RSS-Feed abonnieren
DOI: 10.1055/a-2034-6214
Elektronische Zigaretten – Schadensminimierung oder Schadensverlängerung?
Electronic cigarettes: harm reduction or harm prolongation?Zusammenfassung
Der Beitrag befasst sich mit der Frage, ob Elektronische Zigaretten (E-Zigaretten) den erwiesenen Schaden des Rauchens von Tabakprodukten minimieren können oder zu einer Schadensverlängerung führen. Während das britische Royal College of Physicians Rauchern E-Zigaretten als Substitut für Tabakprodukte empfiehlt, rät die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin Rauchern von der Nutzung der E-Zigarette ab. Drei Hypothesen liegen der Schadensminimierungsstrategie zugrunde. Hypothese 1: Es wird davon ausgegangen, dass E-Zigaretten gesundheitlich weniger Schaden anrichten als Tabakzigaretten. Hypothese 2: Es wird postuliert, dass Raucher motiviert sind, von konventionellen Zigaretten auf E-Zigaretten umzusteigen. Hypothese 3: Es wird vermutet, dass E-Zigaretten ein nebenwirkungsarmes, effektives Mittel zum Rauchstopp sind. Obwohl die langfristigen gesundheitlichen Folgen des E-Zigarettenkonsums nach wie vor unbekannt sind, mehren sich die Befunde, dass E-Zigaretten toxisch wirken, schädlich für das Herz-Kreislauf-System, die Gesundheit der Atemwege und möglicherweise krebserregend sind. Bevölkerungsrepräsentative epidemiologische Erhebungen zeigen, dass drei Viertel aller aktuellen E-Zigarettennutzer in Deutschland gleichzeitig Tabak rauchen. E-Zigaretten haben in wenigen randomisierten klinischen Studien im Vergleich zu Nikotinersatzprodukten höhere Erfolgsraten. Als frei verkäufliche Konsumprodukte unter Realbedingungen findet sich in einer Vielzahl von Studien kein Vorteil für E-Zigaretten. Zudem verlängern E-Zigaretten im Vergleich zu Nikotinersatzprodukten die Nikotinabhängigkeit. Die Hypothesen der Schadensminimierungsstrategie mittels E-Zigaretten müssen nach derzeitigem Kenntnisstand als widerlegt angesehen werden. Daher erscheint es ethisch nicht unproblematisch, wenn Ärzte ihren Patienten E-Zigaretten als Substitut zum Rauchen empfehlen.
Abstract
This paper deals with the question of whether electronic cigarettes (e-cigarettes) can minimize the proven harm of smoking tobacco or may lead to a long-term harm. While the British Royal College of Physicians recommends smokers to use e-cigarettes as a substitute for tobacco products, the German Society for Pneumology and Respiratory Medicine advises smokers against using e-cigarettes. The harm reduction strategy is based on three hypotheses. Hypothesis 1: It is assumed that e-cigarettes cause less damage to health than tobacco cigarettes. Hypothesis 2: It is postulated that smokers are motivated to switch from conventional cigarettes to e-cigarettes. Hypothesis 3: It is assumed that e-cigarettes are an effective means for quitting smoking with few side effects. Although the long-term health consequences of e-cigarette use remain unknown, there is increasing evidence that e-cigarettes are toxic, harmful to cardiovascular system, respiratory health and potentially carcinogenic. Population-representative epidemiological surveys have shown that three-quarters of all current e-cigarette users in Germany smoke tobacco at the same time. In a few randomized clinical trials, e-cigarettes showed higher success rates compared to nicotine replacement products. As over-the-counter consumer products, a large number of studies have found no advantage for e-cigarettes under real conditions. In addition, e-cigarettes prolong nicotine dependence compared to nicotine replacement products. According to the current state of knowledge, the hypotheses behind the harm minimization strategy using e-cigarettes must be regarded as refuted. It therefore appears ethically problematic when doctors recommend e-cigarettes to their patients as a substitute for smoking.
