Report on E-Cigarettes: Royal College of Physicians

E-cigarettes are likely to bring benefits for public health and should be widely promoted to smokers to help them quit tobacco, an influential British doctors group has said.

The report from Britain's Royal College of Physicians (RCP) is likely to further fuel a debate over electronic cigarettes.
While stressing that tobacco smoking is both addictive and lethal, the group concluded that e-cigarettes are "much safer than smoking".
It said e-cigarettes are not a gateway to smoking and do not lead to the normalisation of the habit - two issues often cited by critics who fear the devices can lure children and young people into smoking habits.
"None of these products has to date, attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people," the RCP says in its 200-page report.
E-cigarettes, which heat nicotine-laced liquid into vapour, have rapidly grown into a global market for "vaping" products that was estimated at around €6.1billion in 2015.

 

Tobacco related deaths, predicted to hit one billion
Tobacco smoking kills half of all smokers, plus at least another 600,000 non-smokers annually, via second-hand smoke.
This makes it the world's biggest preventable killer, with a predicted death toll of a billion by the end of the century, according to the World Health Organization.
Many public health experts think e-cigarettes, or vapes, which do not contain tobacco, are a lower-risk alternative to smoking, but some questions remain about their long-term safety.
Professor Linda Bauld, deputy director of the UK Centre for Tobacco and Alcohol Studies and a co-author of the RCP report, said that unlike tobacco, nicotine does not cause cancer, heart and lung diseases.
"The ideal is for people to use nothing," she said, but when the alternative is smoking, people should be encouraged to use nicotine "delivered in a cleaner form than in deadly cigarettes".
"This is what tobacco harm reduction is - it reduces the harm from tobacco while recognising that some people will still use nicotine in other safer forms."
John Britton, chair of the RCP Tobacco Advisory Group which published the report, acknowledged that e-cigarettes were "a topic of great controversy" but said his group's analysis "lays to rest almost all of the concerns over these products".
The anti-smoking group ASH UK welcomed the report, saying it showed "that switching to vaping is a positive and sensible life choice" for smokers.
"Electronic cigarette vapour does not contain smoke, which is why vaping is much less harmful," said Deborah Arnott, ASH's chief executive.

Study indicates e-cigarettes harm lungs

E-cigarettes generate toxic chemicals similar to those found in tobacco and may harm the lungs and immune system, new research suggests.

The findings, from a study of mice, indicate that "vaping" is far from being a safe alternative to smoking tobacco.

In the experiments, mice exposed to e-cigarette fumes suffered mild damage to their lungs and became far more susceptible to respiratory infections.

Their immune responses to both viruses and bacteria were weakened by such an extent that some animals died.

Scientists also found that e-cigarette vapour contained "free radical" toxins similar to those found in cigarette smoke and air pollution.

Free radicals are highly reactive molecules that can damage DNA and cell membranes.

Professor Shyam Biswai, from Johns Hopkins University in the US, who led the research published in the online journal Public Library of Science ONE, said: "Our findings suggest that e-cigarettes are not neutral in terms of the effects on the lungs.

"We have observed that they increase the susceptibility to respiratory infections in the mouse models. This warrants further study in susceptible individuals, such as COPD (chronic obstructive pulmonary disorder) patients who have switched from cigarettes to e-cigarettes, or to new users of e-cigarettes who may have never used cigarettes."

Co-author Dr Thomas Sussan, also from Johns Hopkins, said: "E-cigarette vapour alone produced mild effects on the lungs, including inflammation and protein damage.

"However, when this exposure was followed by a bacterial or viral infection, the harmful effects of e-cigarette exposure became even more pronounced.

Click here to view article: The study is thought to be the first to investigate an animal's response to e-cigarette inhalation.

View on RTE/News/Health

HSE bans e-cigarettes from 1 May

The Health Service Executive is to ban the use of electronic cigarettes in all health service facilities from the beginning of next month.

The move follows a review of their safety and the impact of e-cigarettes on its smoke-free campus policy.

Electronic cigarettes are battery-powered devices that resemble ordinary cigarettes and deliver nicotine through inhaled vapour.

The HSE said the sale and use of e-cigarette at its facilities, including hospitals, will be banned from 1 May.

It said that as the organisation responsible for health promotion and improvement, it can only recommend "safe and effective products" and strategies for quitting smoking.

It said that there is no conclusive evidence that e-cigarettes are safe for long-term use, or are effective as a smoking cessation aid.

The HSE is also concerned that because the devices resemble ordinary cigarettes, their use may promote or re-normalise smoking, disrupt the environment for non-smokers and make it harder for smokers to quit.

Read more information here on RTE/Health

Lung cancer survival rates poor - UK study

Half of people with lung cancer die within six months of diagnosis, says a report from Macmillan Cancer Support which looked at variations in cancer survival rates.

