May 30, 2003 St. Louis, May 29, 2003 -- A study at Washington University School of Medicine in St. Louis predicts that smokers might significantly reduce the adverse health effects of their habit if they could switch from cigarettes to inhalers that deliver doses of "clean" nicotine. Cigarette-sized doses of pure nicotine could be delivered using inhalers modeled after those used by people with asthma. The study is published in the June issue of the journal Tobacco Control. Nicotine inhalers, which are not currently available, would deliver doses of nicotine deep into the lungs similar to cigarettes. Researchers expect these inhalers to have the same drug effect as cigarettes and to be just as addictive. But they also predict that inhalers would be safer than cigarettes because they would lack the chemicals in smoke that are most responsible for smoking-related deaths from cancer, emphysema and heart disease. Inhalers also would eliminate the problem of second-hand smoke.
"There seems to be no effective way to convince many smokers to quit," says principal investigator Walton Sumner II, M.D., associate professor of medicine. "If one accepts that cigarette smoking will under no circumstances disappear, then one becomes committed to considering ways to make the habit safer. I'm not ready to recommend the use of these devices. But I do recommend that we study them as an alternative to cigarette smoking."
Sumner, whose father died of smoking-related lung cancer, began studying the use of nicotine inhalers as a substitute for cigarettes after witnessing the limited success of smoking cessation and prevention programs. In addition, he says, the medical literature and historic accounts of tobacco control efforts demonstrate the difficulty, and perhaps impossibility, of significantly lowering smoking rates.
According to the Centers for Disease Control and Prevention, 26 percent of adult American men and 21 percent of women smoke. The U.S. Surgeon General's goal, through the "Healthy People 2010" disease-prevention initiative, is to reduce smoking prevalence to 12 percent by the end of the decade.
"I seriously doubt that we will achieve that target under the present circumstances," says Sumner, who also is a member of the cancer prevention and control program at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.
His research suggests that nicotine inhalers, however, could lead to such a dramatic drop.
Sumner developed a computer program called Differences in Expected Mortality Adjusted for Nicotine Delivery Systems (DEMANDS). Using 1990 smoking patterns as a baseline, the program predicts the years of potential life gained or lost up to age 65 and up to age 85 as a consequence of changes in the safety and prevalence of nicotine use.
DEMANDS makes predictions based on four general components of smoking that contribute to tobacco-related disease: nicotine; smoke, which is composed of thousands of gases and particulates; carbon monoxide, a highly toxic gas; and so-called correlates of smoking, which are characteristics of smokers unrelated to cigarettes that increase a person's risk of death (for example, poverty, alcoholism and psychiatric illness).
The model showed that as long as nicotine contributes less than one-third of the risk of smoking-related illness, widespread use of nicotine inhalers might significantly reduce premature death due to coronary artery disease, respiratory-tract cancers, lung disease and other causes of premature death. It also could meet or exceed the goal of Healthy People 2010.
"This study suggests that the use of nicotine inhalers should be considered," Sumner says. "The challenge is to convince the tobacco control community that this is a rational alternative that should be studied."
Sumner II W. Estimating the health consequences of replacing cigarettes with nicotine inhalers. Tobacco Control, June 2003.
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
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