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.


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