Publikationsverlauf
Eingereicht: 30. Januar 2023
Angenommen nach Revision: 09. Februar 2023
Artikel online veröffentlicht:
28. März 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet 2021; 397: 2337-2360 DOI: 10.1016/s0140-6736(21)01169-7. (PMID: 34051883)
- 2 Mons U, Kahnert S. Neuberechnung der tabakattributablen Mortalität – Nationale und regionale Daten für Deutschland. Gesundheitswesen 2019; 81: 24-33 DOI: 10.1055/s-0042-123852. (PMID: 28505702)
- 3 Royal College of Physicians. Smoking and health 2021: a coming of age for tobacco control?. London: RCP; 2021
- 4 McKee M. Evidence and E-Cigarettes: Explaining English Exceptionalism. Am J Public Health 2019; 109: 965-966 DOI: 10.2105/ajph.2019.305132. (PMID: 31166720)
- 5 WHO. WHO report on the global tobacco epidemic 2021: addressing new and emerging products. Geneva: WHO; 2021
- 6 Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin in Zusammenarbeit mit medizinischen Fachgesellschaften und Organisationen. Empfehlungen zum Umgang mit der elektronischen Zigarette (E-Zigarette). Pneumologie 2022; 76: 473-478 DOI: 10.1055/a-1862-3112.
- 7 Smith MR, Clark B, Lüdicke F. et al. Evaluation of the Tobacco Heating System 2.2. Part 1: Description of the system and the scientific assessment program. Regul Toxicol Pharmacol 2016; 81 (Suppl. 02) S17-S26 DOI: 10.1016/j.yrtph.2016.07.006. (PMID: 27450400)
- 8 Nutt DJ, Phillips LD, Balfour D. et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res 2014; 20: 218-225 DOI: 10.1159/000360220. (PMID: 24714502)
- 9 McNeill A, Brose LS, Calder R. et al. E-cigarettes: an evidence update. A report commissioned by Public Health England. London: Public Health England; 2015
- 10 Eissenberg T, Bhatnagar A, Chapman S. et al. Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes. Am J Public Health 2020; 110: 161-162 DOI: 10.2105/ajph.2019.305424. (PMID: 31913680)
- 11 Murray R, Evison M, Callister M. Nicotine or tobacco abstinence? A reply to Hanewinkel et al. Eur Respr Rev 2022; 31: 220089 DOI: 10.1183/16000617.0089-2022. (PMID: 36323419)
- 12 Hanewinkel R, Niederberger K, Pedersen A. et al. Reply to: “Nicotine or tobacco abstinence?”. Eur Respir Rev 2022; 31: 220158 DOI: 10.1183/16000617.0158-2022. (PMID: 36323420)
- 13 Pipe AL, Mir H. E-Cigarettes Reexamined: Product Toxicity. Can J Cardiol 2022; 38: 1395-1405 DOI: 10.1016/j.cjca.2022.08.001. (PMID: 36089290)
- 14 Neczypor EW, Mears MJ, Ghosh A. et al. E-Cigarettes and Cardiopulmonary Health: Review for Clinicians. Circulation 2022; 145: 219-232 DOI: 10.1161/circulationaha.121.056777. (PMID: 35041473)
- 15 McConnell R, Barrington-Trimis JL, Wang K. et al. Electronic Cigarette Use and Respiratory Symptoms in Adolescents. Am J Respir Crit Care Med 2017; 195: 1043-1049 DOI: 10.1164/rccm.201604-0804OC. (PMID: 27806211)
- 16 Jonas A. Impact of vaping on respiratory health. Bmj 2022; 378: e065997 DOI: 10.1136/bmj-2021-065997. (PMID: 35851281)
- 17 Wills TA, Soneji SS, Choi K. et al. E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. Eur Respir J 2021; 57 DOI: 10.1183/13993003.01815-2019.
- 18 Farber HJ, Conrado Pacheco Gallego M, Galiatsatos P. et al. Harms of Electronic Cigarettes: What the Healthcare Provider Needs to Know. Ann Am Thorac Soc 2021; 18: 567-572 DOI: 10.1513/AnnalsATS.202009-1113CME.
- 19 Asfar T, Jebai R, Li W. et al. Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies. Tob Control 2022; DOI: 10.1136/tc-2022-057495.
