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Biomedical subjects

Karl Fagerström

Publications and source records attributed to Karl Fagerström.

9 recordsLinked to original sources
PubMed2006

Would alternate tobacco products use be better than smoking?

Tobacco use is dominated by cigarette smoking. Most toxicity due to cigarette smoking is related to the burning process. Several observations suggest that unburned or oral tobacco is less harmful than cigarette smoking. Up to now, physicians have advised a policy based on two ideas: (i) young people should not start smoking and (ii) the only choice for smokers is to quit. However, numerous smokers cannot or do not want to give up; eventually, one out of two lifelong smokers will die from smoke-related diseases. Thus, it is legitimate to ask if alternate nicotine containing product use would be better than cigarette smoking and limit the tobacco death toll. However, the logic leading to the concept of tobacco harm reduction (THR) turns out to be much more complex than it looks at a first glance.

Behavior, Addictive↗
PubMed2006

Current trends in international tobacco control.

The tobacco control policy tools developed in a few rich countries in the 1970s, 1980s, and 1990s are currently being implemented widely in many poorer countries, thanks in part to the astonishing success of the Framework Convention on Tobacco Control (FCTC). With smoking rates already high in most of the Third World, however, the projections for the twenty-first century are grim: up to 1 billion tobacco-caused deaths, which raises the issue of what more can be done, particularly to help people who already are addicted to nicotine. Only massive and effective smoking cessation programs could reduce this death toll significantly, at least in the short-term. Tobacco control's existing tools, if widely applied, likely will reduce premature deaths significantly but can be expected to leave unacceptably high levels of tobacco-related mortality. This finding has sparked fierce discussions among anti-tobacco activists about the role of harm reduction in curbing death and disease. This article discusses whether harm reduction is possible with the tobacco industry subject to a largely unregulated environment for tobacco products.

Global Health↗
PubMed2006

Neuropharmacology and potential efficacy of new treatments for tobacco dependence.

This review considers some of the novel therapies that are under development for the treatment of tobacco dependence, outlines their efficacy in clinical studies and explains their mechanisms of action in terms of contemporary theories for the psychobiology of the dependence. It focuses on three treatments with differing mechanisms of action that are at different stages of clinical development. The first is varenicline, a partial agonist at the alpha4beta2 nicotinic receptors, which are thought to play a central role in the addiction to nicotine. Preclinically, this drug mimics the effects of nicotine on dopamine (DA) release in the nucleus accumbens when given alone but attenuates this response to a subsequent nicotine challenge and reduces nicotine self administration. Very encouraging results have been seen in the five clinical studies that have been reported with this drug. The second compound, rimonabant, is a cannabinoid CB1 receptor antagonist. Preclinically, this compound reduces nicotine self administration, DA turnover in nucleus accumbens and attenuates reinstatement of nicotine-seeking behaviour. Clinically, the drug is well tolerated but its effects on smoking cessation are equivocal. However, it has the valuable additional property of inhibiting post-cessation weight gain. Nicotine 'vaccines' are the final group of treatments considered, which involves raising antibodies in the blood that limit the amount of nicotine that penetrates into the brain, thereby reducing the psychopharmacological responses to the drug. The vaccines also reduce DA turnover in nucleus accumbens and reinstatement of nicotine-seeking behaviour after nicotine readministration. The three vaccines discussed are well tolerated and show signs of good efficacy; however, the increase in antibody titre, evoked by the treatment, shows significant inter-individual variation and is generally short lived. Thus, although this approach may provide a valuable aid to smoking cessation, it seems unlikely that it can be used for primary prevention.

Animals↗
PubMed2005

The nicotine market: an attempt to estimate the nicotine intake from various sources and the total nicotine consumption in some countries.

