPD, asthma, lung cancer, operated smokers]. / L'aide à l'arrêt du tabac des fumeurs atteints de BPCO, d'asthme, de cancer bronchique, et opérés.

Smoking is the cause of addictive behavior. Tobacco addiction is a chronic disease that makes difficult to stop smoking and leads to further use. Smoking is a risk factor for COPD, asthma and lung cancer; it may be the cause of severe perioperative complications. This finding justifies that smokers benefit from advice of stopping smoking and smoking cessation assistance. Helping patients to stop smoking increases the chances of quitting, improves the prognosis of tobacco-related diseases, the effectiveness of their treatments and the quality of life of the patients. This article updates the modalities of smoking cessation assistance in smokers with COPD, asthma and lung cancer in operated patients. The goal of the management must be the complete cessation of tobacco smoke intoxication, which alone reduces tobacco mortality.

N.U.A.G.E.S: a survey of nebulisation practice in France with regard to ERS guidelines.

UNLABELLED: A survey of nebulisation practice in France was conducted under the aegis of the French respiratory society in 2004. METHODS: Analysis of a questionnaire was obtained from 3674 physicians. RESULTS: A total of 2439 physicians were general practitioners (GPs), 698 were chest physicians, and 537 paediatricians. The main reasons to use nebulisation are (1) for chest physicians efficacy in treating various pathologies with long-term administration (1 wk to 1 month) of approved drugs, and (2) for GP's local action properties. While chest physicians learned about nebulisation during their university training and do not ask for additional information, GPs learned by practical experience or from colleagues and ask for further information. CONCLUSION: This study will help to develop targeted educational programmes on nebulisation practice.

[Particle size in the smoke produced by six different types of cigarette]. / Tailles particulaires de la fumée produite par six différents types de cigarettes.

INTRODUCTION: For several decades a more peripheral distribution of the broncho-pulmonary pathologies related to tobacco has been observed. METHODS: The aim of this study is to examine whether changes in the particle size of cigarette smoke as the result of new manufacturing technologies could play a part in the observed epidemiologic changes through a more distal disposition of smoke particles in the airways. Using a smoking machine and a low pressure electrostatic impactor we measured the particle size of the smoke from six different types of cigarette, representing old and new manufacturing techniques. The effect of a filter was assessed by a size analyser measuring the electrical mobility of the particles. RESULTS: The results show a difference in particle size between the primary smoke inhaled by the smoker, S1 (0.27 +/- 0.03 microm.) and the secondary smoke, S2 inhaled by passive smokers (0.09 +/- 0.01 microm). There is no difference in particle size between the 6 different types of cigarette. Filters dilute the smoke without altering particle size. CONCLUSION: The recent alterations in the distribution of tobacco related pathologies cannot be explained by changes in particle size in cigarette smoke. The explanation has to sought elsewhere.

[Where do Parisian teenagers buy their cigarettes?] / Quels adolescents achètent leurs cigarettes chez le buraliste à Paris ?

INTRODUCTION: The objective of this work was to assess the background of the implementation of the ban of tobacco sales to minors before the change of French law in 2016. METHODS: The analysis focused on two questions to teenagers on buying tobacco, added to the four cross-sectional annual surveys of the association "Paris Sans Tabac" from 2012 to 2015. RESULTS: In total, 7025 schoolchildren (12-15 years old), 3299 high school students (16-17 years old) and 3243 adult students (18-20 years old) responded. The proportion of daily smokers was respectively 3.2%, 19.0% and 22.0%. The overall smoking rate (daily+occasional) was 13.8%, 37.9% and 39.5% respectively. Among daily smokers, 90.7% of respondents had bought their tobacco from tobacconist. This source was used by 74.6% of daily smokers aged 12-15 years, 92.0% of the 16-17 years old and 94.0% of the18-19 years old teenagers. Drinking more than four glasses of alcohol on the same day or having used cannabis in the preceding month was associated with a greater chance of buying tobacco at the tobacconist. Starting to buy tobacco from a tobacconist below the age of 12 was associated with a high dependence score (HSI=2.4±1.9) compared to those who bought after 15 years (HSI=0.5±0.7) (P<0.001). CONCLUSIONS: Before 2016, Parisian teenagers who smoked daily mostly bought their cigarettes from a tobacconist.

