Respiratory Function, Physical Capacity, and Metabolic Syndrome Components in Combustible Cigarettes and Heated Tobacco Products Users: A Four-Year Follow-Up Cohort Study
DOI:
https://doi.org/10.12974/2312-5470.2022.08.02Keywords:
Heated tobacco products, Combustible cigarettes, Cohort study, Health outcomes, smoking, COPD self-reported scoreAbstract
Purpose: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and is the fourth leading cause of death in Kazakhstan. Cigarette smoking is a prevalent risk factor for COPD. While quitting smoking is the preferred way to reduce COPD risk, literature suggests that heated tobacco products (HTP) might be a better option for people who cannot quit smoking. The aim of this paper was to analyze the long-term effects of shifting to HTP use in long-term smokers compared to continued combustible cigarettes (CC) use.
Patients and methods: A cohort of 1200 participants (400 HTP and 800 CC) aged 40-59 years with a minimum of 10 pack-year smoking history were recruited and followed for four years. The functional outcomes compared between HTP and CC users included: (1) COPD Assessment Test (CAT); (2) post-bronchodilator lung function; (3) 6-minute walking distance (6MWD) test; and (4) metabolic syndrome components. One way ANOVA was used to compare functional outcomes between visits, while multivariable linear mixed models were used to test associations between health outcomes and smoking type (HTP vs. CC) over time.
Results: Out of 1200 participants 893 (609 CC users and 284 HTP users) remained in the study by the fourth year of follow up. Comparison between functional outcomes showed that most of them have improved between visits, while lung function and fasting blood glucose levels got worse. Linear mixed models showed HTP use was associated with better functional outcomes over time compared to CC users. Lung function decrease was significantly less in HTP users, while improvements in CAT scores, waist circumference, and systolic blood pressure were significantly better compared to CC users.
Conclusion: This study demonstrated that HTP users experienced it to a significantly lesser decrease in lung function compared to CC users, while demonstrating better improvements in other functional outcomes. The results of this study suggest that HTP might be a less deleterious alternative compared to CC in people with long history of CC use and who cannot quit smoking.
References
Wang H, Naghavi M, Allen C, et al. Global, regional, and national life expectancy, all-cause mortality, and cause- specific mortality for 249 causes of death, 1980– 2015: a systematic analysis for the G lobal Burden of Disease Study 2015. The Lancet 2016; 388(10053): 1459-544. https://doi.org/10.1016/S0140-6736(16)31012-1
Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and metaanalysis. J Glob Health 2015; 5(2): 020415. https://doi.org/10.7189/jogh.05.020415
Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnos is, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195(5): 557-82. https://doi.org/10.1164/rccm.201701-0218PP
Shah T, Churpek MM, Coca Perraillon M, et al. Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion. Chest 2015; 147(5): 1219-26. https://doi.org/10.1378/chest.14-2181
Soriano JB, Abajobir AA, Abate KH, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990– 2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet Respiratory Medicine 2017; 5(9): 691-706. https://doi.org/10.1016/S2213-2600(17)30293-X
Sharman A, Zhussupov B, Sharman D, et al. Cross-Sectional Study of Chronic Obstructive Pulmonary Disease Prevalence Among Smokers, Ex-Smokers, and Never-Smokers in Almaty, Kazakhstan: Study Protocol. JMIR Res Protoc 2017; 6(7): e143.
[published Online First: 20170725]. https://doi.org/10.2196/resprot.7422
Pezzuto A, Stumbo L, Russano M, et al. "Impact of Smoking Cessation Treatment" on Lung Function and Response Rate in EGFR Mutated Patients: A Short-Term Cohort Study. Recent Pat Anticancer Drug Discov 2015; 10(3): 342-51. https://doi.org/10.2174/1574892810666150806111014
Pezzuto A, Lionetto L, Ricci A, et al. Inter-individual variation in CYP2A6 activ ity and chronic obstructive pulmonary disease in smokers: Perspectives for an early predictive marker. Biochim Biophys Acta Mol Basis Dis 2021; 1867(1): 165990. https://doi.org/10.1016/j.bbadis.2020.165990
Pezzuto A, Carico E. Effectiveness of smoking cessation in smokers with COPD and nocturnal oxygen desaturation: Functional analysis. Clin Respir J 2020; 14(1): 29-34.
[published Online First: 20191024]. https://doi.org/10.1111/crj.13096
Karadogan D, Onal O, Sahin DS, et al. Factors associated with current smoking in COPD patients: A cross-sectional study from the Eastern Black Sea region of Turkey. Tob Induc Dis 2018; 16: 22.
[published Online First: 20180522]. https://doi.org/10.18332/tid/90665
Polosa R, Morjaria JB, Prosperini U, et al. Health outcomes in COPD smokers using heated tobacco products: a 3-year follow-up. Intern Emerg Med 2021; 16(3): 687-96.
[published Online First: 20210323]. https://doi.org/10.1007/s11739-021-02674-3
Sharman AY, I., Erenchina, E. Tyulebekova, G. Bekzhanova, A. Respiratory Function and Physical Capacity in Combustible Cigarettes and Heated Tobacco Products Users: a Two-Year Follow-Up Cohort Study. Global Journal of Respiratory Care 2021; Vol. 7.
[published Online First: 20211112]. https://doi.org/10.12974/2312-5470.2021.07.05
Sharman A, Zhussupov B, Sharman D, et al. Lung Function in Users of a Smoke-Free Electronic Device With HeatSticks (iQOS) Versus Smokers of Conventional Cigarettes: Protocol for a Longitudinal Cohort Observational Study. JMIR Res Protoc 2018; 7(11): e10006.
[published Online First: 20181105]. https://doi.org/10.2196/10006
Halpin DMG, Criner GJ, Papi A, et al. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 203(1): 24-36. https://doi.org/10.1164/rccm.202009-3533SO
Ratajczak A, Jankowski P, Strus P, et al. Heat Not Burn Tobacco Product-A New Global Trend: Impact of Heat-NotBurn Tobacco Products on Public Health, a Systematic Review. International journal of environmental research and public health 2020; 17(2).
[published Online First: 20200108] https://doi.org/10.3390/ijerph17020409
Drovandi A, Salem S, Barker D, et al. Human Biomarker Exposure From Cigarettes Versus Novel Heat-Not-Burn Devices: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2020; 22(7): 1077-85. https://doi.org/10.1093/ntr/ntz200
Lüdicke F, Ansari SM, Lama N, et al. Effects of Switching to a Heat-Not-Burn Tobacco Product on Biologically Relevant Biomarkers to Assess a Candidate Modified Risk Tobacco Product: A Randomized Trial. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2019; 28(11): 1934-43.
[published Online First: 20190703]. https://doi.org/10.1158/1055-9965.EPI-18-0915
