Regular ECs use may help smokers with COPD attenuate conventional cigarette consumption or remain abstinent, as well as improve subjective and objective COPD outcomes
Italian researchers report health benefits of e-cigarette use among smokers with COPD, an inflammatory disease of airways that causes respiratory symptoms, a progressive decline of lung function, respiratory failure.


COPD is predicted by the WHO to become the third leading cause of death in 2030. The follow up of patients over two years allowed the researchers to evaluating the effect of the e-cigarette on exacerbation of COPD.

For Riccardo Polosa and his co-authors, vaping “may aid smokers with COPD reduce their cigarette consumption or remain abstinent”. In case of dual use of electronic and combustible cigarettes or with exclusive use of e-cigarettes the researchers noticed “marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes”.

Exacerbation of COPD, a worsening of respiratory symptoms

What the authors call an exacerbation of COPD is in fact a worsening of respiratory symptoms related to the chronic disease. The causes of exacerbation can be an infection in the lungs but most of the time, the exact cause remains unknown. Some authors report higher exacerbation rates during air pollution peaks or during periods when common allergens like pollens are present in the atmosphere.

During the exacerbation, the airways become narrower and excess of mucus block the path, leading to an obstruction. Anticipating an exacerbation is not possible and a treatment is possible only after the exacerbation has been diagnosed. Generally, the diagnostic is a reduction of the saturation of oxygen in the blood, which is already the sign of a severe case.

In brief, there is no rule to prevent exacerbation of COPD, the length of the recovery period, from weeks to months, depends on the severity of the crisis and the success of the treatment. Hence, patients with COPD have a constant fear of exacerbation that can lead to death.

Smoking cessation is recommended to patients with COPD

Smoking cessation first but any other actions that may be efficient at reducing COPD annual exacerbation rate are welcome. And what the researchers report here is that COPD patients who smoke significantly decrease the risk of exacerbation when using an e-cigarette, even if they don’t become exclusive vapers and continue to smoke.

Among these 48 patients, the use of an e-cigarette as an alternative to conventional cigarettes reduces their smoking or allows then to quit. The delivery of nicotine alleviates tobacco withdrawal symptoms, and combat ritual and social aspects of “smoking”. Patients were also asked to fill up a questionnaire designed to measure the impact of COPD on a person’s life, CAT.

Major findings of the study

Substantial reduction in conventional cigarette consumption

  • 54.2% were abstinent from tobacco smoking,
  • 45.8% were dual users.

Conventional cigarette consumption among dual users decreased by 1 pack per day on average (from about 24 cig/day to 4 cig/day).

Significant reduction in annual COPD exacerbations

Among COPD e-cigarette users, annual exacerbations decreased from 2.3 to 1.8 after 12 months and 1.4 after 24 months, on average. The decrease was less market among dual users (1.5 after 24 months) but still significant.

No significant differences in the lung function

The GOLD criteria was used to evaluate the status of the patient with respect to COPD decreased but this effect was not associated with a recovery of lung function, as observed with asthma patients. A few patients, e-cigarette users, downstaged from GOLD stage 4 (Very Severe COPD) to Stage 3  or 2 (Severe or Moderate COPD) over the course of the experiment, which traduces an overall improvement of the severity of the obstruction or airflow limitation.

Improved overall COPD status

Health status was evaluated thanks to a six-minute walk distance (6MWD) and the CAT test.

An historic 50% abstinence rate

38% of complete abstinence and 42% of smoking reduction had been described in the UK, in a survey conducted among patients with COPD. The 50% abstinence rate obtained, here, is one of the largest described to date in smoking cessation literature. By itself, smoking cessation significantly improves life expectancy and reduces outcomes related to smoking, principally through the reduction of exposure to carbon monoxide.

Vaping also turned to green almost all health warnings that concur to chronic diseases in those patients with COPD. The researchers describe, for example a decrease of hypertension, diabetes, which indicate that the benefit of the e-cigarette, in this case, is not limited to the lung function. finally, the recovery of health performance is attested by, for example, an increase in the distance ran in 6 minutes compared to a control group.

Through the text, the authors repeat that their study is preliminary and that, due to limitations, results should be interpreted with caution, especially to assert a causal relationship. The preliminary status that the authors give to this peer-reviewed publication allows them to formulate several hypotheses that they will address in other experiments. The research was supported by a research grant from the University of Catania, Italy, from which the lead author is a full-time academic. Authors disclose no competing interests.

More results exposed by Riccardo Polosa, the main author of the publication, during the Vapexpo event in Paris:

What do scientists think about vaping? – Riccardo Polosa at Vapexpo 2016, Paris

Polosa, R., Morjaria, J. B., Caponnetto, P., Prosperini, U., Russo, C., Pennisi, A., & Bruno, C. M. (2016). Evidence for harm reduction in COPD smokers who switch to electronic cigarettes. Respiratory Research, 17(1), 166.

