University researchers predict 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. A study is published in the June issue of the journal Tobacco Control.
Nicotine inhalers, which are not currently available, would deliver doses of nicotine similar to cigarettes deep into the lungs.
Researchers expect these inhalers to have the same drug effect as cigarettes and to be just as addictive. However, 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 would also eliminate the problem of second-hand smoke.
“There seems to be no effective way to convince many smokers to quit,” said 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 said the medical literature and historic accounts of tobacco control efforts demonstrate the difficulty of significantly lowering smoking rates.
The U.S. Surgeon General’s goal, through the “Healthy People 2010” disease-prevention initiative, is to reduce smoking prevalence to 12 percent of the overall population by the end of the decade.
“I seriously doubt that we will achieve that target under the present circumstances,” said 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 the 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 1,990 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 (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 could also meet or exceed the goal of Healthy People 2010.
“This study suggests that the use of nicotine inhalers should be considered,” Sumner said.
“The challenge is to convince the tobacco-control community that this is a rational alternative that should be studied.”