Thermophysiological adaptations to passive mild heat acclimation.

Passive mild heat acclimation (PMHA) reflects realistic temperature challenges encountered in everyday life. Active heat acclimation, combining heat exposure and exercise, influences several important thermophysiological parameters; for example, it decreases core temperature and enhances heat exchange via the skin. However, it is unclear whether PMHA elicits comparable adaptations. Therefore, this study investigated the effect of PMHA on thermophysiological parameters. Participants were exposed to slightly increased temperatures (∼33°C/22% RH) for 6 h/d over 7 consecutive days. To study physiologic responses before and after PMHA, participants underwent a temperature ramp (UP), where ambient temperature increased from a thermoneutral value (28.8 ± 0.3°C) to 37.5 ± 0.6°C. During UP, core and skin temperature, water loss, cardiovascular parameters, skin blood flow and energy expenditure were measured. Three intervals were selected to compare data before and after PMHA: baseline (minutes 30-55: 28.44 ± 0.21°C), T1 (minutes 105-115: 33.29 ± 0.4°C) and T2 (minutes 130-140: 35.68 ± 0.61°C). After 7 d of PMHA, core (T1: -0.13 ± 0.13°C, P = 0.011; T2: -0.14 ± 0.15°C, P = 0.026) and proximal skin temperature (T1: -0.22 ± 0.29°C, P = 0.029) were lower during UP, whereas distal skin temperature was higher in a thermoneutral state (baseline: +0.74 ± 0.77°C, P = 0.009) and during UP (T1: +0.49 ± 0.76°C, P = .057 (not significant), T2:+0.51 ± 0.63°C, P = .022). Moreover, water loss was reduced (-30.5 ± 33.3 ml, P = 0.012) and both systolic (-7.7 ± 7.7 mmHg, P = 0.015) and diastolic (-4.4 ± 4.8 mmHg, P = 0.001) blood pressures were lowered in a thermoneutral state. During UP, only systolic blood pressure was decreased (T2: -6.1 ± 4.4 mmHg, P = 0.003). Skin blood flow was significantly decreased at T1 (-28.35 ± 38.96%, P = 0.037), yet energy expenditure remained unchanged. In conclusion, despite the mild heat stimulus, we show that PMHA induces distinct thermophysiological adaptations leading to increased resilience to heat.

Practical guidelines on e-cigarettes for practitioners and others health professionals. A French 2016 expert's statement.

A group of 11 French medical experts has developed guidelines through a Delphi progressive consensus about smoking management at the e-cigarette era. The lack of scientific data about e-cigarettes led the experts to set out recommendations, mainly based on clinical practice while waiting for scientific validations. The validated smoking cessation treatments keep the first place in the prevention and the treatment of tobacco-induced damages. The e-cigarette, experimented by a large proportion of smokers, is a safer product than tobacco. The health professional must answer the patients about the e-cigarettes: (1) A smoker who questions about e-cigarettes should receive information. Even if there is a lack of data, e-cigarettes offer much lower risks than tobacco. (2) A dual user is at high risk of returning to exclusive tobacco use; he should also optimize other nicotine intakes by combining nicotine replacement therapy and/or optimizing the nicotine intake through the e-cigarette. (3) A smoker who wish to use the e-cigarette in order to quit with or without associated pharmacological treatment should be accompanied and not discouraged. (4) A vaper who is tired to continuing to vape should be accompanied to quit. Specific guidelines are also provided for adolescents, pregnant women, patients during perioperative periods and also for pulmonary, cardiac and schizophrenic patients.

[Smoking and adherence to anti-tuberculosis treatment]. / Tabagisme et observance du traitement antituberculeux.

Smoking and tuberculosis are two major public health issues. Tobacco smoke increases the risk of Mycobacterium tuberculosis infection and the severity of pulmonary tuberculosis. Active smoking increases the risk of relapse of pulmonary and extra-pulmonary tuberculosis after treatment; smokers are less adherent to anti-tuberculosis treatment. Smoking cessation represent a means of controlling the tuberculosis epidemic in developing countries. This general review identified 17 studies in the international literature on the link between active smoking and the adherence to anti-tuberculosis treatment. It highlights a positive association between smoking and a lack of adherence to anti-tuberculosis treatment. This justifies the systematic application of aid to stopping smoking in smokers with tuberculosis.

