(AGENPARL) – lun 16 ottobre 2023 CENTRO DI RICERCA PER LA RIDUZIONE DEL DANNO DA FUMO
CENTER OF EXCELLENCE FOR THE ACCELERATION OF HARM REDUCTION
COEHAR
Catania, 10 Ottobre 2023
All’attenzione della
Sig.ra Stella KYRIAKIDES
Commissaria europea per la Salute e la sicurezza alimentare
Oggetto: Lettera aperta per una ridefinizione delle politiche antifumo
Gent.ma Sig.ra Stella KYRIAKIDES,
le scriviamo in qualità di membri del Centro di Eccellenza per l’Accelerazione della Riduzione del
Danno (CoEHAR) dell’Università di Catania, insieme ad un gruppo di esperti esterni e scienziati
internazionali.
A vent’anni dall’entrata in vigore della Convenzione quadro per il controllo del tabacco (FCTC)
dell’Organizzazione Mondiale della Salute (OMS), le malattie legate al fumo continuano a essere
una delle principali cause di malattie non trasmissibili. La lotta al fumo rimane una priorità.
In Europa, attualmente, fumano circa 100 milioni di persone. Secondo i dati ufficiali di
Eurobarometro, i fumatori nell’Unione Europea sono diminuiti soltanto del 2% tra il 2014 e il 2020,
nonostante l’attuazione delle misure di controllo del tabacco previste dalla FCTC. A questa
velocità, ci vorranno almeno 60 anni per raggiungere l’obiettivo dell’eradicazione del fumo (i.e.
prevalenza del tabagismo al di sotto della soglia del 5%).
Alla luce di questi dati, è tempo di ammettere che le attuali misure di controllo del tabacco non
producono i risultati auspicati in tempi sufficientemente rapidi. Occorre integrare le attuali
politiche di contrasto al fumo con nuove strategie, come quella basata sulla riduzione del
danno, mettendo a disposizione dei fumatori adulti prodotti privi di combustione alternativi
alle sigarette convenzionali, mitigando così il danno legato all’emissione di sostanze tossiche
da combustione del tabacco. Questo approccio è sostenuto con forza da autorità di salute pubblica
prestigiose, incluso l’Institute of Medicine – IOM, che ha prospettato come i prodotti senza
combustione siano in grado di ridurre sostanzialmente la mortalità e la morbilità complessive legate
al tabacco, nonostante comportino una certa esposizione residua, sebbene a livelli
significativamente ridotti (1).
Paradigmatico l’esempio dello “snus” (una tipologia di tabacco per uso orale) che in Svezia ha
portato a una notevole diminuzione del fumo di sigarette con una significativa riduzione dei tassi di
mortalità per cancro ai polmoni e malattie cardiovascolari (2).
L’esempio della Svezia non è isolato. Altri paesi, come il Regno Unito, la Norvegia, il Giappone e
la Nuova Zelanda, che hanno adottato il principio di riduzione del danno, hanno tutti registrato una
significativa riduzione della prevalenza del fumo – anche tra i giovani, ben oltre quanto stimato con
la semplice applicazione delle tradizionali misure di prevenzione e cessazione (3).
Center of Excellence for the acceleration of Harm Reduction (CoEHAR)
University of Catania – Department of Clinical and Experimental Medicine
Address: Torre Biologica, 11 piano – Via S. Sofia 89, 95123 Catania
Website: http://www.coehar.org
CENTRO DI RICERCA PER LA RIDUZIONE DEL DANNO DA FUMO
CENTER OF EXCELLENCE FOR THE ACCELERATION OF HARM REDUCTION
COEHAR
Il programma di ricerca del Centro di Eccellenza CoEHAR ha indagato gli effetti tossicologici dei
prodotti senza combustione (4,5), la loro efficacia e tollerabilità tra i fumatori (6,7), ma anche il
loro impatto sulle condizioni di salute tra le persone affette da broncopneumopatia cronica
ostruttiva che hanno utilizzato questi prodotti per fare lo switch (8,9). Ciò che abbiamo scoperto è
che i prodotti senza combustione:
1) offrono una notevole riduzione dell’esposizione/rischio rispetto alle sigarette tradizionali;
2) aiutano i fumatori a smettere di fumare;
3) sono associati a miglioramenti clinicamente rilevanti in utilizzatori con patologie fumo
correlate, come ad es. in chi ha la broncopneumopatia cronica ostruttiva.
Pertanto, le alternative senza combustione non vanno equiparate alle sigarette convenzionali.
Eppure l’OMS e diverse istituzioni europee continuano a ignorare i benefici derivanti dalla
transizione dai prodotti a combustione alle alternative senza combustione, e tendono a focalizzarsi
solo ed esclusivamente sul loro rischio assoluto.