  • Given that there are many millions of never smokers worldwide who suffer from COPD, do e-cigs/ vaping help them. How many never smoker COPD sufferers were included in this study? Should never smokers begin using e-cigs to alleviate their COPD problems – or is this just more anti-smoker junk science/propaganda?

    • Jérôme Harlay

      I don’t really understand the purpose of your question, BEOW.
      I am certain that no ethical committees would allow researchers to carry out studies on e-cigarettes with non-smokers COPD participants. If you can provide examples, I can easily demonstrate that it is junk science.
      The purpose of this study is to determine whether smokers with COPD would benefit from switching to e-cigarette use. In background is the fact that quitting smoking is difficult for people, even those suffering from COPD, and sometimes conventional cessation helps are not adapted. And some people believe that long-term effects of e-cigarette on health may lead to chronic diseases.
      E-cigarette is no therapy against pulmonary diseases, it is just evaluated here as a help on smoking cessation. The point the authors made is that no aggravation is found when patients with COPD switch to vaping; there are even some benefits.

      • You say; “E-cigarette is no therapy against pulmonary diseases, it is just evaluated here as a help on smoking cessation.”

        That may be true – sort-of, but ‘help’ is not the word I would use. Please read the very first line of your essay that sets the tone of the whole piece;

        ‘Italian researchers report health benefits of e-cigarette use among smokers with COPD”

        later; [e-cig use showed] “marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes”.

        However it does go on to explain;
        “The causes of exacerbation can be an infection in the lungs but most of the time, THE EXACT CAUSE REMAINS UNKNOWN.”

        This is not surprising given the original cause(s) of COPD is still very much a mystery! That there is no recognition of COPD being a major health problem for NON smokers as well as smokers, suggests this research is biased and as you point out, merely a tool for tobacco CONTROL. Of course propaganda is more about what is omitted than what is claimed.

        Anti-smoker propaganda claims that smoking is a cause – but what causes NON smoker COPD – and why does the cause of NON smoker COPD not also cause the smokers equivalent? If e-cigs help smoker COPD then WHY should non smokers not have access to the same benefits? Where is the ethics in ‘helping’ only smokers and ignoring the millions of NON smoking COPD sufferers?

        This is about inferring that COPD is only a smokers ailment – to further the Smoker CONTROL prohibition agenda. It is a carbon copy of the inference that lung cancer is only a smokers disease, which has worked so well in deceiving the public. There are still many who believe that lung cancer is caused by smoking and quitting or not starting provides immunity, when in reality, over 80% of new cases today are diagnosed in NON smokers and, while smoking prevalence has reduced substantially, so-called ‘smoke related illness’ continues to increase at a racing gallop.

        The vaping community should be very wary of being exploited by the tobacco CONTROL industry to serve their blinkered agenda. In my opinion this ‘study’ is just another example of such an exploitation. Beware too of the anti-smoker use of Orwellian newspeak words such as ‘help’ !

        • Jérôme Harlay

          Sorry BEOW, there is no “blinkered agenda” of any tobacco control industry, here. No conspiracy, no propaganda. And I have no tribute to pay to tobacco control.

          The benefit I am speaking about is a RELATIVE BENEFIT compared to smoking, it is not to be taken as an ABSOLUTE BENEFIT. And I apologize if the text is not clear with that.

          In no case should e-vapor be considered a medication and I don’t recommend to people who don’t smoke to turn to Ecigs for any reason, even if traditional medicine is not efficient for them.

          I just report on research of people who show that vaping is better than smoking, even for patients with lung diseases.
          Ecigs are able to help people with COPD because they help them reducing and/or quitting smoking, which improves at the same time some health parameters.

          • I fully understand your text Jerome. It is perfectly clear, as are the messages (both overt and subliminal) that it seeks to propagate. You did not make that text up, you merely reported it. It is sad that you were unable to understand it yourself, failed to work out the implications and had to revert to ‘this must be a conspiracy theory’ when those implications were brought to your attention.

            Please don’t take offence, but it is clear that you have been fully brainwashed into an unquestioning belief of anti-smoker political ideology. Your views on recreational use of e-cigs reveal that you are no friend to the vaper either. You claim to have no connection with tobacco CONTROL yet your views typically suggest otherwise. I suspect you also wrongly ‘believe’ smokers need your help because tall wan to quit but cannot because of the evil influence of tobacco companies keeping them addicted? Were you devastated at the Brexit and Trump victories that smokers, and the more aware, had a not insubstantial influence in bringing about? I am stereotyping I know, but these are general fixed traits (amongst others) I have come to recognise in tobacco CONTROL employees and,heir h,`elpers. I take it that I would be wasting my time pointing out the many health and cognitive benefits of active smoking which you will have no knowledge of at the moment?

            Your attempt to backpedal here however, suggests that there is indeed some level of understanding but insufficient as yet for you to break free from anti-smoker propaganda control. I do think that your heart is in the right place and there is still hope for you if only you could develop that tiny glow of realisation as to how the smoker CONTROL industry really works.