While breast cancer and prostate cancer have a five-year survival rate of more than 80%, lung cancer's is around 10%.

Those who survive lung cancer for five years are then 10 times more likely to get another cancer.

Macmillan said improving early diagnosis was key.

In their report, the cancer charity carried out an analysis of almost 85,000 cancer patients' experiences of the NHS in England from 2004 to 2011.

The research showed that one in five (20%) women with breast cancer and one in four (25%) men with prostate cancer survived for at least seven years after diagnosis in good health.

But the picture was significantly worse for people with lung cancer, or the most common form of brain cancer, of whom less than 1% survived long-term and in good health.

The report suggests that one in five people with lung cancer die within one month of being diagnosed and 73% die within one year.

Most cases of lung cancer are related to smoking, which is the biggest risk factor for the disease.

Although rates of lung cancer are decreasing in men, they are rising in women because of the number of women who continued to smoke during the post-war period and into the 1970s.

See report Cancer's Unequal Burden

View full article on BBC/Health

Less asthma in children since smoking ban

International smoking bans, including the one in Ireland, have led to sharp falls in the numbers of children going to hospital with asthma attacks and the number of babies born before full term. View press release in IT here

The review of 11 studies carried out in North America and Europe, including a 2013 study in Ireland, published in the Lancet today, (view abstract here) shows that the numbers of both fell by a tenth within 12 months of the bans being introduced.

Meanwhile, the number of children born before full term who are smaller than they should be given the stage at which they are born has declined by 5 per cent, said Dr Jasper Been of the Maastricht University Medical Centre.

An Irish study in 2012 found the smoking rates of mothers fell by 12 per cent in the year after the smoking ban was introduced a decade ago. It also reported that pre-term birth risks had fallen by a quarter.

View full article  in The Lancet - Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis

Call for smoking ban in cars carrying children

The Royal College of Physicians of Ireland has called for a complete smoking ban in cars wherever children are present.

It also wants all publicly funded institutions, especially hospitals and academic campuses, to be completely smoke free.

Doctors have made the call in a new policy statement to mark the tenth anniversary of the smoking ban.

The Irish Heart Foundation said that heart attacks have reduced by over 10% as a result of the ban.

The Irish Cancer Society claims that there has been a 25% reduction in the number of people smoking since the ban was introduced.
View news release here

Passive smoking irreversibly damages children's hearts

Exposure to second-hand smoke in childhood causes irreversible damage to children's arteries.

It also increases their risk of heart attacks or strokes when they grow up, according to a an international study published today.

The research, which lends weight to campaigns for smoking to be banned in private cars and homes, found passive smoking leads to a thickening of children's artery walls.

It adds over three years to the age of blood vessels by adulthood.

"Exposure to passive smoke in childhood causes direct and irreversible damage to the structure of the arteries," said Seana Gall, a researcher in cardiovascular epidemiology who led the study at the University of Tasmania.

As well as the six million people a year killed by their own smoking, the World Health Organisation says another 600,000 die every year as a result of exposure to other people's smoke – known as second-hand or passive smoking.

About 40% of all children are regularly exposed to second-hand smoke at home, and almost a third of the deaths attributable to second-hand smoke are in children.

Today’s study, published in the European Heart Journal, was the first to follow children through to adulthood to look at links between exposure to parents' smoking and thickness of the innermost two layers of the arterial wall, known as carotidintima-media thickness (IMT).

Researchers from Finland and Australia looked at data from 2,401 people in Finland and 1,375 people in Australia who were asked about their parents' smoking habits.

The scientists used ultrasound to measure the thickness of the children's artery walls once they had reached adulthood.

The results showed that carotid IMT in adulthood was 0.015mm thicker in those exposed to both parents smoking than in those whose parents did not smoke.

Click here to read more

One in 25 Irish people at risk of developing chronic obstructive pulmonary disease

One in 25 Irish people are at risk of developing chronic obstructive pulmonary disease (COPD) due to a combination of inherited genes and exposure to cigarette smoke, a new study has found.

The study, by researchers from the Alpha One Foundation, the Royal College of Surgeons (RCSI) and Harvard University, is published this month in the American Journal of Respiratory and Critical Care Medicine.

The debilitating lung condition is linked to alpha-1 antitrypsin deficiency (alpha-1), an inherited condition affecting almost 250,000 people in this country.

Alpha-1 antitrypsin is a protein which protects the lungs and people with lower than normal amounts of this protein are at an increased risk of developing COPD.

Doctors leading the research are urging people diagnosed with COPD - an estimated 440,000 people - to get tested for alpha-1 antitrypsin deficiency through a free national screening programme.

Professor Gerry McElvaney, Professor of Medicine at RCSI, principal investigator and chairman of the Alpha One Foundation Ireland said the research was a major breakthrough in understanding the heightened risk of COPD for people with have the combination of one normal and one abnormal alpha-1 antitrypsin gene.

