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Assessment of industry data on pulmonary and immunosuppressive effects of IQOS
  1. Farzad Moazed1,
  2. Lauren Chun2,
  3. Michael A Matthay3,
  4. Carolyn S Calfee3,
  5. Jeffrey Gotts1
  1. 1 Department of Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2 Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, USA
  3. 3 Department of Anesthesia, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Farzad Moazed, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; farzad.moazed{at}


Introduction Heated tobacco products are being touted as novel reduced-harm tobacco products by tobacco companies. In the USA, Philip Morris International submitted a modified risk tobacco product (MRTP) application to the US Food and Drug Administration in 2016 in which it purports that its heated tobacco product, I-Quit-Ordinary-Smoking (IQOS), is associated with reduced harm compared with conventional cigarettes.

Methods We reviewed Philip Morris International’s MRTP application to assess the pulmonary and immune toxicities associated with IQOS use in both animal and human studies.

Results Among rats exposed to IQOS, there was evidence of pulmonary inflammation and immunomodulation. In human users, there was no evidence of improvement in pulmonary inflammation or pulmonary function in cigarette smokers who were switched to IQOS.

Conclusion IQOS is associated with significant pulmonary and immunomodulatory toxicities with no detectable differences between conventional cigarette smokers and those who were switched to IQOS in Philip Morris International’s studies. Philip Morris International also failed to consider how dual use and secondhand aerosol exposure may further impact, and likely increase, the harms associated with these products.

  • non-cigarette tobacco products
  • tobacco industry
  • toxicology

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  • Contributors All authors contributed to the study design/concept, interpretation of the data and drafting/revisions of the manuscript. All authors give final approval and agree to be accountable for all aspects of the work.

  • Funding This study was funded by National Heart, Lung, and Blood Institute (grant no: HL136844), Center for Tobacco Products (grant no: 5P50CA180890).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.