Researchers at the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR*) in Catania, Italy have just published a groundbreaking study. It shows that smokers with chronic obstructive pulmonary disease (COPD) who switched to vaping reduced their yearly flare-ups by about 50 percent, significantly improved their cardio-respiratory health, and increased both their ability to exercise and their quality of life.
The study, led by CoEHAR founder Dr. Riccardo Polosa, is vitally important because COPD, to which emphysema and chronic bronchitis commonly contribute, is devastating. It makes breathing difficult and causes symptoms of wheezing, fatigue, shortness of breath, and a chronic cough. Many patients end up on long-term, portable oxygen therapy as symptoms worsen. Smoking tobacco is the main cause of COPD and almost 15.7 million Americans have been diagnosed with the disease.
The study compiled complete data over a five-year period for 39 participants—19 in the COPD smokers control group and 20 in the COPD e-cigarette user group. The vaping group used a variety of e-cigarettes, with a significant number switching from basic refillable e-cigs to more advanced devices during the study period.
The six-minute walk distance (6MWD) is one way to assess patients’ ability to conduct everyday activities. At five years from baseline, the 6MWD improved by a median of 66.5 meters in e-cigarette users, whereas it increased by a median of only 20 meters in the smoker control group.
The study also reported “significant and constant improvements in lung function [and] CAT scores” (a health questionnaire used for COPD patients) in the vaping group compared with the control group over the five years.
“E-cigarettes can be a massive remedy for COPD and this is important for physicians, patients and their caregivers.”
Another important finding is that only four vapers, or 16.7 percent of those in the larger, baseline study cohort, returned to cigarette smoking over the duration of the study (data for these four individuals were excluded from the vaping-only group findings). This indicates that vaping nicotine is a powerful prevention tool, contributing to long-term abstinence from smoking.
The strengths of the vapers’ nicotine e-liquids were also documented. Most started with 12–18mg/ml (medium/ high) nicotine strength e-liquids, then gradually reduced over time. At five-year follow up, only two out of 20 vapers were still using medium/high nicotine strength; the others were consuming 3–9mg/ml (low) nicotine strength. This is a remarkable outcome in a group of former smokers who were highly nicotine-dependent. While nicotine itself does not contribute to COPD and people should be able to keep vaping at whatever strength they need, this suggests that vaping can help people reduce the amount of nicotine they use if they wish to.
“The most important finding of the study is that COPD patients can abstain from smoking cigarettes indefinitely if suitable substitution is available,” Dr. Polosa told Filter. “E-cigarettes can be a massive remedy for COPD and this is important for physicians, patients and their caregivers. The study confirms that ‘harm reversal’ is achievable and that it can be maintained for years. We are telling the world that substantial health gains are within reach when substituting deadly tobacco cigarettes for vaping products.”
“This study is very informative due to its prospective design, inclusion of a control group, long-term follow-up, and even more importantly, its focus on older smokers,” Dr. Annie Kleykamp, a tobacco harm reduction expert and research associate professor of anesthesiology and perioperative medicine at the University of Rochester School of Medicine and Dentistry, told Filter. “Participants were on average about 65 years old. This study gives support to the idea that older smokers switching to e-cigarettes can improve their health and potentially slow the effects of COPD. … Ideally, larger-sample studies will be completed that replicate these findings.”
“My clinical experience tells me that—quite surprisingly—most COPD smokers don’t have a good reason to quit.”
Smokers with COPD have not responded well to smoking cessation programs. This inability to stop has confounded researchers because the disease is profoundly life-changing and leads to premature death.
“My clinical experience tells me that—quite surprisingly—most COPD smokers don’t have a good reason to quit,” said Polosa. “At their age and with their debilitating condition, they don’t have much to hope for but a good cigarette! They are well aware that smoking cigarettes is bad for their COPD, but the consolation from smoking appears to be far greater than any health benefit from stopping smoking.”
This is a tragic mindset. But a number of powerful factors combine to make quitting difficult. Smokers with COPD are heavily dependent on the positive effects of nicotine. Moreover, pervasive stigma leads to shame and a downward spiral of hopelessness and helplessness.
Nicotine replacement therapies (NRT) like the patch, gum and inhaler have little appeal because they don’t provide enough nicotine and its absorption is too slow. Most importantly, these products don’t replicate the rituals of smoking as vaping does. The smoking cessation medications bupropion and varenicline have serious side effects, including suicidal thoughts, and can interact in dangerous ways with other drugs, most notably alcohol. Older adults are more susceptible to adverse side effects. Conventional NRTs and going “cold turkey” have failed this vulnerable group of smokers—not the other way around.
Older adults who experience smoking-related diseases have been all-but-forgotten in the panic around teen vaping and the flavor wars, as Annie Kleykamp has described for Filter. “It’s an age group that is rarely addressed in tobacco policy or public health campaigns,” she noted. “It’s frustrating given the benefits they could gain if we could take some of the attention we focus on youth and turn it to the other end of the age spectrum.”
Reducing or stopping smoking at any age is beneficial to health. We cannot give up on older adults with smoking-related diseases. This new study clearly demonstrates that vaping makes it possible for the most inveterate smokers with serious health conditions to improve their health and quality of life. Healthcare providers, as best practice, should recommend that senior smokers with COPD transition to vaping.
Photograph by Helen Redmond
* CoEHAR has received grants from the Foundation for a Smoke-Free World.The Influence Foundation, which operates Filter, has also received grants from the Foundation for a Smoke-Free World. Filter’s Editorial Independence Policy applies.