Tobacco--particularly smoked products--has been associated with great harm and growing public disapproval and can be expected to suffer in the marketplace. This situation has created opportunities for other less harmful nicotine-containing products such as smokeless tobacco and nicotine replacement products, which are gaining public support. Little is known about the level of nicotine intake in our society. Tobacco sales are known, but how much nicotine is extracted and actually absorbed by users is largely unknown. The present study is a first attempt to estimate uptake of nicotine from tobacco and nicotine replacement products and to map nicotine consumption in a few countries, with special emphasis on Sweden. Relevant pharmacokinetic studies for three types of nicotine-containing products (cigarettes, smokeless tobacco, and nicotine replacement products) were analyzed for bioavailable nicotine. Estimates of nicotine intake from each category were made. These were then multiplied by the amount consumed in the respective countries. Tobacco consumption statistics were usually from official records of taxed sales. In Sweden about 54% of all nicotine intake comes from smoked sources, 45% from nonsmoked tobacco, and 1.3% from nicotine replacement products. For men, 63% of the nicotine consumed comes from nonsmoked tobacco. Per-capita nicotine intake per year for adults aged 15 years or older is 3,321 mg for Austria, 3,043 mg for Sweden, 3,014 mg for Denmark, 2,955 mg for the United States, 2,244 mg for Norway, and 2,023 mg for Finland. Compared with cigarette smokers, snus users seem to have a somewhat higher daily intake (34 mg vs. 25 mg). The cleanest nicotine products, nicotine replacement products, represent a negligible part (about 1%) of the total nicotine consumption in most countries.

Adolescent↗
PubMed2003

Nicotine dependence: development, mechanisms, individual differences and links to possible neurophysiological correlates.

There is now little doubt that the majority of people who smoke tobacco do so to experience the psychopharmacological properties of the nicotine present in the smoke and that a significant proportion of habitual tobacco users become addicted to the drug nicotine. In the US some 80% and in Europe (Germany) 39% of smokers have been classified as dependent according to the diagnostic guidelines of the American Psychiatric Association. As a result, direct nicotine replacement is used increasingly by many people who want to stop smoking. The objectives of this review are to outline the mechanisms involved in the development and maintenance of nicotine dependence and to link behavioural observations to possible neurophysiologic correlates.

Arousal↗
PubMed2003

New perspectives in the treatment of tobacco dependence.

Tobacco dependance treatment is a long lasting journey that is now approaching the fifty-years landmark. Beginning with lobeline in the late Fifties, and passing through the development of nicotine replacement therapy, the pharmacological therapy of nicotine dependance has now reached a new phase of intense and florishing research. The purpose of this review is to briefly overview the history of tobacco dependence treatments and to lead the reader towards the future, not only in terms of drug therapy but also of new goals like relapse prevention strategies and smoking reduction. Neurobiology of drug addiction mechanisms better understanding has recently unmasked new therapeutical targets and has lead to the development of new drugs. Nicotine vaccine, tetrahydrocannabinoid receptor blockers, partial agonists for the nicotine receptors are now under evaluation. Interference with the liver enzymes metabolising nicotine is another approach who has just reached the testing phase. The article will briefly overview each of this new promising drug treatments.

Humans↗
PubMed2002

The epidemiology of smoking: health consequences and benefits of cessation.

Tobacco use is the single most important preventable health risk in the developed world, and an important cause of premature death worldwide. Smoking causes a wide range of diseases, including many types of cancer, chronic obstructive pulmonary disease, coronary heart disease, stroke, peripheral vascular disease, and peptic ulcer disease. In addition, smoking during pregnancy adversely affects fetal and neonatal growth and development. Recent decades have seen a massive expansion in tobacco use in the developing world and accelerating growth in smoking among women in the developed world. Globally, smoking-related mortality is set to rise from 3 million annually (1995 estimate) to 10 million annually by 2030, with 70% of these deaths occurring in developing countries. Many of the adverse health effects of smoking are reversible, and smoking cessation treatments represent some of the most cost effective of all healthcare interventions. Although the greatest benefit accrues from ceasing smoking when young, even quitting in middle age avoids much of the excess healthcare risk associated with smoking. In order to improve smoking cessation rates, effective behavioural and pharmacological treatments, coupled with professional counselling and advice, are required. Since smoking duration is the principal risk factor for smoking-related morbidity, the treatment goal should be early cessation and prevention of relapse.

Cardiovascular Diseases↗