[The e-cigarette disrupts other consumptions in Parisian teenagers (2012-2014)]. / L'e-cigarette bouleverse les autres consommations des adolescents parisiens (2012 à 2014).

OBJECTIVES: To analyze experimentation with and use of e-cigarette by middle school and high school students in Paris. METHOD: Since 2012, questions about e-cigarette use have been included in the cross-sectional survey on tobacco that is administered annually since 1991 by the Paris sans tabac association. Overall, 2% of the 12-19 years-old attending school in Paris were surveyed. RESULTS: Of the 10,051 teenagers aged 12-19 surveyed in 2012-2014, 21.8% (n=2194) had tried e-cigarettes. Among these experimenters, 58.9% (n=1292) were smokers, 37.4% (n=820) were non-smokers and 3.7% (n=82) were ex-smokers. From 2012 to 2014, the rate of e-cigarette experimenters increased significantly (from 7.9% to 26.3% for 12-15 years and from 12.2% to 47.2% for 16-19 years-old). The rate of regular e-cigarettes users increased in the same proportion. However over this time, there has been a decline from 15.3% to 10.9% in the rate of 12-15 year old smokers (regular or occasional) and from 38.3% to 33.5% of smokers aged 16-19. Other consumption (cannabis, alcohol abuse) also decreased but no causal relationship can be established. CONCLUSION: The annual doubling of e-cigarette experimentation and regular use rates has been associated with a decrease in the consumption of tobacco and other products. These data should provide some reassurance against fears that e-cigarette use among young people will provide a significant gateway to tobacco smoking.

Two schedules of teniposide with or without cisplatin in advanced non-small-cell lung cancer: a randomized study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group.

PURPOSE: We conducted a randomized trial to investigate the value of the addition of cisplatin to teniposide (VM26) and to investigate the schedule dependence of the topoisomerase II inhibitor VM26, in advanced non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Two hundred twenty-five NSCLC patients were randomized to receive VM26 120 mg/m2 on days 1, 3, and 5 or 360 mg/m2 on day 1 only, either as a single drug or in combination with cisplatin 80 mg/m2 on day 1. Cycles were repeated every 3 weeks. Response rates, side effects, and survival were compared according to the 2 x 2 factorial design of this study. RESULTS: The response rate of the two cisplatin-containing arms was superior to that of the two arms that contained VM26 only (22% v 6%, P < .001); progression-free survival and survival times were also longer in the cisplatin-containing arms (median, 4.3 v 2.2 months, P = .003; median 7.2 v 5.9 months, P = .008, respectively). Toxicity was significantly higher in the cisplatin-containing arms; the most frequent side effects were leukopenia, nausea and vomiting, and alopecia. The schedule of VM26 did not significantly influence the response rate, progression-free survival interval, or survival duration. However, the response rate of the 1-day administration was significantly lower than that of the 3-day administration when given as single drugs. CONCLUSION: The addition of cisplatin to VM26 improves the response rate, progression-free survival interval, and survival duration over VM26 alone, although at the cost of a significant increase in toxicity. Cisplatin should be considered as the basis for combination chemotherapies in advanced NSCLC.

Outbreak of tuberculosis in a migrants' shelter, Paris, France, 2002.

SETTING: An overcrowded 362-bed migrants' shelter in Paris, France. OBJECTIVES: To investigate an outbreak of tuberculosis (TB), to identify a common source of contamination and to prevent further transmission. METHODS: The outbreak was identified by radiographic screening and an active search for undeclared hospital treated cases, completed by strain phenotyping and a search for contact cases. RESULTS: Between October 2001 and October 2002, 56 cases of active TB were identified, 30 by radiological screening and 20 by contacting neighbouring hospitals. All cases involved men, with a median age of 30 years. Pulmonary involvement was present in 54% of cases, and nine patients were sputum smear-positive. Thirty-four of the 37 phenotyped strains clustered together. CONCLUSION: The grouping of the cases in time and place, the large number of cases with early-stage disease and the identical RFLP banding patterns of most of the isolates indicate that this outbreak results from transmission that occurred in France. This report underlines the need for public health departments in industrialised countries to maintain effective anti-tuberculosis control programmes.