https://doi.org/10.4081/monaldi.2025.3316
Acute effects of heated tobacco smoking: a single-center study
Submitted: December 24, 2024
Accepted: February 21, 2025
Published: March 17, 2025
Accepted: February 21, 2025
Abstract Views: 251
PDF_EARLY VIEW: 83
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The idea of heated tobacco products (HTPs) is to deliver nicotine to the consumer by heating the tobacco rather than burning it, possibly causing less release of many harmful and potentially harmful chemical constituents (HPHCs), including carbon monoxide (CO). This prospective observational study targets studying the acute effects of HTPs regarding exhaled CO, serum cotinine level, and pulmonary function. A total of 91 participants were included; 46 current traditional cigarette smokers were instructed not to smoke for a minimum of 12 hours before the study (not following the smoking cessation program) and then divided into two groups. Group 1 contained 23 participants who smoked their usual cigarette brands, and Group 2 consisted of 23 participants who smoked the I-Quit-Ordinary-Smoking tobacco sticks. Group 3 is the control group, including 45 normal healthy non-smoker participants. All participants were subjected to the subsequent thorough medical history and clinical examination, followed by assessment of the following parameters before smoking as well as 5 minutes after smoking (either heated tobacco or traditional cigarettes according to their groups): oxygen saturation (SpO₂), heart rate (HR), measurement of exhaled CO, spirometry, and blood sample for serum cotinine level (which was assessed 5 minutes as well as 30 minutes after smoking). The study's findings showed that after smoking cigarettes, the amount of CO in the air was higher (mean 32.83±16.73 standard deviation) than after smoking heated tobacco, which was statistically significant. Serum cotinine levels also went up after smoking in both groups, but they were slightly higher after HTPs than after conventional cigarettes (CCs). Spirometry and SpO2 levels went down after smoking in groups 1 and 2, while HR levels went up after smoking in both groups, with a p-value of less than 0.001. We concluded that the HTPs have acute respiratory and cardiovascular effects similar to CCs but with less exhaled CO.
Stratton K, Shetty P, Wallace R, Bondurant S. Clearing the smoke: the science base for tobacco harm reduction–executive summary. Tob Control 2001;10:189-95.
DOI: https://doi.org/10.1136/tc.10.2.189
Pataka A, Kotoulas S, Chatzopoulos E, et al. Acute effects of a heat-not-burn tobacco product on pulmonary function. Medicina 2020;56:292.
DOI: https://doi.org/10.3390/medicina56060292
Caponnetto P, Maglia M, Prosperini G, et al. Carbon monoxide levels after inhalation from new generation heated tobacco products. Resp Res 2018;19:164.
DOI: https://doi.org/10.1186/s12931-018-0867-z
Brinkman GL, Coates EO Jr. The effects of bronchitis, smoking, and occupation on ventilation. Am Rev Respir Dis 1963;87:684-93.
Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70-88.
DOI: https://doi.org/10.1164/rccm.201908-1590ST
Chan YH. Biostatistics 102: quantitative data – parametric & non-parametric tests. Singap Med J 2003;44:391-6.
Chan YH. Biostatistics 103: qualitative data –tests of independence. Singap Med J 2003;44:498-503.
Chan YH. Biostatistics 104: correlational analysis. Singap Med J 2003;44:614-9.
Rabenstein A, Rahofer A, Vukas J, et al. Usage pattern and nicotine delivery during ad libitum consumption of pod e-cigarettes and heated tobacco products. Toxics 2023;11:434.
DOI: https://doi.org/10.3390/toxics11050434
Vukas J, Mallock-Ohnesorg N, Rüther T, et al. Two different heated tobacco products vs. cigarettes: comparison of nicotine delivery and subjective effects in experienced users. Toxics 2023;11:525.
DOI: https://doi.org/10.3390/toxics11060525
Majek P, Jankowski M, Brożek GM. Acute health effects of heated tobacco products: comparative analysis with traditional cigarettes and electronic cigarettes in young adults. ERJ Open Res 2023;9:00595-2022.
DOI: https://doi.org/10.1183/23120541.00595-2022
Deveci SE, Deveci F, Açik Y, Ozan AT. The measurement of exhaled carbon monoxide in healthy smokers and non-smokers. Resp Med 2004;98:551-6.
DOI: https://doi.org/10.1016/j.rmed.2003.11.018
Bekki K, Inaba Y, Uchiyama S, Kunugita N. Comparison of chemicals in mainstream smoke in heat-not-burn tobacco and combustion cigarettes. J UOEH 2017;39:201-7.
DOI: https://doi.org/10.7888/juoeh.39.201
Maloney S, Eversole A, Crabtree M, et al . Acute effects of JUUL and IQOS in cigarette smokers. Tob Control 2020:tobaccocontrol-2019:055475.
DOI: https://doi.org/10.1136/tobaccocontrol-2019-055475
Zhang X, Sun Y, Cheung YTD, et al. Cigarettes, heated tobacco products, and dual use: exhaled carbon monoxide, saliva cotinine, and total tobacco consumed by Hong Kong tobacco users. Tob Control 2024;33:457-63.
