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Heated cigarettes release same cancer-causing chemicals as traditional cigarettes

Smoke released from heat-not-burn tobacco cigarettes contains the same harmful components as conventional tobacco cigarette smoke, according to data published in JAMA Internal Medicine.

“The tobacco industry’s most recent response to the documented harms of cigarette smoking was to launch new heat-not-burn (HNB) tobacco cigarettes,” Reto Auer, MD, MAS, from the Institute of Primary Health Care at the University of Bern in Switzerland, and colleagues wrote. “Philip Morris International created IQOS (I-Quit-Ordinary-Smoking): disposable tobacco sticks soaked in propylene glycol, which are inserted in a holder in the HNB cigarette.”

“Philip Morris International claims that IQOS releases no smoke because the tobacco does not combust and the tobacco leaves are only heated not burned,” they added. “However, there can be smoke without fire. The harmful components of tobacco cigarette smoke are products of incomplete combustion (pyrolysis) and the degradation of tobacco cigarettes through heat (thermogenic degradation).”

Auer and colleagues analyzed and compared the contents and toxic compounds released in IQOS (IQOS Holder, IQOS Pocket Charger, Marlboro HeatSticks [regular], and Heets, Philipp Morris SA) smoke with conventional cigarettes (Lucky Strike Blue Lights). They used gas chromatography paired with a flame ionization detector to assess volatile organic compounds and nicotine, as well as high-performance liquid chromatography paired with a fluorescence detector to assess polycyclic aromatic hydrocarbons.

Data indicated that IQOS smoke contains similar levels of volatile organic compounds and nicotine as conventional cigarettes. In addition, heat-not-burn cigarettes released higher levels of the polycyclic aromatic hydrocarbon acenaphthene than conventional cigarettes. Other polycyclic aromatic hydrocarbons and carbon monoxide were also present in IQOS smoke. IQOS had a lower temperature than the conventional cigarette (330 C vs. 684 C). Eighty-four percent of nicotine found in conventional cigarette smoke was present in IQOS smoke.

“The smoke released by IQOS contains elements from pyrolysis and thermogenic degradation that are the same harmful constituents of conventional tobacco cigarette smoke,” Auer and colleagues concluded. “Our analyses reveal that advertising slogans such as ‘heat-not-burn’ are no substitute for science. Dancing around the definition of smoke to avoid indoor-smoking bans is unethical.”

The researchers call for further evaluation of the health effects of IQOS, but insist that heated tobacco products be subjected to the same indoor-smoking bans as conventional tobacco cigarettes.

In an accompanying editor’s note, Mitchell H. Katz, MD, from the Los Angeles County Department of Health Services, noted that while heat-not-burn tobacco cigarettes are not yet for sale in the United States, PMI has applied to sell these products with the FDA.

“These products threaten the progress that has been made on decreasing the harms of second-hand smoke because existing bans may not apply to these heat-not-burn products,” he wrote. “However, as convincingly reported by Auer and colleagues, although these products may or may not produce smoke, they release cancer-causing chemicals.”

“If the FDA does approve the sale of these products, existing smoking bans should be amended to include these products,” Katz concluded. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.