Il nostro auspicio è quello che, alla luce delle evidenze scientifiche, l’FCTC e l’Unione Europea
conducano una review attenta, bilanciata, e trasparente sulle evidenze scientifiche disponibili
riguardo ai prodotti senza combustione, a paragone con le sigarette convenzionali, tale da offrire
informazioni indispensabili per poter prendere decisioni utili nell’interesse di milioni di fumatori.
Ci mettiamo a disposizione della Commissione Europea anche per eventuali audizioni di
esperti sul tema.
Cordialmente,
Membri CoEHAR
(elencati in ordine alfabetico)
1. Angela Maria AMORINI, Department of Biomedical and Biotechnological Sciences,
University of Catania, Italy
2. Carmelina Daniela ANFUSO, Department of Biomedical and Biotechnological Sciences,
University of Catania, Italy
3. Ignazio BARBAGALLO, Department of Drug Sciences, University of Catania, Italy
4. Francesco BASILE, Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Italy
5. Sebastiano BATTIATO, Department of Mathematics and Computer Sciences, University
of Catania, Italy
6. Brahim BENHAMOU, Cadi Ayyad University, Morocco
7. Gaetano BERTINO, Department of Clinical and Experimental Medicine, University of
Catania, Italy
8. Alberto BIANCHI, Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Italy
9. Antonio G. BIONDI, Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Italy
10. Emma CACCIOLA, Department of Medical, Surgical Sciences and Advanced
Technologies, University of Catania, Italy
Center of Excellence for the acceleration of Harm Reduction (CoEHAR)
University of Catania – Department of Clinical and Experimental Medicine
Address: Torre Biologica, 11 piano – Via S. Sofia 89, 95123 Catania
Website: http://www.coehar.org
CENTRO DI RICERCA PER LA RIDUZIONE DEL DANNO DA FUMO
CENTER OF EXCELLENCE FOR THE ACCELERATION OF HARM REDUCTION
COEHAR
11. Rossella R. CACCIOLA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
12. Bruno Santi CACOPARDO, Department of Clinical and Experimental Medicine,
University of Catania, Italy
13. Aldo E. CALOGERO, Department of Clinical and Experimental Medicine, University of
Catania, Italy
14. Maria Teresa CAMBRIA, Department of Biological, Geological and Environmental
Sciences, University of Catania, Italy
15. Davide CAMPAGNA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
16. Pasquale CAPONNETTO, Department of Educational Sciences, University of Catania,
Italy
17. Filippo CARACI, Department of Drug Sciences, University of Catania, Italy
18. Agatino CARIOLA, Department of Law, University of Catania, Italy
19. Massimo CARUSO, Department of Biomedical and Biotechnological Sciences, University
of Catania, Italy
20. Adriana CIANCIO, Department of Law, University of Catania, Italy
21. Rosita A. CONDORELLI, Department of Clinical and Experimental Medicine, University
of Catania, Italy
22. Antonino DI PINO, Department of Clinical and Experimental Medicine, University of
Catania, Italy
23. Fabio CIBELLA, Institute of Biomedicine and Molecular Immunology, National Research
Council, Italy
24. Jennifer DI PIAZZA, Hunter Bellevue School of Nursing at Hunter College at the City
University of New York, USA
25. Adriana DI STEFANO, Department of Law, University of Catania, Italy
26. Filippo DRAGO, Department of Biomedical and Biotechnological Sciences, University of
Catania, Italy
27. Rosalia EMMA, Department of Clinical and Experimental Medicine, University of Catania,
Italy
28. Salvatore FAILLA, Department of Chemical Sciences, University of Catania, Italy
29. Rosario FARACI, Department of Economics and Business, University of Catania, Italy
30. Salvatore FERLITO, Department of Medical, Surgical Sciences and Advanced
Technologies, University of Catania, Italy
31. Margherita FERRANTE, Department of Medical, Surgical Sciences and Advanced
Technologies, University of Catania, Italy
32. Giancarlo A. FERRO, Department of Law, University of Catania, Italy
33. Francesco FRASCA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
34. Lucia FRITTITTA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
35. Virginia FUOCHI, Department of Biomedical and Biotechnological Sciences, University of
Catania, Italy
36. Pio M. FURNERI, Department of Biomedical and Biotechnological Sciences, University of
Catania, Italy
37. Antonio GAGLIANO, Department of Electrical, Electronics and Computer Engineering,
University of Catania, Italy
38. Giovanni GALLO, Department of Mathematics and Computer Sciences, University of
