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.

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.

[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.

[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.

[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.

[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.

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.

[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.

[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.

[Comparison of the aerosol produced by electronic cigarettes with conventional cigarettes and the shisha]. / Comparaison de l'aérosol de la cigarette électronique à celui des cigarettes ordinaires et de la chicha.

In previous studies of the smoke from regular cigarettes and water pipes, we measured aerosol particle sizes in three streams; S1, inhaled by the smoker, S2, released by the device itself and S3, exhaled by the smoker. We used an electrostatic low-pressure impactor (ELPI), giving particle size distributions in real time and calculated median diameters, D50, and dispersion (σg). This allowed us to predict airway deposition. In addition, the aerosol particle half-life in the air was used as a measure of the risk to others from passive smoking. With the same equipment, we measured the particle sizes and persistence in air of the liquid aerosol generated by e-cigarettes (Cigarettec®) containing water, propylene glycol and flavorings with or without nicotine. Aerosol generation was triggered by a syringe or by the inspiration of volunteer smokers. The D50 data obtained in S1, were 0.65 µm with nicotine and 0.60 µm without nicotine. Deposition in the airways could then be calculated: 26% of the total would deposit, of which 14% would reach the alveoli. These data are close to those found with regular cigarettes. For S3, D50 data were 0.34 µm and 0.29 µm with or without nicotine. The half-life in air of the S3 stream was 11 seconds due to a rapid evaporation. The-e-cigarette aerosol, as measured here, is made of particles bigger than those of cigarette and water pipe aerosols. Their deposition in the lung depends on their fate in the airways, which is unknown. Contrary to tobacco smoke, which has a half-life in air of 19 to 20 minutes, the risk of passive "smoking" exposure from e-cigarettes is modest.

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.

[Tobacco smoking and latent tuberculous infection]. / Tabagisme et infection tuberculeuse latente.

Tobacco smoking has a significant impact on the risk of tuberculosis and the mortality of the disease. There is a strong dose-response relationship both in terms of quantity and duration of smoking. Latent tuberculous infection and tuberculosis disease are different stages of the same infectious process but the relation between smoking and the risk of being infected with Mycobacterium tuberculosis is less well understood. The aim of this review is to describe the relationship between tobacco consumption and tuberculous infection and the mechanism by which smoking increases the risk. It outlines the public health consequences of the increased risk of latent tuberculous infection due to active and passive smoking. This justifies promotion of smoking cessation as a way of limiting the epidemic of tuberculosis in developing countries.

[Airway deposition of nanoparticles from second hand cigarette smoke]. / Rétention dans les voies aériennes des particules nanométriques de l'aérosol de la fumée de cigarette au cours du tabagisme passif.

INTRODUCTION: Second hand cigarette smoke consists predominantly of nanoparticles (with two dimensions less than 100 nanometres). The aim of this study was to examine the aerosol of cigarette smoke suspended in the air of a smoking room, its disappearance over the course of time, and its retention in the airways of passive smokers, as these processes remain poorly characterised. METHODS: A smoking machine produced cigarette smoke in a room. A low pressure electrostatic impactor with 13 plates, measured the size distribution and the concentration of the smallest particle sizes in the room air. Healthy adult volunteers (n=14) inhaled and exhaled this air through a nasal mask, allowing calculation of the retention of nanometric particles. RESULTS: The tobacco smoke aerosol was composed of 75% of nanometric particles. The half-life of these particles in the air was 18min. After 2h, 3% of the tobacco smoke particles remained suspended in the air. In passive smokers, the measured airway retention was on average 20%. CONCLUSION: This work shows that 75% of second hand cigarette smoke aerosol is made up of nanoparticles. When non-smokers inhale this passively, 20% of the particles are retained in their respiratory tract.