Read abstract here

View full article in Irish Times here

Cancer 'tidal wave' on horizon, warns WHO

Large numbers of people do not know there is a lot they can do to reduce their exposure to risk

The globe is facing a "tidal wave" of cancer, and restrictions on alcohol and sugar need to be considered, say World Health Organization scientists.

It predicts the number of cancer cases will reach 24 million a year by 2035, but half could be prevented.

The WHO said there was now a "real need" to focus on cancer prevention by tackling smoking, obesity and drinking.

The World Cancer Research Fund said there was an "alarming" level of naivety about diet's role in cancer.

Fourteen million people a year are diagnosed with cancer, but that is predicted to increase to 19 million by 2025, 22 million by 2030 and 24 million by 2035.

The developing world will bear the brunt of the extra cases.

The WHO's World Cancer Report 2014 said the major sources of preventable cancer included:

• Smoking
• Infections
• Alcohol
• Obesity and inactivity
• Radiation, both from the sun and medical scans
• Air pollution and other environmental factors
• Delayed parenthood, having fewer children and not breastfeeding

For most countries, breast cancer is the most common cancer in women. However, cervical cancer dominates in large parts of Africa.

Meanwhile, a survey of 2,046 people in the UK by the World Cancer Research Fund (WCRF) suggested 49% do not know that diet increases the risk of developing cancer.

A third of people said cancer was mainly due to family history, but the charity said no more than 10% of cancers were down to inherited genes.

Read full article here

Portiuncula Hospital Ballinasloe is now a smoke free campus

Portiuncula Hospital Ballinasloe (PHB) introduced a smoke free campus policy on Monday 02 December.

It is no longer possible to smoke anywhere on the hospital grounds, for example entrances, doorways, walkways, internal roads, car parks, cars, bicycle shelters etc.

As a leading healthcare provider, PHB is committed to reducing the use of tobacco and its harmful health effects. PHB aims to create a healthier, smoke free, clean environment for its patients, staff and visitors.

The policy applies to all staff, patients, visitors, contractors and anyone who enters the hospital buildings / grounds.

Chris Kane, A/General Manager says “The introduction of a Smoke Free Campus policy will take time but the success of this type of policy in other hospitals along with the goodwill of our patients and staff indicates that the majority of people support the policy.

'A Tobacco Free Future' Report Launched

The number of children taking up smoking and women who smoke during pregnancy has declined over the past decade, a new report has found.

However, disadvantaged children remain at particular risk of exposure to second-hand smoke.

The findings are contained within A Tobacco-Free Future, an all-island report on tobacco, inequalities and childhood published this week by the Institute of Public Health inIreland (IPH) and the TobaccoFree Research Institute Ireland.

The World Health Organisation said there are three key “windows of exposure” in terms of tobacco-related harm in childhood; in the womb, directly through children taking up smoking and through exposure to second hand smoke.

It found smoking rates during pregnancy fell by around a third in the Republic of Ireland between 1997/1998 and 2007/2008.

Click here to read more

Law for standardised cigarette packs moves closer

The Government has this week approved the General Scheme for legislation to provide for much larger health warnings on cigarette packets. The Cabinet has approved the Heads of the Bill that will make it mandatory for tobacco to be sold in Standardised Packaging which will greatly increase the health warnings and reduce the ability of tobacco manufacturers to promote their brand.

The Public Health (Standardised Packaging of Tobacco) Bill 2013 will outlaw forms of branding such as trademarks and logos on cigarette packs and on roll-your-own packs and will determine the size and positioning of the warnings.

 Ireland’s standardised packaging will have graphic warnings and text selected from a library of graphic images and warnings developed by the European Commission for Member States

There is strong evidence that standardised packaging will increase the effectiveness of health warnings, reduce false health beliefs about cigarettes and reduce brand appeal particularly among youth and young adults.

Click here to view full DOH press release

View also in Irish Times

OECD health at a glance report 2013

A major overview of health in Ireland published today shows that the Irish are still near the top of the international league table for smoking and drinking and have a greater propensity towards obesity than people in many other countries.  

The Organisation for Economic Co-operation and Development’s Health at a Glance 2013 report confirms the serious impact of the recession on health spending which had been growing in Ireland at 7 per cent annually during the boom years between 2000 and 2009. 

The report says that the fall in Irish spending reflects the substantial reforms undertaken, including cuts to cost of health care, such as wages and pharmaceuticals.

But the report also confirms the encouraging progress made in combating serious illnesses in the last two decades. Deaths due to cancer fell by 21 per cent, ischemic heart disease by 59 per cent and cerebrovascular disease by 54 per cent between 1990 and 2011. In all three instances, the rate of decline was greater than the OECD average.

However, the smoking data comes from 2007 and therefore may not give a completely accurate picture of current trends.

Click here for link to full article in the Irish Times