Background: This observational cohort study aimed to investigate the long-term effects of transitioning from combustible cigarettes (CC) to heated tobacco products (HTPs) on COPD Assessment Test (CAT) scores among individuals with a history of prolonged smoking.

Material and Methods: A cohort of 1200 participants aged 40-59 years with at least 10 pack-years of smoking history was followed for 48 months. Participants were categorized into nine groups based on their HTP and CC usage levels to explore variations in health outcomes. The primary outcome measure was the change in CAT scores over the study period.

Results: Results showed that heavy CC smokers constituted 47.8% of the participants at the beginning of the study, while light CC smokers, heavy HTP smokers, and light HTP smokers accounted for 17.9%, 30.9%, and 2.1%, respectively. All HTP groups exhibited statistically significant differences compared to heavy CC smokers. The CAT score was notably lower in the group of heavy HTP smokers (-0.865±0.139, p<0.001) and light HTP smokers (-1.693±0.408, p<0.001) compared to heavy CC smokers. Additionally, each increase in CC or HTP use per day resulted in significant changes in CAT scores. Transitioning to HTP use was associated with a significant reduction in CAT scores compared to those who continued smoking CC after one year (-0.662±0.316, p=0.0361).

Conclusions: These preliminary findings suggest that transitioning from CC to HTP use may have beneficial effects on COPD-related health outcomes. The observed improvements in CAT scores and trends indicating enhanced respiratory health and exercise tolerance support HTPs as a potential harm reduction strategy for long-term smokers. However, further investigation and long-term follow-up are necessary to validate these findings and fully ascertain the health benefits associated with HTP use as an alternative to CC.

AUTHORS: Almaz Sharman, Vladimir Arnautov, Irina Yermakova, Aisulu Bekzhanova, Gulnara Tyulebekova

AFFILIATION: Academy of Preventive Medicine of Kazakhstan

Background: The purpose of this study is to evaluate the effectiveness of an integrated approach to the implementation of the outpatient stage of rehabilitation with mandatory lifestyle modification in patients with COPD after outpatient treatment of an exacerbation of moderate severity.

Material and Methods: This study implemented on the basis of State Budget Institution of Rostov region of Russia “City Polyclinic N^o4 in Rostov-on-Don”. Patients with COPD were divided into two groups: clinical observation group (n=50) using an integrated approach with mandatory lifestyle modification (smoking cessation, the use of alternative nicotine delivery methods) and the control (n=30) group, without mandatory lifestyle modification in the outpatient stage of pulmonary rehabilitation program.

Results: In the course of this study, it was revealed that the maximum level of blood oxygen saturation was achieved in the subgroup of patients who have completely given up smoking. Among the patients who used alternative nicotine delivery methods there was a tendency to increase the level of blood saturation (p=0.061), which once again confirms the decrease in the severity of hypoxia while minimizing exposure to tobacco smoke in patients with low motivation to quit smoking or with its absence, as an intermediate stage of quitting smoking. In the first group of patients there was a statistically significant improvement in quality-of-life indicators characterizing the state of physical health: physical functioning, role functioning and the total level of physical health.

Conclusions: The results confirm that the influence on the main pathogenetic links of the process by reducing the degree of exposure to the risk factor certainly improves the subjective perception of the state of one’s own physical health at any stage of pathology development.

AUTHOR: Tatyana Tayutina

AFFILIATION: Federal State Budgetary Educational Institution of Higher Education Rostov State Medical University of the Ministry of Health of the Russian Federation

Background: Smoking is a main risk factor for cardiovascular events. One of the stroke reasons for smoking patients with arterial hypertension (AH) and multifocal atherosclerosis (MFA) is a violation in the hemostasis system, leading to the formation of a hypercoagulation state. The aim of this study was to establish the features of hemostatic system disorders and the possibility of their correction in smoking patients with MFA and AH.

Material and Methods: The study included 134 patients with AH and MFA (mean age - 53.7±7.76 years), of which 32 (23.9%) were smokers (group 1) and 102 (76.1%) were non-smokers (group 2). The average smoking experience among group 1 was 24.21±1.86 years. All 134 patients received comparable hypotensive therapy, had MFA and lipid spectrum targets. Hemostasis parameters were evaluated using a thrombodynamics test (TD) on the diagnostic laboratory system “Thrombodynamics Recorder T-2” (HemaCor, Russia).

Results: The TD test determined the qualitative and quantitative characteristics of the coagulation state of blood plasma. Analyzing the parameters of coagulation hemostasis, such TD indicators as the initial clot growth rate (Vi, µm/min) and the stationary clot growth rate (Vst, µm/min) were higher than the reference values in group 1. Analysis of the effect of smoking on hemostasis parameters revealed a statistical difference in smoking patients for the clot growth rate (p=0.023), the initial clot growth rate (p=0.007) and the clot size (p=0.05). The growth of spontaneous clots was noted in both groups, without any significant differences.

Conclusions: Smoking patients with AH and MFA, have changes in the coagulation link of hemostasis, indicating an increased risk of thrombosis. Smoking cessation should be a component of treatment. Considering that the main harm is caused by tobacco combustion products, the harm reduction concept and switching to smokeless products can be recommended for patients who are not motivated to quit smoking.

AUTHORS: Svetlana Vedenskaya, Olga Smolenskaya, Vadim Grachev, Ekaterina Klyachina

AFFILIATION: Ural State Medical University, Yekaterinburg, Russian Federation

Everybody knows that tobacco smoking is the major responsible cause for chronic respiratory diseases, cardiovascular disorders and cancer that can be prevented if we do take appropriate measures.

We recognize that a great number of actions to decrease the morbidity and mortality has been taken in the past and consequently there is a decline in the prevalence of tobacco smoking with these interventions.

We are at the beginning of the XXI Century and tobacco smoking has been around more than two thousands of years, since many civilizations in Central and South America. Those are facts that cannot be ignored. Although we acknowledge that smoking is an old concept of life, society has changed, smokers are changing and tobacco industry is developing with the introduction of new products of reduced risks; facing this reality, we do need a new attitude, new interventions and new strategies to counteract this social behavior.

We urge a different approach to this old problem, with new preventive measures, lowering the taxes for reduced risk tobacco products (less harm, less taxes), the right to correctly inform the consumers for better decisions and helping the policy makers and regulators with updated scientific-evidence and technical details concerning this issue.

We cannot just rely on traditional cigarettes behaviors because experience shows to us that continuing prevention with cessation (including those receiving psychological and pharmacological support) is not sufficient, since only 30-40% of smokers are able to quit. Nowadays, those policies should be complemented with another tool, Harm Reduction, like it happens with ST Diseases, HIV Disorders, reducing the risk of those behaviors. This is why prevention, combined with smoking cessation and complemented with Harm Reduction are the three tools that we do need to get better results dealing with this situation.

Certainly, we need more data, but we cannot wait 10-15 years in order to get the final information; my opinion is that we do have available toxicological studies and biomarkers to clarify this approach.

AUTHOR: Manuel Pais-Clemente

AFFILIATION: Porto University School of Medicine, Porto, Portugal