- 20 The Lancet. E-cigarettes: time to realign our approach?. Lancet 2019; 394: 1297 DOI: 10.1016/s0140-6736(19)32277-9. (PMID: 31609211)
- 21 Banks E, Yazidjoglou A, Brown S. et al. Electronic cigarettes and health outcomes: systematic review of global evidence. Canberra: National Centre for Epidemiology and Population Health; 2022
- 22 Pope 3rd CA, Burnett RT, Krewski D. et al. Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship. Circulation 2009; 120: 941-948 DOI: 10.1161/circulationaha.109.857888. (PMID: 19720932)
- 23 Tverdal A, Bjartveit K. Health consequences of reduced daily cigarette consumption. Tob Control 2006; 15: 472-480 DOI: 10.1136/tc.2006.016246. (PMID: 17130377)
- 24 Jarvis MJ. Why people smoke. Bmj 2004; 328: 277-279 DOI: 10.1136/bmj.328.7434.277. (PMID: 14751901)
- 25 Dawkins L, Cox S, Goniewicz M. et al. ‘Real-world’ compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. Addiction 2018; 113: 1874-1882 DOI: 10.1111/add.14271.
- 26 OʼConnor R, Durkin SJ, Cohen JE. et al. Thoughts on neologisms and pleonasm in scientific discourse and tobacco control. Tobacco Control 2021; 30: 359-360 DOI: 10.1136/tobaccocontrol-2021-056795.
- 27 Pisinger C, Godtfredsen N, Bender AM. A conflict of interest is strongly associated with tobacco industry-favourable results, indicating no harm of e-cigarettes. Prev Med 2019; 119: 124-131 DOI: 10.1016/j.ypmed.2018.12.011. (PMID: 30576685)
- 28 Sreeramareddy CT, Acharya K, Manoharan A. Electronic cigarettes use and ‘dual use’ among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014–2019). Sci Rep 2022; 12: 20967 DOI: 10.1038/s41598-022-25594-4. (PMID: 36470977)
- 29 Coleman SRM, Piper ME, Byron MJ. et al. Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence. Curr Addict Rep 2022; 9: 353-362 DOI: 10.1007/s40429-022-00448-1. (PMID: 36467719)
- 30 Kotz D, Böckmann M, Kastaun S. The Use of Tobacco, E-Cigarettes, and Methods to Quit Smoking in Germany. Dtsch Arztebl Int 2018; 115: 235-242 DOI: 10.3238/arztebl.2018.0235. (PMID: 29716687)
- 31 Pisinger C, Rasmussen SKB. The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review. Int J Environ Res Public Health 2022; 19 DOI: 10.3390/ijerph192013687. (PMID: 36294263)
- 32 Beard E, Brown J, Michie S. et al. Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis. BMJ Open 2018; 8: e016046 DOI: 10.1136/bmjopen-2017-016046.
- 33 Hedman L, Galanti MR, Ryk L. et al. Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis. Tob Prev Cessat 2021; 7: 62 DOI: 10.18332/tpc/142320. (PMID: 34712864)
- 34 Chen R, Pierce JP, Leas EC. et al. Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017–2019. Tob Control 2022; DOI: 10.1136/tobaccocontrol-2021-056901.
- 35 Barufaldi LA, Guerra RL, de Albuquerque RCR. et al. Risk of smoking relapse with the use of electronic cigarettes: A systematic review with meta-analysis of longitudinal studies. Tob Prev Cessat 2021; 29: 29 DOI: 10.18332/tpc/132964.
- 36 Pierce JP, Chen R, Kealey S. et al. Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products. JAMA Netw Open 2021; 4: e2128810 DOI: 10.1001/jamanetworkopen.2021.28810. (PMID: 34665239)
- 37 Pound CM, Zhang JZ, Kodua AT. et al. Smoking cessation in individuals who use vaping as compared with traditional nicotine replacement therapies: a systematic review and meta-analysis. BMJ Open 2021; 11: e044222 DOI: 10.1136/bmjopen-2020-044222.