DOI: https://doi.org/10.1136/tc-2022-057598
Hardie G, Gale N, McEwan M, et al. An abuse liability assessment of the glo tobacco heating product in comparison to combustible cigarettes and nicotine replacement therapy. Sci Rep 2022;12:14701.
DOI: https://doi.org/10.1038/s41598-022-19167-8
Phillips-Waller A, Przulj D, Pesola F, et al . Nicotine delivery and user ratings of IQOS heated tobacco system compared with cigarettes, juul, and refillable e-cigarettes. Nicotine Tob Res 2021;23:1889-94.
DOI: https://doi.org/10.1093/ntr/ntab094
Goldenson NI, Augustson EM, Chen J, Shiffman S. Pharmacokinetic and subjective assessment of prototype JUUL2 electronic nicotine delivery system in two nicotine concentrations, JUUL system, IQOS, and combustible cigarette. Psychopharmacology 2022;239:977-88.
DOI: https://doi.org/10.1007/s00213-022-06100-0
Brossard P, Weitkunat R, Poux V, et al . Nicotine pharmacokinetic profiles of the Tobacco Heating System 2.2, cigarettes, and nicotine gum in Japanese smokers. Regul Toxicol Pharmacol 2017;89:193-9.
DOI: https://doi.org/10.1016/j.yrtph.2017.07.032
Kougias M, Vardavas CI, Anagnostopoulos N, et al. The acute effect of cigarette smoking on the respiratory function and FENO production among young smokers. Exp Lung Res 2013;39:359-64.
DOI: https://doi.org/10.3109/01902148.2013.830654
Unverdorben M, Mostert A, Munjal S, et al. Acute effects of cigarette smoking on pulmonary function. Regul Toxicol Pharmacol 2010;57:241-6.
DOI: https://doi.org/10.1016/j.yrtph.2009.12.013
Flouris AD, Chorti MS, Poulianiti KP, et al. Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhal Toxicol 2013;25:91-101.
DOI: https://doi.org/10.3109/08958378.2012.758197
Chorti M, Poulianiti K, Jamurtas T, et al. Effects of active and passive electronic and tobacco cigarette smoking on lung function. Toxicol Lett 2012;211:S64.
DOI: https://doi.org/10.1016/j.toxlet.2012.03.250
Moazed F, Chun L, Matthay MA, et al. Assessment of industry data on pulmonary and immunosuppressive effects of IQOS. Tob Control 2018;27:s20-5.
DOI: https://doi.org/10.1136/tobaccocontrol-2018-054296
Pezzuto A and Carico E. Effectiveness of smoking cessation in smokers with COPD and nocturnal oxygen desaturation: functional analysis. Clin Respir J 2020;14:29-34.
DOI: https://doi.org/10.1111/crj.13096
Sohal S, Eapen M, Naidu V, Sharma P. IQOS exposure impairs human airway cell homeostasis: direct comparison with traditional cigarette and e-cigarette. ERJ Open Res 2019;5:00159-2018.
DOI: https://doi.org/10.1183/23120541.00159-2018
Başaran R, Güven NM, Eke BC. An overview of iQOS® as a new heat-not-burn tobacco product and its potential effects on human health and the environment. Turk J Pharm Sci 2019;16:371-4.
DOI: https://doi.org/10.4274/tjps.galenos.2018.79095
Kopa PN, Pawliczak R. IQOS - a heat-not-burn (HnB) tobacco product - chemical composition and possible impact on oxidative stress and inflammatory response. A systematic review. Toxicol Mech Methods 2020;30:81-7.
DOI: https://doi.org/10.1080/15376516.2019.1669245
Barthwal MS and Singh S. Early detection of chronic obstructive pulmonary disease in asymptomatic smokers using spirometry. J Assoc Physicians India 2014;62:238-42.
Gonzalez Ruiz JM, Barrueco M, Cordovilla R, et al. Usefulness of CO measurement in expired air in the study of tobacco consumption by youths and adolescents. Rev Clin Esp 1998;198:440-2.
Wall MA, Johnson J, Jacob P, Benowitz NL. Cotinine in the serum, saliva, and urine of nonsmokers, passive smokers, and active smokers. Am J Public Health 1988;78:699-701.
DOI: https://doi.org/10.2105/AJPH.78.6.699
Larenjeira R, Pillon S, Dunn J. Environmental tobacco smoke exposure among non-smoking waiters: measurement of expired carbon monoxide levels. Sao Paulo Med J 2000;118:89-92.
DOI: https://doi.org/10.1590/S1516-31802000000400003
Dutt S, Gogia T, Gupta M. A comparative study on pulmonary function tests in smokers & nonsmokers. Indian J Clin Anat Physiol 2021;8:53-6.
DOI: https://doi.org/10.18231/j.ijcap.2021.012
Ethics Approval
The study was approved by the Institutional Review Board of the Faculty of Medicine, Cairo University (IRB Code No. MD-337-2021) on 20/2/2022 and was performed following the principles of the Declaration of Helsinki.How to Cite
Ahmed, Naglaa B., Ayman E. Salem, Eman A. AbdulGawad, Hebatallah H. Ahmed, and Menna H. Mohamed Abdel Gawad. 2025. “Acute Effects of Heated Tobacco Smoking: A Single-Center Study”. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2025.3316.
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