Rebuttal from Samuel Chung, Charles D. Bengtson, Michael D. Kim and Matthias Salathe.
Rebuttal from Samuel Chung, Charles D. Bengtson, Michael D. Kim and Matthias Salathe.
复制标题
DOI：
10.1113/jp280093
复制
发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Salathe M
中科院分区：
文献类型：
--
作者：
Chung S;Bengtson CD;Kim MD;Salathe M
Begh 和 Aveyard（2020）认为，电子烟由于风险降低而成为有价值的戒烟工具。然而，电子烟作为戒烟工具仍然存在争议。该领域最大规模的研究（Hajek 等人，2019）似乎存在缺陷，并指出了传统戒烟计划不会面临的危险。虽然与尼古丁替代疗法 (NRT) 相比，电子烟似乎与更高的戒烟率相关，但 NRT 组中只有 3% 的人服用伐尼克兰，没有人服用安非他酮。如果将 NRT 与药物干预相结合，它的戒烟率将与该研究中电子烟组的戒烟率相同（例如 Anthenelli 等人，2016 年）。更重要的是，与电子烟组中实现持续戒烟的 18% 参与者相比，更多的参与者 (25%) 成为电子烟和可燃香烟的双重使用者。考虑到双重用户可能面临更大的呼吸道疾病风险，这是有问题的（Bhatta＆Glantz，2020）。此外，Hajek 研究中的 NRT 部门表明，只有 9% 的人继续使用 NRT，并在 1 年后成功戒烟，而 80% 的电子烟使用者继续吸电子烟，基本上用另一种有害的尼古丁输送装置取代了一种有害的尼古丁输送装置。电子烟比吸烟危害更小的说法是基于蒸汽中有毒化学物质的含量低于烟草烟雾。然而，与疾病相关的化学物质在较低暴露水平下的毒性相对较高（Lanphear，2017），并且缺乏对蒸气成分的长期研究。尽管与电子烟相关的肺损伤的爆发可能与维生素 E 醋酸酯和/或四氢大麻酚有关，但其他电子烟蒸汽成分也可能有所贡献（Krishnasamy 等人，2020）。此外，减少有毒物质暴露并不会导致风险线性降低：将吸烟量从每天 20 支烟减少到 1 支，只会降低患冠状动脉疾病的风险
Begh and Aveyard (2020) reason that e-cigarettes are valuable smoking cessation tools due to their reduced risk profiles. However, vaping as a smoking cessation tool remains controversial. The largest study in this area (Hajek et al. 2019) seemed flawed and pointed to dangers that traditional smoking cessation programmes do not face. While e-cigarettes appeared associated with higher rates of smoking cessation compared to nicotine replacement therapy (NRT), only 3% in the NRT arm were on varenicline and none on bupropion. If NRT is combined with pharmacological interventions, it achieves quit rates equal to the e-cigarette arm in that study (eg Anthenelli et al. 2016). More importantly, an even greater number of participants (25%) became dual users of e-cigarettes and combustible cigarettes than the 18% of participants in the e-cigarette arm who achieved sustained abstinence from tobacco. This is problematic when considering that dual users may be at greater risk of respiratory illness (Bhatta & Glantz, 2020). Furthermore, the NRT arm in the Hajek study showed that only 9% continued NRT with successful cessation at 1 year follow-up, while 80% of the e-cigarette users continued to vape, basically replacing one harmful nicotine delivery device with another.The assertion that vaping is less harmful than smoking is based on lower levels of toxic chemicals in vapour than tobacco smoke. However, chemicals linked to disease are proportionately more toxic at lower levels of exposure (Lanphear, 2017) and longterm studies on vapour constituents are missing. Although the outbreak of vaping-related lung injuries is possibly related to vitamin E acetate and/or tetrahydrocannabinol, other e-cigarette vapour constituents could contribute (Krishnasamy et al. 2020). Furthermore, reduction in toxic exposure is not resulting in linear risk reduction: reducing smoking from 20 cigarettes per day to 1 reduces the risk for developing coronary artery disease only