- 38 Hartmann-Boyce J, Lindson N, Butler AR. et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022; 11: Cd010216 DOI: 10.1002/14651858.CD010216.pub7. (PMID: 34519354)
- 39 Russel C, McKeganey N, Katsampouris E. et al. A randomised community-based trial of a closed-system pod e-vapour product and nicotine replacement therapy for cigarette abstinece and reduction. Society for Research on Nicotine and Tobacco (SRNT) 2021 Annual Meeting February 24–27 2021. virtual:PH-353 p230 2021.
- 40 Batra A, Kiefer F, Andreas S. et al. S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“. SUCHT 2021; 67: 55-75 DOI: 10.1024/0939-5911/a000703.
- 41 Nationale Versorgungs Leitlinien. NVL COPD, 2. Auflage. Zugriff am 28. Februar 2023 unter: https://wwwleitliniende/themen/copd/2-auflage 2021
- 42 Bals R, Boyd J, Esposito S. et al. Electronic cigarettes: a task force report from the European Respiratory Society. Eur Respir J 2019; 53 DOI: 10.1183/13993003.01151-2018.
- 43 Ferkol TW, Farber HJ, La Grutta S. et al. Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies. Eur Respir J 2018; 51 DOI: 10.1183/13993003.00278-2018. (PMID: 29848575)
- 44 Herbst RS, Hatsukami D, Acton D. et al. Electronic Nicotine Delivery Systems: An Updated Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res 2022; 28: 4861-4870 DOI: 10.1158/1078-0432.Ccr-22-2429.
- 45 McDonald CF, Jones S, Beckert L. et al. Electronic cigarettes: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25: 1082-1089 DOI: 10.1111/resp.13904.
- 46 Signes-Costa J, de Granda-Orive JI, Ramos Pinedo Á. et al. Official Statement of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on Electronic Cigarettes and IQOS. Arch Bronconeumol (Engl Ed) 2019; 55: 581-586 DOI: 10.1016/j.arbres.2019.04.023.
- 47 Society for Adolescent Health and Medicine. Protecting Youth From the Risks of Electronic Cigarettes. J Adolesc Health 2020; 66: 127-131 DOI: 10.1016/j.jadohealth.2019.10.007. (PMID: 31780385)
- 48 Benowitz NL. Nicotine addiction. N Engl J Med 2010; 362: 2295-2303 DOI: 10.1056/NEJMra0809890. (PMID: 18834313)
- 49 Faure P, Tolu S, Valverde S. et al. Role of nicotinic acetylcholine receptors in regulating dopamine neuron activity. Neuroscience 2014; 282: 86-100 DOI: 10.1016/j.neuroscience.2014.05.040. (PMID: 24881574)
- 50 Solingapuram Sai KK, Zuo Y, Rose JE. et al. Rapid Brain Nicotine Uptake from Electronic Cigarettes. J Nucl Med 2020; 61: 928-930 DOI: 10.2967/jnumed.119.230748.
- 51 Hanewinkel R, Niederberger K, Pedersen A. et al. E-cigarettes and nicotine abstinence: a meta-analysis of randomised controlled trials. Eur Respir Rev 2022; 31: 210215 DOI: 10.1183/16000617.0215-2021. (PMID: 35321930)
- 52 Butler AR, Lindson N, Fanshawe TR. et al. Longer-term use of electronic cigarettes when provided as a stop smoking aid: Systematic review with meta-analyses. Prev Med 2022; 165: 107182 DOI: 10.1016/j.ypmed.2022.107182.
- 53 Hartmann-Boyce J, Chepkin SC, Ye W. et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev 2018; 5: Cd000146 DOI: 10.1002/14651858.CD000146.pub5. (PMID: 29852054)
- 54 Stead LF, Buitrago D, Preciado N. et al. Physician advice for smoking cessation. Cochrane Database Syst Rev 2013; 2013: Cd000165 DOI: 10.1002/14651858.CD000165.pub4. (PMID: 23728631)
- 55 Hanewinkel R. Gesundheitsrisiken der E-Zigarette. MMW Fortschr Med 2023; 165: 62-63 DOI: 10.1007/s15006-023-2249-9. (PMID: 36759479)