Catania, Italy
Center of Excellence for the acceleration of Harm Reduction (CoEHAR)
University of Catania – Department of Clinical and Experimental Medicine
Address: Torre Biologica, 11 piano – Via S. Sofia 89, 95123 Catania
Website: http://www.coehar.org
CENTRO DI RICERCA PER LA RIDUZIONE DEL DANNO DA FUMO
CENTER OF EXCELLENCE FOR THE ACCELERATION OF HARM REDUCTION
COEHAR
39. Fabio GALVANO, Department of Biomedical and Biotechnological Sciences, University of
Catania, Italy
40. Agostino GAUDIO, Department of Clinical and Experimental Medicine, University of
Catania, Italy
41. Giuseppe GRASSO, Department of Chemical Sciences, University of Catania, Italy
42. Francesca GUARINO, Department of Biomedical and Biotechnological Sciences,
University of Catania, Italy
43. Antonino GULINO, Department of Chemical Sciences, University of Catania, Italy
44. Shipra GUPTA, Oral Health Sciences Centre, Post graduate Institute of Medical Education
and Research, India
45. Emmanuele A. JANNINI, Department of Systems Medicine, University of Rome Tor
Vergata
46. Sandro LA VIGNERA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
47. Giuseppe LAZZARINO, Department of Biomedical and Biotechnological Sciences,
University of Catania, Italy
48. Caterina LEDDA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
49. Rosalia Maria LEONARDI, Department of General Surgery and Medical-Surgical
Specialties, University of Catania, Italy
50. Luigi LA VIA, Teaching Hospital AOUP “G. Rodolico – San Marco”, Catania, Italy;
51. Giovanni LI VOLTI, Department of Biomedical and Biotechnological Sciences, University
of Catania, Italy
52. Antonio LONGO, Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Italy
53. Gabriella LUPO, Department of Biomedical and Biotechnological Sciences, University of
Catania, Italy
54. Mario MALERBA, Department of Translational Biomedicine, University of Eastern
Piedmont, Italy
55. Luigi MARLETTA, Department of Electrical, Electronics and Computer Engineering,
University of Catania, Italy
56. Costanza NICOLOSI, Department of Law Sciences, University of Catania, Italy
57. Guido NICOLOSI, Department of Political and Social Sciences, University of Catania,
Italy
58. Francesco NOCERA, Department of Electrical, Electronics and Computer Engineering,
University of Catania, Italy
59. Renée O’LEARY, ECLAT Srl, Spin-off of the University of Catania, Catania, Italy;
60. Gea OLIVERI CONTI, Department of Medical, Surgical Sciences and Advanced
Technologies, University of Catania, Italy
61. Alessandro ORTIS, Department of Mathematics and Computer Sciences, University of
Catania, Italy
62. Giuseppe PALAZZO, Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Italy
63. Manish PANCHASARA, SkillsEdge, India;
64. Rosalba PARENTI, Department of Biomedical and Biotechnological Sciences, University
of Catania, Italy
65. Eugenio PEDULLÀ, Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Italy
Center of Excellence for the acceleration of Harm Reduction (CoEHAR)
University of Catania – Department of Clinical and Experimental Medicine
Address: Torre Biologica, 11 piano – Via S. Sofia 89, 95123 Catania
Website: http://www.coehar.org
CENTRO DI RICERCA PER LA RIDUZIONE DEL DANNO DA FUMO
CENTER OF EXCELLENCE FOR THE ACCELERATION OF HARM REDUCTION
COEHAR
66. Salvatore PIRO, Department of Clinical and Experimental Medicine, University of
Catania, Italy
67. Riccardo POLOSA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
68. Alfredo PULVIRENTI, Department of Clinical and Experimental Medicine, University of
Catania, Italy
69. Maria Catena QUATTROPANI, Department of Educational Sciences, University of
Catania, Italy
70. Venerando RAPISARDA, Department of Clinical and Experimental Medicine, University
of Catania, Italy
71. Renata RIZZO, Department of Clinical and Experimental Medicine, University of Catania,
Italy
72. Simone RONSISVALLE, Department of Drug Sciences, University of Catania, Italy
73. Giuseppe RONSISVALLE, Department of Drug Sciences, University of Catania, Italy
74. Martino RUGGIERI, Department of Clinical and Experimental Medicine, University of
Catania, Italy
75. Maria SANTAGATI, Department of Biomedical and Biotechnological Sciences, University
of Catania, Italy
76. Cristina SATRIANO, Department of Chemical Sciences, University of Catania, Italy
77. Laura SCIACCA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
78. Maria Salvina SIGNORELLI, Department of Clinical and Experimental Medicine,
