A new study that was recently published in the International Journal of Chronic Obstructive Pulmonary Disease, led by Riccardo Polosa, MD, PhD (Department of Clinical and Experimental Medicine of the University of Catania, Italy), suggests that electronic cigarette (EC) use may reverse some of the harm resulting from tobacco smoking in patients with chronic obstructive pulmonary disease (COPD).

Furthermore, EC use may ameliorate objective and subjective COPD outcomes, which may persist in the long term. The investigators conducted a long-term prospective reevaluation of changes in objective and subjective respiratory parameters in a total of 44 COPD patients: those who had ceased conventional cigarette smoking or substantially reduced it by switching to EC use (n=22) compared to control COPD patients who were smokers not using EC at the time of the study (n=22). The compelling findings of the study showed that COPD patients who switched to EC presented the following positive long-term (3-year) effects: 

Significantly reduced conventional cigarette use (from a mean of 21.9 cigarettes/day at baseline to a mean of 2/day at 1-year follow-up) Had respiratory infections and COPD exacerbations that were markedly attenuated, and their respiratory physiology was not worsened by EC use Showed consistently improved overall health status and physical activity Relapsed to conventional cigarette smoking at a low rate (8.3%) Importantly, COPD patients who used EC but continued to smoke conventional cigarettes (dual users), attenuated daily smoking of conventional cigarettes by at least 75%. Dual-user COPD patients showed a consequent amelioration in their respiratory parameters and quality of life.

"While the sample size in the study was relatively small, the results may provide preliminary evidence that long-term use of ECs is unlikely to result in substantial health concerns in COPD patients", said the authors. "Quitting smoking is a key strategy not only to prevent the onset of COPD but also to stop its progression to more severe disease stages.

Given that many COPD patients continue smoking despite their symptoms, the electronic cigarette could be an effective and safe alternative to the tobacco cigarettes also in this vulnerable population. Over an observation period of 3 years, only two patients (8.3%) relapsed to cigarette smoking, and both patients were dual users," added Polosa. This is an important consideration, given that smokers with COPD are known to perform poorly in smoking-cessation programs because of their high relapse rate.

Dr. Caponetto, a co-researcher, suggested that the low rate of relapse of COPD smokers who switched to EC in this study is due to "the fact that ECs reproduce the smoking experience and accompanying rituals with large compensatory effect at both physical and behavioural levels." 

In terms of health amelioration, co-researcher Dr. Caruso said, "the finding that COPD exacerbations were halved in patients who stopped or considerably reduced their smoking habit following switching to ECs was an important finding that confirms the potential for harm reversal of these products". The work undertaken by Polosa and colleagues contributes to the growing literature in this field, acknowledging that EC are much less harmful than combustible tobacco products. This is a very important health issue.