Evidence for harm reduction in COPD smokers who switch to electronic cigarettes

Abstract

BackgroundElectronic cigarettes (ECs) are battery-operated devices designed to vaporise nicotine, which may help smokers quitting or reducing their tobacco consumption. There is a lack of data on the health effects of EC use among smokers with COPD and whether regular use results in improvement in subjective and objective COPD outcomes.We investigated long-term changes in objective and subjective respiratory outcomes in smokers with a diagnosis of COPD who quit or reduced substantially their tobacco consumption by supplementing with or converting only to ECs use.MethodsWe conducted a retrospective chart review of patients with COPD to identify those reporting regular daily use of ECs on at least two follow-up visits at 12- (F/up1) and 24-months (F/up2). Regularly smoking COPD patients were included as a reference group.ResultsA marked reduction in cigarette consumption was observed in ECs users. A significant reduction in COPD exacerbations was reported in the COPD EC user group, their mean (±SD) decreasing from 2.3 (±1) at baseline to 1.8 (±1; p = 0.002) and 1.4 (±0.9; p < 0.001) at F/up1 and F/up2 respectively. A significant reduction in COPD exacerbations was also observed in ECs users who also smoked conventional cigarettes (i.e. ‘dual users’). COPD symptoms and ability to perform physical activities improved statistically in the EC group at both visits, with no change in the control group.ConclusionsThese findings suggest that ECs use may aid smokers with COPD reduce their cigarette consumption or remain abstinent, which results in marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes.

Exacerbations of COPD

“…Although there is some evidence for lower annual exacerbation rates in smokers who switch to electronic cigarettes [47], there is also evidence that electronic cigarettes may have significant pulmonary toxicity [48]. Therefore, some organisations have suggested caution in using electronic cigarettes as a form of nicotine replacement therapy until further data are available [49].…”

Electronic cigarettes and lung toxicity

“…8 This study demonstrated that these patients had a reduction in the frequency of acute exacerbations over 12 month and 24 month periods. In addition, dual users who reduced the amount of conventional tobacco cigarette smoking also had a reduction in the frequency of acute exacerbations.…”

“…In addition, dual users who reduced the amount of conventional tobacco cigarette smoking also had a reduction in the frequency of acute exacerbations. 8 To date, there is no information on the long-term effects of e-cigarettes on lung function in never smokers who adopt exclusive e-cigarette use. There is limited information in patients with lung disease, such as asthma or COPD.…”

Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018

“…A meta-analysis evaluating 7,332 patients with COPD reported that the combination of cognitive behavioural therapy (CBT) and nicotine replacement therapy was [34]. Electronic cigarette products are becoming increasingly popular [35]. However, their efficacy and safety are not well defined and thus their widespread use is not advocated [12].…”