University of Catania, Italy
79. Lucia SPICUZZA, Department of Clinical and Experimental Medicine, University of
Catania, Italy
80. Marco TATULLO, Technologica Research Institute, Marrelli Hospital, Italy
81. Daniele TIBULLO, Department of Biomedical and Biotechnological Sciences, University
of Catania, Italy
82. Venera TOMASELLI, Department of Political and Social Sciences, University of Catania,
Italy
83. Paolo VIGNERI, Department of Clinical and Experimental Medicine, University of
Catania, Italy
84. Vladislav VOLAREVIC, Faculty of Medical Sciences, University of Kragujevac, Serbia
85. Luca ZANOLI, Department of Clinical and Experimental Medicine, University of Catania,
Italy
86. Agata ZAPPALÀ, Department of Biomedical and Biotechnological Sciences, University of
Catania, Italy
Esperti esterni in riduzione del danno da fumo
87. Karl FAGERSTROM, Ph.D, President, Fagerstrom Consulting AB, Sweden
88. Konstantinos FARSALINOS, MD, MPH, External Research Associate, University of
Patras, Greece; University of West Attica, Greece
89. Bruno DA CRUZ MAIA, Neurocritical Care Unit, Lisbon Central Hospital; and NOVA
Medical School, Lisbon, Portugal
90. Fredrik H. NYSTROM, MD, PhD, professor, senior consultant in internal medicine,
Department of Health, Medicine and caring Sciences, Faculty of Medicine and Health
Sciences, Linköping University, Sweden
91. Heino Johann STÖVER, PhD, Professor, Dr., Frankfurt University of Applied Sciences,
Germany
Center of Excellence for the acceleration of Harm Reduction (CoEHAR)
University of Catania – Department of Clinical and Experimental Medicine
Address: Torre Biologica, 11 piano – Via S. Sofia 89, 95123 Catania
Website: http://www.coehar.org
CENTRO DI RICERCA PER LA RIDUZIONE DEL DANNO DA FUMO
CENTER OF EXCELLENCE FOR THE ACCELERATION OF HARM REDUCTION
COEHAR
Referenze:
Stratton K, Shetty P, Wallace R, Bondurant S, editors. Clearing the Smoke [Internet]. National
Academies Press (US); 2001. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK222375/
Gartner CE, Hall WD, Vos T, Bertram MY, Wallace AL, Lim SS. Assessment of Swedish snus for
tobacco harm reduction: an epidemiological modelling study. Lancet. 2007 Jun
16;369(9578):2010–4.
Fagerström K. Can alternative nicotine products put the final nail in the smoking coffin? Harm
Reduct J. 2022 Dec 1;19(1):131. doi: 10.1186/s12954-022-00722-5.
Caruso M, Emma R, Distefano A, Rust S, Poulas K, Zadjali F, Giordano A, Volarevic V,
Mesiakaris K, Al Tobi M, Boffo S, Arsenijevic A, Zuccarello P, Giallongo C, Ferrante M, Polosa R,
Li Volti G; Replica Project Group. Electronic nicotine delivery systems exhibit reduced bronchial
epithelial cells toxicity compared to cigarette: the Replica Project. Sci Rep. 2021 Dec
17;11(1):24182. doi: 10.1038/s41598-021-03310-y.
Caruso M, Emma R, Distefano A, Rust S, Poulas K, Giordano A, Volarevic V, Mesiakaris K, Boffo
S, Arsenijevic A, Karanasios G, Pulvirenti R, Ilic A, Canciello A, Zuccarello P, Ferrante M, Polosa
R, Li Volti G. Comparative assessment of electronic nicotine delivery systems aerosol and
cigarette smoke on endothelial cell migration: The Replica Project. Drug Test Anal. 2022 Jul 25.
doi: 10.1002/dta.3349.
Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R. EffiCiency
and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective
12-month randomized control design study. PLoS One. 2013 Jun 24;8(6):e66317.
Caponnetto P, Campagna D, Maglia M, Benfatto F, Emma R, Caruso M, Caci G, Busà B, Pennisi
A, Ceracchi M, Migliore M, Signorelli M. Comparing the Effectiveness, Tolerability, and
Acceptability of Heated Tobacco Products and Refillable Electronic Cigarettes for Cigarette
Substitution (CEASEFIRE): Randomized Controlled Trial. JMIR Public Health Surveill. 2023
Apr 4;9:e42628. doi: 10.2196/42628.
Polosa R, Morjaria JB, Prosperini U, Busà B, Pennisi A, Malerba M, Maglia M, Caponnetto P.
COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up. Ther Adv
Polosa R, Morjaria JB, Prosperini U, Busà B, Pennisi A, Gussoni G, Rust S, Maglia M,
Caponnetto P. Health outcomes in COPD smokers using heated tobacco products: a 3-year
follow-up. Intern Emerg Med. 2021 Apr;16(3):687-696. doi: 10.1007/s11739-021-02674-3.
Center of Excellence for the acceleration of Harm Reduction (CoEHAR)
University of Catania – Department of Clinical and Experimental Medicine
Address: Torre Biologica, 11 piano – Via S. Sofia 89, 95123 Catania
Website: http://www.coehar.org